Behavioural and cognitive-behavioural interventions for sleep disorders in infants and children: A review (original) (raw)

2000

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Abstract

This review covers the literature on behavioural and cognitive-behavioural treatments for sleep disturbance in infants, pre-school, and school-age children. Treatment areas are dyssomnias (disorders of initiating, maintaining, or excessive sleep) and parasomnias (behaviours which occur predominantly during sleep). Interventions aimed at preventing sleep disorder through targeting infant sleep patterns are also examined. Controlled experimental studies are the main focus of

A randomized controlled trial of an intervention for infants’ behavioral sleep problems

BMC Pediatrics, 2015

Background: Infant behavioral sleep problems are common, with potential negative consequences. We conducted a randomized controlled trial to assess effects of a sleep intervention comprising a two-hour group teaching session and four support calls over 2 weeks. Our primary outcomes were reduced numbers of nightly wakes or parent report of sleep problem severity. Secondary outcomes included improvement in parental depression, fatigue, sleep, and parent cognitions about infant sleep. Methods: Two hundred thirty five families of six-to-eight month-old infants were randomly allocated to intervention (n = 117) or to control teaching sessions (n = 118) where parents received instruction on infant safety. Outcome measures were observed at baseline and at 6 weeks post intervention. Nightly observation was based on actigraphy and sleep diaries over six days. Secondary outcomes were derived from the Multidimensional Assessment of Fatigue Scale, Center for Epidemiologic Studies Depression Measure, Pittsburgh Sleep Quality Index, and Maternal (parental) Cognitions about Infant Sleep Questionnaire. Results: One hundred eight intervention and 107 control families provided six-week follow-up information with complete actigraphy data for 96 in each group: 96.9 % of intervention and 97.9 % of control infants had an average of 2 or more nightly wakes, a risk difference of -0.2 % (95 % CI: -1.32, 0.91). 4 % of intervention and 14 % of control infants had parent-assessed severe sleep problems: relative risk 0.3, a risk difference of -10 % (CI: 0.11, 0.84-16.8 to -2.2). Relative to controls, intervention parents reported improved baseline-adjusted parental depression (CI: -3.7 to -0.4), fatigue (CI: -5.74 to -1.68), sleep quality (CI: -1.5 to -0.2), and sleep cognitions: doubts (CI: -2.0 to -0.6), feeding (CI: -2.1 to -0.7), anger (CI: -1.8 to -0.4) and setting limits (CI: -3.5 to -1.5). The intervention improved caregivers' assessments of infant sleep problem severity and parental depression, fatigue, sleep, and sleep cognitions compared with controls.

Sleep problems in pre-school children: a review of the literature

Child: Care, Health and Development, 1994

This paper reviews the literature on sleep problems in preschool children, aiming to raise awareness of the current knowledge in this . field. The article begins with a discussion of the prevalence of sleep problems in young children. Disorders of initiating and maintaining sleep are by far the most common type of sleep problem in this age group, and are therefore the focus of this review. The effects of sleep disturbance are examined, focusing on how parents often feel desperate and in need of support outside the family. The causes of sleep problems are considered and the complexity in identifying causal factors is highlighted. The article continues with an exploration of the treatment of sleep problems, suggesting that much of the advice given to parents is contradictory. The literature demonstrates that the use of medication is common, but it appears that this method of treatment is of limited benefit. It seems that behaviour modification or a psychodynamic approach may be much more successful, and the use of self-help manuals/booklets has been shown to be useful by some authors. Finally, preventative strategies are discussed highlighting the need for further research in this area.

Practice parameters for behavioral treatment of bedtime problems and night wakings in infants and young children

Sleep, 2006

Bedtime problems and frequent night wakings are highly prevalent in infants, toddlers, and preschoolers. Evidence suggests that sleep disruption and/or insufficient sleep have potential deleterious effects on children's cognitive development, regulation of affect, attention, health outcomes, and overall quality of life, as well as secondary effects on parental and family functioning. Furthermore, longitudinal studies have demonstrated that sleep problems first presenting in infancy may become chronic, persisting into the preschool and school-aged years. A solid body of literature now exists supporting the use of empirically-based behavioral management strategies to treat bedtime problems and night wakings in infants, toddlers, and preschoolers. The following practice parameters present recommendations for the use of behavioral (i.e., non-pharmacological) treatments of bedtime problems and night wakings in young children (aged 0 - 4. years 11 months). A companion review paper on ...

Chapter - Behavioural Management of Paediatric Sleep Difficulties

Allergy and Sleep, 2019

This chapter is a brief overview of a range of behavioural approaches that can be used to help support people who are experiencing sleep difficulties. The core aspects of these management strategies are the same regardless of the specific health difficulties people might be experiencing. Management of atopy-related symptoms should be optimised in order for behavioural techniques to have the best possible chances of success. There may be situations in which the management of atopy might itself impact on sleep, or become associated with getting to sleep, in which case these should be considered carefully in order to give the patient the best chance of independently managing their symptoms, so that in the event of sleep difficulties they are not reliant on other people for their resolution. Essential foundations of good sleep include a consistent sleep schedule with a regular bedtime routine, which does not change on non-work or school days, and an age-appropriate bedtime.

Managing sleep disorders in children: which is the best strategy?

Georgian medical news

This review aims to critically analyze the literature studies showing the effectiveness of cognitive-behavioral strategies in the treatment of sleep disorder during the developmental age. About 15-35% of children suffer from sleep disorder. If they are not treated right away, it can persist into adulthood. Recent studies demonstrate an effective cognitive-behavior treatment for these disturbances. In this regard, the most effective method seems to be extinction (standard, with parental presence, graduated), the bedtime routine, scheduled awakenings, and preventive parent education. The procedures of extinction, not only its effectiveness, have limited application for the difficulty that compares to the parents following the procedure of the intervention. They are not able to ignore their children when they are crying for long prolonged period of time. Bedtime routine is relevant in the prevention and treatment of sleep disorders. The scheduled awakenings are a useful technique that ...

Behavioral treatment of bedtime problems and night wakings in infants and young children

Sleep, 2006

This paper reviews the evidence regarding the efficacy of behavioral treatments for bedtime problems and night wakings in young children. It is based on a review of 52 treatment studies by a task force appointed by the American Academy of Sleep Medicine to develop practice parameters on behavioral treatments for the clinical management of bedtime problems and night wakings in young children. The findings indicate that behavioral therapies produce reliable and durable changes. Across all studies, 94% report that behavioral interventions were efficacious, with over 80% of children treated demonstrating clinically significant improvement that was maintained for 3 to 6 months. In particular, empirical evidence from controlled group studies utilizing Sackett criteria for evidence-based treatment provides strong support for unmodified extinction and preventive parent education. In addition, support is provided for graduated extinction, bedtime fading/positive routines, and scheduled awake...

The Zurich 3-Step Concept for the Management of Behavioral Sleep Disorders in Children: A Before-and-After Study

Journal of clinical sleep medicine : JCSM : official publication of the American Academy of Sleep Medicine, 2015

Several strategies have been found to be effective for the treatment of childhood behavioral sleep disorders. One which has yet to be evaluated is the Zurich 3-step concept, which combines basic concepts of the two-process model of sleep regulation (introducing a regular rhythm and adjusting bedtime to sleep need) with behavioral strategies. This uncontrolled before-and-after study describes our concept and its step-wise approach, assesses changes in sleep-wake variables and behavior problems, and examines associations between changes in sleep-wake variables and behavior problems. A total of 79 children with sleep problems (age range 6-47 months, 42% females) were included. Sleep problems were assessed by the Infant Sleep Questionnaire, sleep-wake variables by diary and actigraphy, and behavior problems of children ≥18 months by the Child Behavior Checklist. A significant decrease in nocturnal wake duration (Cohen's d = -0.34) and a significant increase in the duration of the lo...

Childhood sleep disorders: diagnostic and therapeutic approaches

Current neurology and neuroscience reports, 2002

Pediatric sleep physiology begins with development of the sleep/wake cycle, and the origins of active versus quiet sleep. The 24-hour circadian cycle becomes established at 3 to 6 months. Sleep disorders are rationally approached in pediatrics as age-related. Disorders during infancy commonly include mild, usually self-limited conditions such as sleep-onset association disorder, excessive nighttime feedings, and poor limit-setting. These require behavioral management to avoid long-term deleterious sleep habits. In contrast, other sleep disorders are more ominous, including sudden infant death syndrome (SIDS), central congenital hypoventilation syndrome, and sleep apnea. Childhood is generally the golden age of sleep, with brief latency, high efficiency, and easy awakening. Parasomnias, sometimes stage specific, are manifest here. Adolescents have sleep requirements similar to preteens, posing a challenge for them to adapt to school schedules and lifestyles. Narcolepsy, usually diagn...

Sleep Regulation, Physiology and Development, Sleep Duration and Patterns, and Sleep Hygiene in Infants, Toddlers, and Preschool-Age Children

Current Problems in Pediatric and Adolescent Health Care, 2017

Sleep problems are common, reported by a quarter of parents with children under the age of 5 years, and have been associated with poor behavior, worse school performance, and obesity, in addition to negative secondary effects on maternal and family well-being. Yet, it has been shown that pediatricians do not adequately address sleep in routine wellchild visits, and underdiagnose sleep issues. Pediatricians receive little formal training in medical school or in residency regarding sleep medicine. An understanding of the physiology of sleep is critical to a pediatrician's ability to effectively and confidently counsel patients about sleep. The biological rhythm of sleep and waking is regulated through both circadian and homeostatic processes. Sleep also has an internal rhythmic organization, or sleep architecture, which includes sleep cycles of REM and NREM sleep. Arousal and sleep (REM and NREM) are active and complex neurophysiologic processes, involving both neural pathway activation and suppression. These physiologic processes change over the life course, especially in the first 5 years. Adequate sleep is often difficult to achieve, yet is considered very important to optimal daily function and behavior in children; thus, understanding optimal sleep duration and patterns is critical for pediatricians. There is little experimental evidence that guides sleep recommendations, rather normative data and expert recommendations. Effective counseling on child sleep must account for the child and parent factors (child temperament, parent-child interaction, and parental affect) and the environmental factors (cultural, geographic, and home environment, especially media exposure) that influence sleep. To promote health and to prevent and manage sleep problems, the American Academy of Pediatrics (AAP) recommends that parents start promoting good sleep hygiene, with a sleeppromoting environment and a bedtime routine in infancy, and throughout childhood. Thus, counseling families on sleep requires an understanding of sleep regulation, physiology, developmental patterns, optimal sleep duration recommendations, and the many factors that influence sleep and sleep hygiene.

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REVIEW ARTICLE: Behavioural and cognitive-behavioural interventions for sleep disorders in infants and children: A review

Sleep Medicine Reviews, 1999

This review covers the literature on behavioural and cognitive-behavioural treatments for sleep disturbance in infants, preschool , and school-age children. Treatment areas are dyssomnias (disorders of initiating, maintaining, or excessive sleep) and parasomnias (behaviours which occur predominantly during sleep). Interventions aimed at preventing sleep disorder through targeting infant sleep patterns are also examined. Controlled experimental studies are the main focus of this review but case studies and clinical reports are also included. It is concluded that, for families willing to undertake behavioural and cognitivebehavioural interventions, some treatments appear effective for some infant and child sleep problems, in the short term at least. The adequacy of current research is discussed, and suggestions for future research are given.

A systematic review of prevention and treatment of infant behavioural sleep problems

Acta Paediatrica

The evolution of sleep-wake patterns from multiple sleep episodes to one main consolidated sleep episode at night is a complex developmental process substantially engaging and challenging the parents during the first years. Sleep behaviour problems are developmentally normative; yet, parents who are able to attain appropriate strategies for settling their babies may decrease their child´s risk for longlasting problems. It is important to establish good sleep routines and gradually teach their baby to self-soothe. If parents do not have effective strategies for settling their baby, it can lead to ongoing adjustment problems for the baby. 1 Complaints about difficulty falling

Behavioral Interventions for Infant Sleep Problems: A Randomized Controlled Trial

Pediatrics, 2016

To evaluate the effects of behavioral interventions on the sleep/wakefulness of infants, parent and infant stress, and later child emotional/behavioral problems, and parent-child attachment. A total of 43 infants (6-16 months, 63% girls) were randomized to receive either graduated extinction (n = 14), bedtime fading (n = 15), or sleep education control (n = 14). Sleep measures included parent-reported sleep diaries and infant actigraphy. Infant stress was measured via morning and afternoon salivary cortisol sampling, and mothers' self-reported mood and stress. Twelve months after intervention, mothers completed assessments of children's emotional and behavioral problems, and mother-child dyads underwent the strange situation procedure to evaluate parent-child attachment. Significant interactions were found for sleep latency (P < .05), number of awakenings (P < .0001), and wake after sleep onset (P = .01), with large decreases in sleep latency for graduated extinction a...

Practice parameters for behavioral treatment of bedtime problems and night wakings in infants and young children: An American Academy of Sleep Medicine report

Sleep

Bedtime problems and frequent night wakings are highly prevalent in infants, toddlers, and preschoolers. Evidence suggests that sleep disruption and/or insufficient sleep have potential deleterious effects on children's cognitive development, regulation of affect, attention, health outcomes, and overall quality of life, as well as secondary effects on parental and family functioning. Furthermore, longitudinal studies have demonstrated that sleep problems first presenting in infancy may become chronic, persisting into the preschool and school-aged years. A solid body of literature now exists supporting the use of empirically-based behavioral management strategies to treat bedtime problems and night wakings in infants, toddlers, and preschoolers. The following practice parameters present recommendations for the use of behavioral (i.e., non-pharmacological) treatments of bedtime problems and night wakings in young children (aged 0 - 4. years 11 months). A companion review paper on ...

Cognitive–behavioral treatment for childhood sleep disorders

Clinical Psychology Review, 2005

Sleep problems are very prevalent during childhood and may have adverse developmental impact. The efficacy of a number of cognitive-behavioral interventions for the most prevalent problems such as difficulty falling asleep and night-wakings has been repeatedly demonstrated with relatively rapid outcomes and high success rates. Preventive interventions in infancy have shown some promise in lowering the rates of sleep problems in infants of trained parents. Cognitive-behavioral interventions have also been proposed for childhood parasomnias (sleepwalking, night terrors, nightmares, and rhythmic behaviors), however, very limited research has been conducted to assess the efficacy of these interventions. Specific methodological issues, limitations and needs have been identified in the clinical literatures. These issues include: (a) integrating objective sleep assessment methods in clinical research; (b) identifying the specific curative factors of various effective interventions; (c) the absence of long-term follow-up studies for assessing relapse problems; (d) assessing the role of mode of delivery (i.e., professional consultation versus written information) in treatment efficacy; and (e) the need to expand the research on clinical interventions for the parasomnias.

Treatment efficacy in behavioral pediatric sleep medicine

Journal of Psychosomatic Research, 2003

Behavioral interventions have been identified as the treatment of choice for many forms of pediatric sleep disturbance. We adopt criteria established by the Task Force on Promotion and Dissemination of Psychological Procedures (1996) to evaluate the literature base describing behavioral interventions for pediatric sleep disturbance. Three well-established interventions, one promising intervention and one probably efficacious intervention, have emerged for bedtime refusal and frequent nighttime awakenings. Only one intervention for sleep terrors and sleepwalking has sufficient empirical support to be considered promising. Behavioral interventions targeting circadian rhythm disorders (e.g., delayed sleep phase), nightmares and rhythmic movement disorder (RMD) have not been researched sufficiently to be considered empirically supported. D

SLEEP PROBLEMS IN EARLY CHILDHOOD

The literature is based on showing the early childhood sleep problems among 0 to 4 years old children including their parents in Australia. The study will effectively show the normal developmental sleep expectations in this particular age group and what are the theoretical explanations behind it. A critical evaluation will also be made upon the research evidence that will show the contribution of both the parents and the child. There will be a short brief on the methodological approach that will determine the course of the review.

Classification of young children's sleep problems: A pilot study

Journal of Developmental & Behavioral Pediatrics, 2001

The psychosocial and cultural contexts in which young children's sleep patterns and bedtime routines develop influence how sleep problems are defined. It is important to consider how parent-child bedtime and middle-of-the night interactions change with age and differ across ethnic and socioeconomic groups. Is night waking a problem only when the child disturbs the parent's sleep? At what age should children "sleep through the night"? When should cosleeping be considered a problem? Researchers and clinicians have only recently begun to systematically define terms, describe cultural practices, and conduct empirical assessments of developmental changes. Varying views about what constitutes a sleep "disorder" during the first few years of life persist. In this report, preliminary results of a pilot study are presented that attempt to systematically quantify sleep behaviors in toddlers. A nosology that modifies DSM-IV dyssomnia criteria for younger children (aged 12-48 months) is described. Because young children rarely meet strict DSM-IV criteria for diagnosis, the term protodyssomnias is used, suggesting a potential precursor of a later full-blown dyssomnia. Finally, a potential early indicator of later sleep disruption is reported. Current Classification Schemes The DSM-IV (American Psychiatric Association, 1994) defines dyssomnias as a group of disorders characterized by difficulty in initiating or maintaining sleep. Few infants and toddlers meet the impairment and/or severity criteria necessary to make a definitive DSM-IV diagnosis. The International Classification of Sleep Disorders: Diagnostic and Coding Manual (ICSD-DCM) (American Sleep Disorders Association, 1990) subclassifies "extrinsic" sleep disorders into categories using terms such as inadequate sleep hygiene, adjustment sleep disorder, insufficient sleep syndrome, or sleep onset association disorder. For each of these syndromes there are duration and acuity criteria; however, some of the labels are cumbersome and the criteria are neither empirically nor developmentally determined. Moreover, family health practitioners generally are not familiar with the ICSD-DCM. The Diagnostic Classification of Mental Health and Developmental Disorders of Infancy and Early Childhood (DC 0-3) (Zero to Three, 1994) is yet another nosology, developed by infancy specialists, that focuses on young children from birth to 3