Behavioral treatment of bedtime problems and night wakings in infants and young children—An American Academy of Sleep Medicine review

Department of Psychology, Saint Joseph's University, 5600 City Avenue, Philadelphia, PA 19131, USA.
Sleep (Impact Factor: 4.59). 11/2006; 29(10):1263-76.
Source: PubMed


This paper reviews the evidence regarding the efficacy of behavioral treatments for bedtime problems and night wakings in young children. It is based on a review of 52 treatment studies by a task force appointed by the American Academy of Sleep Medicine to develop practice parameters on behavioral treatments for the clinical management of bedtime problems and night wakings in young children. The findings indicate that behavioral therapies produce reliable and durable changes. Across all studies, 94% report that behavioral interventions were efficacious, with over 80% of children treated demonstrating clinically significant improvement that was maintained for 3 to 6 months. In particular, empirical evidence from controlled group studies utilizing Sackett criteria for evidence-based treatment provides strong support for unmodified extinction and preventive parent education. In addition, support is provided for graduated extinction, bedtime fading/positive routines, and scheduled awakenings. Additional research is needed to examine delivery methods of treatment, longer-term efficacy, and the role of pharmacological agents. Furthermore, pediatric sleep researchers are strongly encouraged to develop standardized diagnostic criteria and more objective measures, and to come to a consensus on critical outcome variables.

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    • "This approach is under evaluation in a larger randomized, controlled study (Sciberras et al. 2010). Case reports also indicate efficacy of behavioral programs in reducing the severity of dyssomnia in children with ADHD (Mindell et al. 2006). "
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    ABSTRACT: Attention-deficit/hyperactivity disorder (ADHD) is commonly associated with disordered or disturbed sleep. The relationships of ADHD with sleep problems, psychiatric comorbidities and medications are complex and multidirectional. Evidence from published studies comparing sleep in individuals with ADHD with typically developing controls is most concordant for associations of ADHD with: hypopnea/apnea and peripheral limb movements in sleep or nocturnal motricity in polysomnographic studies; increased sleep onset latency and shorter sleep time in actigraphic studies; and bedtime resistance, difficulty with morning awakenings, sleep onset difficulties, sleep-disordered breathing, night awakenings and daytime sleepiness in subjective studies. ADHD is also frequently coincident with sleep disorders (obstructive sleep apnea, peripheral limb movement disorder, restless legs syndrome and circadian-rhythm sleep disorders). Psychostimulant medications are associated with disrupted or disturbed sleep, but also 'paradoxically' calm some patients with ADHD for sleep by alleviating their symptoms. Long-acting formulations may have insufficient duration of action, leading to symptom rebound at bedtime. Current guidelines recommend assessment of sleep disturbance during evaluation of ADHD, and before initiation of pharmacotherapy, with healthy sleep practices the first-line option for addressing sleep problems. This review aims to provide a comprehensive overview of the relationships between ADHD and sleep, and presents a conceptual model of the modes of interaction: ADHD may cause sleep problems as an intrinsic feature of the disorder; sleep problems may cause or mimic ADHD; ADHD and sleep problems may interact, with reciprocal causation and possible involvement of comorbidity; and ADHD and sleep problems may share a common underlying neurological etiology.
    ADHD Attention Deficit and Hyperactivity Disorders 08/2014; 7(1). DOI:10.1007/s12402-014-0151-0
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    • "Extinction, while shown to be effective, was not included due to difficulties with parental compliance in previous research (C. M. Johnson, 1991; Mindell et al., 2006; Trilling, 1989). Additional hesitations are also associated with extinction such as possible response bursts in the form of temper tantrums and concerns regarding possible child abuse during tantrums or crying episodes as indicated by the American Academy of Pediatrics (2001). "
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    ABSTRACT: This study investigated the effectiveness of a behavioral treatment package for sleep problems in children diagnosed with Autism Spectrum Disorders. Treatment consisted of four behaviorally based components: circadian rhythm management, positive bedtime routines, white noise, and graduated extinction. A multiple-baseline design across three participants was used. Families completed a baseline of various lengths followed by 1 month of intervention. Results indicated the treatment package was effective in decreasing sleep onset latency and the frequency of night awakenings. A week of follow-up data showed continued improvement. Parents reported their children slept better and satisfaction with the four intervention components.
    Child & Family Behavior Therapy 07/2014; 36(3):204-221. DOI:10.1080/07317107.2014.934171 · 0.67 Impact Factor
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    • "An experimental study examining nap deprivation in 30-36 month old children found less effective emotion regulation in sleep-restricted preschoolers [27]. Additionally, studies demonstrating improvements in family and child functioning following behavioural sleep intervention suggest that poor child sleep is at least partially causal [4]. On a societal level, childhood sleep problems are associated with additional healthcare costs [28]. "
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    ABSTRACT: Night wakings and bedtime problems in infants and young children are prevalent, persistent, and associated with a variety of impairments in youth and their families. Assessment strategies include clinical interview, sleep diaries, actigraphy, and subjective measures. A number of treatment approaches with varying degrees of empirical support are available, and several novel strategies have been evaluated in recent years. Appropriate sleep scheduling and a bedtime routine are important components of any treatment program.
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