The behavioural treatment of sleep difficulties in children with an intellectual disability

Abstract

Reinforcement, instruction giving, partner support strategies, bedtime routine, and standard extinction were taught to the parents of three boys (aged 5-10 years) with an intellectual disability and sleeping difficulties. Sleep was measured using sleep diaries and actigraphy, and daytime behaviour was monitored using diaries and direct observation. At referral, all children needed a parent present to fall asleep, two had co-sleeping difficulties, and two had night waking difficulties. At post-intervention, all children were falling asleep independently, co-sleeping was eliminated for two children, and night waking was reduced in one child. An extinction burst was experienced by two children, with one family putting their child back to bed 259 times on the first night. Though one child still had night waking difficulties following intervention, actigraph recording demonstrated an improvement in his sleep quality. In addition to the children's independence, improvements were seen for sleep length, sleep latency, and morning wake time. However, improvements in daytime behaviour showed inconsistency across behaviours and settings. Improvement in sleep was maintained at a three month follow-up. It was concluded that using extinction to address sleep problems in children with an intellectual disability is effective and approved of by parents, but any impact on daytime behaviour is equivocal.

Are we ignoring the problem of sleep disorder in children with intellectual disabilities?

“…However, the need for ongoing screening of sleep problems in all children with intellectual disabilities is highlighted by this study, particularly boys and children from single-parent households. There is plenty of evidence for the effectiveness of behavioural interventions in reducing sleep problems for children with intellectual disabilities [13][14][15][16][17]. The use of medication as another way to induce sleep in children is inconclusive, but it seems that drug treatment may be effective at least in the short-term or while parents redeem their sleep debt to commence a behavioural treatment approach [18].…”

Behavioral approaches to the treatment of sleep problems in children with developmental disorders: What is the state of the art?

“…The description of treatment was quite general in all of Didden and colleague's studies, and did not appear to involve the degree of parent training or a training manual as in Thackeray and Richdale (2002) or Weiskop et al (2001Weiskop et al ( , 2005.…”

Medical treatment of autism spectrum disorders

“…Patients with sleep-onset insomnia can often be managed with improved sleep hygiene and parent training in behavioral management, as described above. Such techniques help promote more positive behaviors and can improve initial settling behaviors and reduce night wakenings [42,43]. When behavioral interventions are inadequate, or families are unable to carry them out effectively, pharmacologic treatments are often used.…”