A Behavioral Approach to Sleep Problems
Editorial: Mitchell Taubman, Ph.D.
Dr. Taubman is a co-director of the Autism Partnership
From the perspective of Applied Behavior Analysis, several factors may contribute to sleep difficulties (falling, staying, and going back to sleep) for children with autism spectrum disorder, and most typically a comprehensive approach is utilized (Jin, Hanley, & Beaulieu, 2013).
In clinical practice, intervention efforts customarily begin with at least an informal assessment of what sleep problems may be occurring and what may be contributing to the difficulties. Examined are such factors as absence of sleep-conducive bedtime routines, problematic patterns (e.g., unrealistically early bedtimes), inadvertent reinforcement of bedtime difficulties (e.g., cuddling with the child or the child being removed from bed and given a snack after crying and calling out), and possible contributions of other sleep inhibitory issues (e.g., stereotypic behavior, tantrums). As appropriate, recommendations are made to rule out any medical issues and attention (and respect) is also paid to any contributory cultural pr actices (e.g., co-sleeping).
Before the intervention begins, parents are prepared for what is to come, including how much front-loaded effort may be necessary, and practical considerations are taken into account. The goal of sleep interventions is to improve the child’s independent ability to fall asleep as well as return to sleep. Establishing consistent routines that promote a quiet, calm, restful, sleep-conducive state is key. Music, dim lights, story reading, and use of objects like soft blankets and stuffed animals can be included. Efforts also focus on reinforcement of relevant targets such as staying in bed or cooperatively engaging in the bedtime routine. Avoidance of inadvertent support of sleep problems (e.g., nighttime removal of the child to the parent’s bed) is emphasized. Systematic change to the sleep pattern (e.g., establishment of a late bedtime carefully and gradually faded to earlier times) may also be included, as may work on contributory, sleep incompatible (e.g., repetitive or escalated) behaviors. Such work can initially be quite involved and time-consuming, representing a substantial family commitment. However, with consistent effort we have found this approach to be highly effective and of benefit for all (for more information, see A Work In Progress, Leaf & McEachin, 1999).
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.
Leaf, R. & McEachin, J. (1999). A work in progress. New York: DRL Books.