Negative Effects of Poor Sleep
- Positively correlated with Wiggs & Stores, 1996; Zuckerman, Stevenson, & Bailey, 1987
- Family stress Kataria et al. 1987, Richman 1981
Co-occurring Sleep Disorder
- ADHD: 25% - 50%
- ASD: 50%-80%
- Depression: up to 90%
- Anxiety: up to 88%
Detecting Sleep Problems
- Parents often do not discuss sleep problems with their pediatrician (Stein et al., 2001).
- In one study involving 600 community-based pediatricians, less than 40% questioned adolescents directly (Owens, 2001).
- 80% of children diagnosed with sleep problems are prescribed medication.
- Evidence suggests that pharmacology has positive short term effect but lacks any long term benefits (Ramchandani et al. 2000).
- Additionally, a 48.9% of pediatricians surveyed suggest to parents that children will outgrow sleep problems (mindell et al. 1994).
- Behavioral intervention is found to have positive short term effect without the long term decline.
- Bed refusal
- Sleep-onset delay
- Night waking
- “The term emphasizes the fact that the behavior operates upon the environment to generate consequences.” – Skinner
- Behavior consistently elicited by a reflexive or classically conditioned stimulus.
Stimulus > Reflex Behavior
- A previously neutral stimulus comes to evoke a specific response by being repeatedly paired with another stimulus that evokes the response.
- The circadian cycle is marked by cycles of phases of rapid-eye-movement (REM) and non-REM sleep.
- REM regularly precedes periods arousals.
- Sleep cycles are under purely endogenous control for the first 3 – 6 months.
- Screening tool such as BEARS (B = bedtime issues, E = Excessive daytime sleepiness, A = night awakenings, R = regularity and duration of sleep, S = snoring).
- Increased detection of sleep problems from 4.1% to 16% (n = 195).
- Generally considered an inappropriate treatment.
- Many parents cannot ignore bedtime crying.
- Extinction burst (increase in severity and variability).
- Cortez de Sousa et al. (2007):
- Regular sleep pattern
- Relaxation techniques
- 15 min naps early in day but no naps later in the day.
- No caffeine after 2pm.
- Engeljardt et al., 2013: No TV in the bedroom and limit access to visual media during the day for children with Autism.
- France and Hudson (1990):
- Introduced regularly scheduled story time before bed.
- Adams and Rickert (1989):
- 4 – 7, 20 minute, quiet activities before bedtime.
- Also included a faded bedtime.
- Delayed sleep onset:
- Bedtime is set at average sleep onset + 30 minutes.
- If child fell asleep within 15 minutes of bedtime, bedtime was made 30 minutes earlier the next night.
- If the child did not fall asleep within 15 minutes of bedtime, bedtime was made 30 minutes later the following night.
- Pizza and Fisher (1991) - If sleep onset does not occur within 15 minutes, remove from bed and keep awake for 1 hour.
Graduated Extinction/Progressive Waiting
- Crying and leaving the bedroom
Schedule Competing Reinforcers Before Sleep
- Interfering behaviors:
- O’Reilly et al. (2004) conducted paired choice assessment and then schedule preferred activity before bedtime.
- Jin et al. (2013) did the same based on parent interview.
- Bedtime Pass
- Scheduled Waking
- Basic information and sleep problem history.
- Develop sleep goals.
- ID specific sleep problems.
- ID antecedents and consequences of problem behavior.
- ID sleep schedule and sleep dependencies
- ID interfering behaviors and their likely reinforcers Treatment options