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The Lighter Touch: Less-Restriction in Sequentially Implemented Behavioral Sleep Interventions for Children with Rare

Emma C Woodford1, Laurie K McLay2,3, Karyn G France2

  • 1Faculty of Health, Te Kaupeka Oranga, University of Canterbury, Christchurch, New Zealand. emma.woodford@pg.canterbury.ac.nz.

Journal of Autism and Developmental Disorders
|February 7, 2024
PubMed

Insights

Behavioral sleep interventions effectively treat sleep difficulties in children with rare genetic neurodevelopmental conditions (RGNC). Less restrictive strategies are often sufficient and should be prioritized before more intensive approaches.

Area of Science:

  • Pediatric Sleep Medicine
  • Neurodevelopmental Disorders
  • Behavioral Interventions

Background:

  • Sleep difficulties are prevalent in children with rare genetic neurodevelopmental conditions (RGNC).
  • Behavioral interventions are common for neurodevelopmental conditions but understudied in RGNC.
  • Research is needed to identify effective and minimally restrictive interventions for this population.

Purpose of the Study:

  • To investigate the effectiveness and acceptability of behavioral sleep interventions for children with RGNC.
  • To determine the minimally sufficient components of behavioral sleep interventions.
  • To apply a principle of least restriction in intervention sequencing.

Main Methods:

  • A single-case multiple baseline design was employed.
  • Eight children with RGNC (mean age 7.3 years) participated.
  • Intervention components were sequentially administered based on the principle of less restriction.

Main Results:

  • Significant improvements were observed in sleep onset latency (7/7 children), night wakings (6/7), and early morning waking/unwanted bed-sharing (3/3).
  • Most improvements occurred during less restrictive intervention phases (circadian, antecedent, positive reinforcement).
  • Five participants required modified extinction procedures; improvements were maintained at follow-up and interventions were parent-acceptable.

Conclusions:

  • Function-based, less restrictive behavioral strategies are effective for treating sleep difficulties in children with RGNC.
  • These strategies can be sufficient and should be implemented before more restrictive approaches.
  • Prioritizing less restrictive interventions ensures effectiveness and parent acceptability.
Abstract

Keywords:
Behavioral interventionsLeast restrictiveNeurodevelopmental disordersRare genetic disordersSleep

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