A Conceptual Framework for Understanding and Designing Behavioral Interventions for Sleep Problems in Children on the Autism Spectrum

Behavioral Sleep Interventions for Children with Rare Genetic Neurodevelopmental Conditions: A Retrospective Analysis of Overall Outcomes for 26 Cases

“…In children with neurodevelopmental conditions (e.g., autism, RGNC), sleep difficulties are generally understood to be the result of a complex interaction between biopsychosocial and behavioral variables (Richdale & Schreck, 2009;Veatch et al, 2021). Specifically, the behavioral model of sleep disturbance posits that sleep onset occurs at the end of a behavior chain, motivated by sleep pressure, that starts with a bedtime routine and ends with the behavioral quietude necessary for sleep to occur (Blampied, 2013;Blampied & van Deurs, 2022). Antecedent variables (i.e., variables that precede and/or regulate a behavior) can affect this behavior chain by altering motivation and cues for sleep (Loring & Malow, 2022).…”

“…Homeostatic sleep pressure arising from sleep deprivation, delayed bedtime, or excessive daytime activity can increase an individual's motivation to sleep and, thus, the reinforcing value of sleep (Borbély et al, 2016;Laraway et al, 2003). Further, each step in the behavior chain leading up to sleep onset is under stimulus control whereby each sequential step provides the discriminative stimulus for the step that follows (Blampied, 2013;Blampied & van Deurs, 2022). When discriminative stimuli are absent (e.g., because of a variable bedtime routine) or insufficiently salient, the behavior chain is disrupted.…”

“…Moreover, when discriminative stimuli are consistently experienced at sleep onset, these cues may become required for sleep onset. Thus, some discriminative stimuli (e.g., a regularly available soft toy) can support, while others (e.g., the absence of parental presence following NWs when otherwise present at initial sleep onset) can interfere with sleep onset both at the start of the night and following NWs (Blampied & van Deurs, 2022). Furthermore, reinforcement contingencies also play a critical role in sleep.…”

“…Consequences that occur immediately following a behavior may increase or decrease the future likelihood of that behavior (Cooper et al, 2020). If sleepconducive (e.g., lying quietly in bed) or sleep-interfering (e.g., calling out) behaviors are reinforced (e.g., by some parental response), this is likely to result in continuation of that behavior (Blampied & van Deurs, 2022;McLay & Lang, 2022).…”

“…To effectively treat sleep difficulties that are underpinned by behavioral factors, it is essential to identify and address the contributing antecedent and consequence variables (Blampied & van Deurs, 2022;Jin et al, 2013;. Functional Behavioral Assessment (FBA) guides the identification of relevant antecedents, contingencies of reinforcement, and other contextual factors to inform the development of individualized interventions for a range of behavioral difficulties including sleep disturbance (Blampied, 2013;Jin et al, 2013).…”