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A faded bedtime with response cost protocol for treatment of multiple sleep problems in children
1Johns Hopkins University School of Medicine, Baltimore, Maryland.
Insights
This study regulated sleep-wake cycles in 4 developmentally delayed individuals using a faded bedtime procedure. This method successfully improved sleep latency and duration, addressing severe sleep disturbances.
Area of Science:
- Pediatric Sleep Medicine
- Developmental Psychology
- Behavioral Sleep Therapy
Background:
- Severe sleep disturbances are common in individuals with developmental delays.
- Existing treatments for pediatric sleep disorders have limitations.
Purpose of the Study:
- To evaluate the effectiveness of a faded bedtime procedure with response cost for regulating sleep-wake cycles in developmentally delayed individuals.
- To improve sleep onset latency, duration, and reduce nighttime awakenings and excessive daytime sleep.
Main Methods:
- A faded bedtime procedure was used, systematically delaying bedtimes to increase sleep onset probability.
- A response cost component (1-hour removal from bed) was implemented for failure to achieve short sleep latency.
- Following initial delay, a fading procedure advanced bedtimes and increased sleep duration.
Main Results:
- All 4 individuals showed increased nighttime sleep duration post-treatment.
- Two individuals experienced a decrease in excessive daytime sleep.
- Three individuals showed a reduction in nighttime awakenings.
Conclusions:
- The faded bedtime procedure with response cost is an effective method for regulating sleep-wake cycles in developmentally delayed individuals with severe sleep disturbances.
- Both environmental and biological mechanisms are hypothesized to contribute to treatment efficacy.
- This procedure offers advantages over other treatments for pediatric sleep disorders.
Abstract:
The sleep-wake cycles of 4 developmentally delayed individuals with longstanding severe sleep disturbances were regulated using a faded bedtime procedure with response cost. Bedtimes were systematically delayed for each individual, thus increasing the probability of short latency to sleep onset. The response cost component, consisting of removing the individual from bed for 1 hour, was implemented when an individual did not experience short latency to sleep onset. A fading procedure was then applied successfully to advance the bedtimes and to gradually increase durations of sleep. Specifically, all 4 individuals had decreased amounts of nighttime sleep that increased following treatment. Two of the 4 individuals showed excessive daytime sleep that decreased following treatment. Three of the 4 individuals experienced decreases in night wakings following treatment. Both environmental and biological manipulations of the sleep-wake cycle are hypothesized as mechanisms of treatment. The relative advantages of this procedure over other procedures for the treatment of pediatric sleep disorders are discussed, as are directions for future research.