Behavioural management of sleep problems.

Abstract

SUMMARY The outcome of 19 consecutive children referred with sleep disorders and managed by behavioural methods is described. An 84 % success rate is reported, which was maintained at 6 months' follow up. Successful outcome was associated with absence of marital discord and attendance of both parents at treatment sessions.A sleep problem is one of the most common disorders reported by parents of preschool children. Difficulty may be experienced settling a child to sleep or in frequent night waking, or both. This may seriously disrupt family life leading to fatigue, irritability, limitations on the parents' activities, and marital strain. Bax has drawn attention to the association of sleep problems with child abuse and maternal depression.'Most epidemiological studies have investigated the prevalence of night waking rather than settling problems. One study reported night waking in 23 % of infants at 1 year, 24% at 18 months, and 14% at age 3 years.2 Other studies report similar data.3-5 Richman et al.6 found that 13 % of 3 year olds were having difficulty settling to sleep and 14% were waking at night. The longitudinal studiesl 4 5 substantiate the clinical impression that in many children night waking persists through the preschool years.

Predictors of outcome in infant and toddlers functional or behavioral disorders after a brief parent–infant psychotherapy

“…The results concerning predictive factors for child outcome are in line with certain findings noted in the literature, in particular parental separation [14,48], the type of disorder in the child [15,42], and the presence of the father at consultations [2,23]. The intensity of the disturbances in the child (reflected here by the global SCL score) and the initial psychological condition of the mother are associated with the child's outcome in univariate analysis, but do not in this study constitute independent predictive factors since the association is no longer found in multivariate analysis.…”

“…The impact of paternal attendance at consultations is a particularly interesting result, and is in line with studies conducted in different populations [2,23]. One of the issues is the reasons underpinning the presence or absence of the fathers.…”

“…Greater severity [14,48] and difficulties in the family (parental separation, psychiatric disorders in parents, dysfunctions in family relationships) [15,23,48] are also associated with poorer prognosis. In a population of children with sleep disorders, managed using behavioral methods, Jones et al [23] found that successful outcome was associated with absence of marital discord and attendance of both parents at treatment sessions.…”

A Behavioral Model of Infant Sleep Disturbance

“…Continued activity may postpone sleep in children, but eventually, bed-refusing children will inexorably fall asleep, often after a period of brief quietude on the periphery of family activities, or while held by a parent (e.g., Jones & Verduyn, 1983;Sanger et al, 1981). One strategy used by parents of children who exhibit bed refusal is to wait until the child has fallen asleep before putting him or her to bed, thereby avoiding prebed conflict (Keener, Zeanah, & Anders, 1988).…”

Discussion of Extinction-Based Behavioral Sleep Interventions for Young Children and Reasons Why Parents May Find Them Difficult

“…Jones and Verduyn did not even suggest "cry it out" in an intervention study they conducted because "few parents are able to consign their child to such distress and a late response may exacerbate the problem" 31 These protests make it harder for parents to ignore and occur even in modified forms of extinction. Some parents have stated they do not have the will to change behavior.…”