Outcomes of a Behavioral Intervention for Sleep Disturbances in Children with Autism Spectrum Disorder

Abstract

This study evaluated the effectiveness of Bedtime Fading with Response Cost (BFRC) in decreasing sleep disturbances in children with Autism Spectrum Disorder (ASD) using parents as change agents by implementing treatment in the home environment. A non-concurrent multiple baseline design across three participants was used. Results indicate that BFRC was effective in eliminating unwanted co-sleeping, frequent night awakenings, and dependent sleep onset. Secondary improvements include reducing sleep onset latency, bedtime resistance, and disruptive sleep-related behaviors. Follow-up data demonstrate gains were maintained. Parents reported high satisfaction with BFRC and sleep outcomes for their children. This study extends both the practice and science of parent-implemented behavioral interventions as treatment options for children with ASD and co-occurring sleep disturbances.

Applied behavior analysis measurement, assessment, and treatment of sleep and sleep‐related problems

“…Sleep questionnaires are used frequently to identify sleep concerns and measure the effects of interventions (Abel et al, 2017;Sadeh, 2015;Sanberg et al, 2018). Examples include the Family Inventory of Sleep Habits (FISH; Malow et al, 2009), Pediatric Sleep Questionnaire (PSQ; Chevrin et al, 2000), Behavioral Evaluation of Disorders of Sleep (BEDS; Schreck et al, 2003), and Children's Sleep Habits Questionnaire (CSHQ; Owens et al, 2000).…”

Sleeping sound with autism spectrum disorder (ASD): study protocol for an efficacy randomised controlled trial of a tailored brief behavioural sleep intervention for ASD

“…It is estimated that 40%–80% of children with ASD experience sleep problems,9–13 with sleep-onset delay, shorter sleep duration and frequent prolonged night waking being particularly common 9 13–18. Other common sleep problems include bedtime resistance, sleep anxiety, daytime sleepiness, early waking, co-sleeping, low sleep efficiency and parasomnias 9 13 16–20. Children with ASD will also often experience more than one sleep problem concurrently 16.…”

Parent-Implemented Bedtime Fading and Positive Routines

“…Therefore, by training appropriate cues at bedtime, the length of nighttime wakenings may also decrease. Positive routines are in most occasions implemented by caregivers, the primary change agents for children with ASD, who often make use of visual schedules to facilitate understanding and adherence to the positive routine (Honaker and Meltzer 2016;Sanberg et al 2018).…”

“…Results were maintained at a 3-week follow-up. More recently, Sanberg et al (2018) evaluated the efficacy of bedtime fading combined with response cost on decreasing sleep disturbance in children with ASD. This intervention was found to be effective at reducing sleep onset latency and bedtime resistance.…”