Handling Parents' Concerns Regarding the Behavioural Treatment of Infant Sleep Disturbance

Abstract

Infant sleep disturbance (ISD) is widespread and troublesome. Although effective management techniques have been established, some lay and professional authors have expressed concern about these interventions. These concerns are sometimes shared by parents who seek professional advice while feeling ambivalent about undertaking treatment. These concerns include (a) that ISD is normal and inevitable, (b) that it results from unnatural or artificial cultural practices, (c) the belief that ISD expresses a need state, and (d) the belief that the use of extinction is harmful. These concerns are examined and the management of ISD by extinction and its alternatives are considered in the light of the ethics of professional practice. It is concluded that these concerns are best answered within the context of a professional relationship based on a partnership and the sharing of expertise with parents.

Treating sleep disturbance in infants: What generalizes?

“…As noted above, one justification for modifying the extinction-based procedures by more gradual alternatives is to reduce parental stress and child distress (see France, 1994;France et al, 1996). Although parents rated the checking procedure in the present study as not stressful, this is also consistently true of other behavioral interventions, including unmodified planned ignoring (France, Blampied & Wilkinson, 1991;Lawton et al, 1995;Reid et al, 1999) and other variants (Lawton et al, 1991;France et al, 1991; also see France, Blampied & Wilkinson, 1999).…”

“…Therefore, both the advantages and disadvantages of the graduated checking procedure need to be carefully considered by both clinicians and parents as they make informed decisions about treatment options for ISD (France, 1994;, 2005France et al, 1996;Kuhn & Elliot, 2003;Mindell, 1999).…”

Discussion of Extinction-Based Behavioral Sleep Interventions for Young Children and Reasons Why Parents May Find Them Difficult

“…23 Parental resistance has been highlighted in clinical settings, particularly relating to unmodified extinction ("cry it out"). 14,15,[24][25][26] A survey showed parents found a "bedtime pass" method, where the child was given a pass to leave their bed for something quick (e.g., a drink or hug) once each night without penalty, much more acceptable than ignoring. 27 This preference was not mirrored by professionals.…”

“…28 Objections to treatments can lead to attrition, avoidance, and non-compliance. 17,18,22,25,27 A significant discrepancy between parent and practitioner views could also potentially harm these relationships, and in turn reduce future engagement with that practitioner or possibly other professionals. One result could be significant health issues from ongoing sleep deprivation.…”

“…25 That paper raised the issue of parent concerns, but all points raised were based on the assumption that parents' concerns were due to a lack of knowledge. However, other factors also contribute to resistance to extinction interventions.…”