Real-World Implementation of Infant Behavioral Sleep Interventions: Results of a Parental Survey

Objective To describe parental practices implementing behavioral sleep intervention (BSI) outside a clinical setting. Study design Parents (n = 652), recruited through a Facebook group designed as a peer support group for parents using BSI, completed an online survey about their experience using BSI with their infant or toddler. Results On average, parents implemented BSI when their infant was 5.6 (±2.77) months. Parents most often used modified (49.5%) or unmodified extinction (34.9%), with fewer using a parental presence approach (15.6%). Regardless of BSI type, more parents endorsed “a great deal of stress” during the first night (42.2%) than 1 week later (5.2%). The duration of infant crying was typically greatest the first night (reported by 45%; M = 43 minutes) and was significantly reduced after 1 week (M = 8.54 minutes). Successful implementation of BSI on the first attempt was reported by 83%, with a median and mode of 7 days until completion (79% by 2 weeks). Regardless of BSI type, after intervention parents reported their infant had less difficulty falling asleep, fewer night awakenings, and were more likely to sleep in their room and/or in their own crib/bed. Conclusions The majority of parents report successfully implementing BSI, with significantly reduced infant crying by the end of 1 week and success within 2 weeks. Few differences were found between behavioral approaches

Behavioral treatment of multiple childhood sleep disorders: Effects on child and family.

Sleep disorders are highly prevalent among otherwise healthy young children and can be extremely disruptive to family life. Treatment was initiated in a multiple baseline fashion for the chronic night waking and nighttime disturbance exhibited by a 14-month-old girl. We found that “graduated extinction” (gradually increasing the time before attending to the child’s crying) resulted in rapid reductions in these sleep disorders. Additionally, data on parental depression and marital satisfaction showed general improvement as a function of improved child sleep patterns. These results are discussed as they relate to the treatment of common childhood behavior disorders and their role in family satisfaction

Behavioral intervention for childhood sleep terrors.

Sleep terrors involve a sudden arousal from slow wave sleep accompanied by screaming, crying, and other manifestations of intense fear. Although many children exhibit isolated sleep terror episodes, a few experience these sleep difficulties on a chronic basis. These frequent sleep terrors can lead to a great deal of concern as well as disruption in sleep for other family members. We conducted a study of the effectiveness of one behavioral intervention (scheduled awakenings) for the sleep terrors of three young boys. The boys (5, 6, and 9 years old) had a several-year history of sleep terrors, each more than 2 years. Scheduled awakenings involved arousing the child from sleep approximately 30 minutes before expected sleep terror episodes. Results through a 12-month follow-up using a multiple baseline across children indicated that this intervention quickly and durably reduced the frequency of their nighttime difficulties. Scheduled awakenings are a potentially useful nonmedical intervention for chronic sleep terrors

Choice assessment in residential settings.

The availability of choice has been suggested as an important aspect of quality of life for persons with severe handicaps. However, the psychometric properties of proposed methods of measuring choice have not been fully assessed. The present study introduces the Resident Choice Assessment Scale, a measure designed to assess daily choices available to persons with severe handicaps. Results indicated the instrument to be reliable across raters and time, and to distinguish choice availability across developmental center, nursing home, and group home settings. The scale may be useful for determining the restrictiveness of a living environment for purposes of modification and as a dependent measure for future research

Choice assessment in residential settings.

The availability of choice has been suggested as an important aspect of quality of life for persons with severe handicaps. However, the psychometric properties of proposed methods of measuring choice have not been fully assessed. The present study introduces the Resident Choice Assessment Scale, a measure designed to assess daily choices available to persons with severe handicaps. Results indicated the instrument to be reliable across raters and time, and to distinguish choice availability across developmental center, nursing home, and group home settings. The scale may be useful for determining the restrictiveness of a living environment for purposes of modification and as a dependent measure for future research

It\u27s not where you live but how you live: Choice and adaptive/maladaptive behavior in persons with severe handicaps.

Although it is generally accepted that beneficial effects accrue when relocating persons with severe handicaps from large to smaller facilities, a specific analysis of concurrent environmental changes is needed. The present study investigated the relationship between choice availability and levels of adaptive and maladaptive behavior in persons with severe handicaps following their relocation to smaller residential facilities. Specifically, 57 residents of a large developmental center (30 men and 27 women, mean age 35 years) were relocated to either a transitional developmental center before placement into smaller residential facilities or directly into separate smaller community residences. AAMD Adaptive Behavior Scale, Vineland Maladaptive Behavior Scale, and Resident Choice Assessment Scale data were obtained for both groups over a 1-year follow-up period. Degree of resident choice was significantly correlated with areas of adaptive and, to a lesser extent, maladaptive behavior. Choice availability is proposed as a meaningful variable for modifying residential programs, developing effective behaviors, and classifying living facilities for persons with severe handicaps