The sun is setting and all you can think about is “Not another bedtime!” The yelling and crying last night was enough to last a week. Just when you thought you were in the clear, you hear calls from your child’s bedroom after he wakes up and cannot fall back to sleep. Bedtime can be a stressful time for many parents, as children resist getting ready for bed and have difficulty falling asleep, staying asleep or getting enough sleep.
If this sounds all too familiar to you, you are not alone. In fact, 10-50% of young children whose development is typical and 50-80% of youth with developmental disabilities have sleep problems. Sleep problems not only cause frustration and discord among caregivers, but they are also associated with higher levels of severe problem behavior (e.g., tantrums, aggression, and self-injury), stereotypy, and noncompliance. Sleep problems may also interfere with learning, and persistent sleep problems in childhood are associated with childhood and adult obesity, adolescent behavioral and emotional problems, anxiety in adulthood, and sleep problems through adulthood. However, the good news is that sleep problems can be considered a skill deficit and all children can learn to be better sleepers with the use of behavior therapy, rather than medication.
To date, there is no FDA approval for any pediatric sleep medication, there is no medication labeled for pediatric insomnia, and research does not show evidence of consistent efficacy for pharmacological interventions. Although medication may help your child fall asleep quicker, it often leads to a greater amount of night awakenings. Therefore, behavior therapy is a more effective, long-term solution for sleep problems.
The first step to addressing sleep problems is assessing the specific sleep difficulties experienced by your child and identifying goals for your child’s sleep. “Good sleep” is often characterized by falling asleep quickly, staying asleep throughout the night, waking up without much trouble each morning, and not feeling drowsy during the day. Common sleep problems include delayed sleep onset, which can include sleep-interfering behavior (e.g., crying, calling out, playing, stereotypy, talking to oneself, etc.), night or early awakenings, short sleep duration, and phase shifts (i.e., sleeping at wrong times thus conflicting with daily routines). Children’s sleep problems are assessed using an open-ended interview to identify the personal factors influencing sleep problems. This information is then combined with general information about common factors that influence good sleep and sleep problems in order to develop treatments in collaboration with parents based on the controlling variables.
Individualized and comprehensive treatment consists of five steps: 1) Develop ideal sleep schedule, 2) Create structured nighttime routine, 3) Optimize bedroom conditions, 4) Develop regular sleep dependencies, and 5) Address sleep interfering behavior (Jin, Hanley, & Beaulieu, 2013). When creating a sleep schedule, it is essential to consider age-appropriate sleep amounts and recent sleep history. Additionally, it is important to help your child develop sleep dependencies on things that are routinely and easily present throughout the night. Last, there must be a clear discrepancy between what is available during the day versus at night to ensure good sleep.
Addressing your child’s sleep problems may seem daunting. However, sleep difficulties typically persist without treatment. Isn’t it time that everyone got a good night’s sleep?
References
Jin, C. S., Hanley, G. P., & Beaulieu, L. (2013). An individualized and comprehensive approach to treating sleep problems in young children. Journal of Applied Behavior Analysis, 46, 161-180.
About The Author
Rebecca K. Schulman, Psy.D., BCBA-D is a licensed psychologist in New Jersey and a Board Certified Behavior Analyst at the Doctoral level. Dr. Schulman received her undergraduate degree with honors in Psychology and Education Studies from Brandeis University where she was a member of the Phi Beta Kappa Honor Society. Dr. Schulman earned her Psy.D. in clinical psychology from the Graduate School of Applied and Professional Psychology at Rutgers University. She completed her pre-doctoral internship at Westchester Jewish Community Services, where she completed rotations in the Developmental Disabilities Program, Treatment Center for Trauma and Abuse, Juvenile Starting Over Program, and Learning Center.
Dr. Schulman has extensive experience providing individual, family, and group therapy to children, adolescents and adults. She specializes in cognitive behavioral therapy and applied behavior analysis for children through adults presenting with developmental disabilities, disruptive behaviors, sleep problems, social skills deficits, anxiety disorders, past and present childhood sexual abuse, complex trauma histories, issues related to domestic violence, and sexual problem behaviors.
She also has expertise in using evidence-based treatments to work collaboratively with parents to teach them behavior management strategies and with schools to address challenging behaviors. Dr. Schulman is also skilled in conducting diagnostic evaluations, specifically of autism spectrum disorder, psychological, psychoeducational, and neuropsychological evaluations, and functional behavior assessments (FBAs).
