Applied behavior analysis measurement, assessment, and treatment of sleep and sleep‐related problems

Abstract

This discussion article considers applied behavior analysis measurement, assessment, and treatment of sleep and sleep-related problems among infants, children, and youth who are typically developing and have neurodevelopmental disabilities. Measurement has concentrated on designing practitioner-implemented methods and improving fidelity of data recording through sleep-monitoring instrumentation. The emphasis of assessment is identifying antecedent and consequence variables that promote sleep and evoke and maintain sleep-related problems. Treatment research has evaluated several effective interventions for problems such as delayed sleeponset, night and early morning waking, bedtime resistance, and unwanted co-sleeping. Early and contemporary applied behavior analysis research is reviewed relative to function-based treatment formulation, intervention integrity, social validity, and research-to-practice translation.

Parent-Mediated Home Intervention for Delayed Sleep-Onset and Night Waking in a Child With Autism Spectrum Disorder

“…Mindell et al (2006) posited that childhood sleep problems involve, “a multifactorial pathophysiological mechanism and represent a complex combination of biological, circadian, and neurodevelopmental factors that are influenced by, but not solely attributable to environmental and behavioral variables” (p. 1264). This position is consistent with contemporary behavioral sleep intervention that focuses on the functional influences over normative sleep patterns and sleep problems (Jin et al, 2013; Luiselli, 2021; McLay et al, 2017, 2019). For example, antecedent conditions such as lack of physiological sleep pressure occasioned by going to bed too early, inconsistent bedtime routines, and consumption of caffeine-laden foods and beverages may contribute to sleep-onset delay (Herrmann, 2016; Malow et al, 2009).…”

“…In the present case study, we evaluated a highly individualized parent-mediated home intervention for sleep problems displayed by their child with ASD. Procedures in this case targeted multiple sleep behaviors informed through functional assessment and applied as a multicomponent treatment package (Durand, 2014; Luiselli, 2016, 2021; McLay et al, 2019; Sanberg et al, 2018) including follow-up measurement to confirm the longitudinal effects of intervention.…”

“…Clinicians and students alike should keep pace with the evidence-based sleep research published in peer-reviewed journals (Luiselli, 2021; McLay et al, 2019). Many studies report the most contemporary intervention procedures that can be functionally matched to the controlling contingencies over sleep problems and guide formulation of sleep-enhancement plans (Durand, 2014).…”

“…Notably, Joe had been referred previously to an ASD sleep-specialty clinic and prescribed medications with purported sleep-enhancing effects in this population (Malow et al, 2016). His ASD diagnosis was instrumental in our selection of intervention procedures that had likelihood of success (Durand, 2014;Luiselli, 2021) while recognizing that similar methods such as a routinized bedtime and enhanced sleep hygiene have been employed effectively with typically developing children as well (Kuhn et al, 2020). There are several implications of the case, discussed below, which apply to the current status of behavioral sleep intervention among persons with neurodevelopmental disabilities.…”