Summary of behavioural strategies
◅ Behavioural strategies| Method | Description | Sleep problems addressed |
|---|---|---|
| Bedtime pass | Use ‘bedtime pass’ to restrict specific activity prior to sleep | Pre-sleep disturbances |
| Stimulus fading | Parent gradually increases distance between himself/herself and the child | Co-sleeping |
| Faded bedtime | Bedtime is set earlier and earlier over time | Sleep Latency |
| Faded bedtime with response cost (FBRC) | Engaging child in an activity if they do not fall asleep within a predetermined time; set an earlier bedtime once child has fallen asleep during the predetermined period | Sleep Latency |
| Chronotherapy | Bedtime is set later and later over time | Early morning waking, sleep latency, night-time awakenings |
| Standard extinction | Parent ignores all bedtime disruptions after placing the child in bed | Night-time awakenings, co-sleeping, and pre-sleep disturbances |
| Gradual extinction | Parent ignores undesirable behaviour from child for a pre-determined amount of time before engaging with the child and placing the child back into bed | Bedtime disturbances and co-sleeping |
| Scheduled night time awakening | Parent awakens the child thirty minutes prior to an expected night terror | Night terrors |
Tips for parents
- Adjust the sleep goals according to the child and the family’s needs and practices.
- Initially, try to break the goals down and make small changes. Gradually spill the changes over to other areas.
- Changes take time! Be patient and consistently stick to the goals.
- Set clear and reasonable limits for the child behaviours during the implementation of the sleep plan.
- Consider setting up a reinforcement plan for the child to facilitate appropriate sleep practices. For example, reinforce child with his/her favourite sticker when he/she sticks to a goal for a night. He/she may get a bigger prize when he/she accumulates a certain number of stickers.
- Avoid using sleep as a punishment, or associating bed/bedroom with any punishments. For example, avoid saying “if you do not listen, you are going to bed at 8pm tonight instead of 9pm.” This would make the child perceive sleep negatively.
- Avoid locking child in his/her bedroom. This may scare the child. Parents should help the child sleep in his/her bed appropriately, instead of punishing him/her or making him/her scared.
References
- Christodulu, K.V. & Durand, M. (2004). Reducing Bedtime Disturbance and Night Waking Using Positive Bedtime Routines and Sleep Restriction. Focus on Autism and Other Developmental Disabilities, 19, 130-139.
- Durand, V.M. (2002). Treating sleep terrors in children with autism. Journal of Positive Behavior Interventions, 4(2), 66-72.
- Durand, V. M. (2008). Module 3: Bedtime. In When Children Don't Sleep Well: Interventions for pediatric sleep disorders (pp. 61-66). New York, NY: Oxford University Press.
- Jan, J.E., Owens, J.A., Weiss, M.D., Johnson, K.P., Wasdell, M.B., Freeman, R.D., & Ipsiroglu, O.S. (2008). Sleep hygiene for children with neurodevelopmental disabilities. Pediatrics, 122(6), 1343-1350.
- Johnson, K. P., Giannotti, F., & Cortesi, F. (2009). Sleep patterns in autism spectrum disorders. Child and adolescent psychiatric clinics of North America, 18(4), 917-928.
- Kodak, T., & Piazza, C. C. (2008). Assessment and behavioural treatment of feeding and sleeping disorders in children with autism spectrum disorders. Child and Adolescent Psychiatric Clinics of North America, 17(4), 887–905.
- Vriend, J.L., Corkum, P.V., Moon, E.R., Smith, I.M. (2011) Behavioral Interventions for Sleep Problems in Children With Autism Spectrum Disorders: Current Findings and Future Directions. J. Pediatr. Psychol., 36 (9), 1017–1029.