Beyond the B.A.S.I.C.S. Blog

Sleep Issues

November 26, 2011

Does your child have trouble falling asleep? Does she have trouble staying asleep? Is sleep a battle at your house? I just attended the MABA conference in Baltimore and was amazed at how much I learned I attended a great sleep workshop given by Dr. Gregory Hanley I was nervous about it because I feared it would be a long presentation on extinction (cry-it-out) which is a procedure that I do not typically implement for sleep problems. I was so thrilled to see that it was filled with great information. I am going to summarize it below:

Small Changes:

  1. If a child is fighting sleep for a long time, instead of putting them to bed at the desired bedtime, write down the time they usually fall asleep.  Put them to bed one hour later than that time for 2 days. This will make sleep more valuable and hopefully they will fall asleep right away. After they are falling asleep within 15 minutes, move the bedtime back in 15 minute increments.
  2. Make sure the child has had a healthy snack that does not contain caffeine, sugar, or a food that may cause discomfort (gassy foods, allergens, etc)
  3. Build in a predictable, consistent bedtime routine. This routine is more fun when they are complying but is always present.
  4. Make sure you aren’t expecting them to be in bed longer than is biologically realistic. If you put the child to bed at 6:30pm, you can’t expect them to stay in bed until 8:30am.
  5. Use a sleep cue that will always be present like white noise and let it play constantly.
  6. Ensure your child is not too cold or too hot. A bath right before bed can change the body’s core temperature so it might be a good idea to do the bath early in the routine.
  7. If the child is afraid, offer them some tools to empower themselves. I have heard of clients successfully using a night light, “monster spray”, and/or a phrase like “I am safe in my bed”. Social stories can be used here as well.
  8. If your child is engaging in self-stimulatory behaviors in bed which prevents sleep, it might be worth setting up a video-monitor and going in to block all “stim” attempts for a few nights in a row. Also, make sure all “stim” objects are put away.

Big Changes:

Extinction (I don’t recommend this): The parent completes the night-time routine and then closes the child into the bedroom. The parent does not re-enter and the child will often tantrum or cry themselves to sleep. This can also be done by repeatedly outing the child back to bed every time they get out.

Pass: The child can be given a set number of passes. Each pass can be exchanged for a visit with mom or dad, a drink of water, etc

Timed Visits: This is when a parent enters the room after a set time of quiet to praise and give a kiss. This allows the child to receive parent attention for appropriate behavior and they often fall asleep while waiting for the time to elapse.

Dr. Hanely discussed a small study that he conducted where he used the three different interventions. His study found all 3 methods were equally effective. What was unique about this study was they rated what the parent preferred and what the child preferred. He found that the parents didn’t choose extinction as their favorite intervention but there wasn’t a clear pattern for preference otherwise. They did find that the children preferred the pass and none of them ever preferred extinction.*

The Pass-model is something we often use during the day in my practice and it is very effective. It appears to be effective at night and preferred by the children so it is certainly worth trying!

It is really important to find out why the child is having trouble sleeping or staying asleep and address it from that direction.

*They determined this by pairing each intervention with a card color and then allowed the children to choose the card and then observed the pattern.

Saundra Bishop, BCBA


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