Behaviour Therapy for Child Sleep Disorder

Behaviour Therapy for Child Sleep Disorder Aims: Outlines the nature of behavioural aspects of children’s sleep and how these might be addressed by behaviour therapy. Clinical considerations concerned with the use of behavioural therapy are also highlighted. Consider behavioural aspects (ie, learned behaviours) and their relevance for our understanding of children’s sleep patterns and management of their sleep disorders. Increase awareness of how behavioural factors may play a role in the development and treatment of wide-ranging paediatric sleep disorders and to discuss clinical considerations relevant to management planning and decisions about whether to refer a child for specialist behavioural therapy. Classification: International Classification of Sleep Disorders of ‘‘behavioural insomnia of childhood’’:Â  (present with difficulty settling to sleep, nightwaking and/or early waking difficulties) Overall prevalence rates of 30% ‘‘inappropriate sleep onset asso ciations’’ (ie, where the child has not learnt to fall asleep without a set of problematic or demanding conditions such as parents’ being present), ‘ ‘limit-setting sleep disorder’’ (ie where the care giver demonstrates insufficient or inappropriate limit-setting to establish appropriate sleep behaviour in the child) ‘‘combined’’subtype where these two problems co-exist. 25–50% of 6–12-month olds have difficulty settling to sleep or waking in the night do not decrease with age: by age 3 years, 25–30% have sleeplessness problems With similar percentages reported for the 3–5-year age group, 43% of 8–10-year olds 23% of 10– 17-year olds. These problems are not transient; an epidemiological study of a cohort of 5-year olds suggested that sleeping problems at age 5 years were significantly associated with sleeping difficulties at age 6 months (or before) and that children with sleep problems at age 5 years were more likely to have sleeping problems at 10 years. Over 80 sleep disorders listed in the International Classification of Sleep Disorders, which are divided into six main categories: insomnia, sleep-related breathing disorders, hypersomnia of central origin, circadian rhythm disorders (ex. Delayed sleep phase syndrome) parasomnias (ex. Sleep terrors, nightmares) Helped by beh therapy. sleep-related movement disorder (ex. nocturnal headbanging) (in preliminary reports) Behavioural Interventions: Classical conditioning is a form of associative learning whereby a neutral stimulus is paired with a naturally occurring stimulus, which evokes the desired behavioural response until, after multiple pairings, the neutral stimulus alone is sufficient to elicit the desired behaviour; thus behaviours are conditioned to be elicited by antecedent conditions. Operant conditioning involves the use of consequences to modify the occurrence and form of behaviour. The particular intervention strategy used will vary depending on family and child factors and the nature of the sleep disturbance one hopes to address. General Principles: (The more consistently these principles are applied, the easier it will be for the child to learn) Behaviour can be encouraged by linking it with an antecedent stimulus, which serves to trigger the desired behaviour. Reinforcement- Behaviour is likely to recur if the consequences of the behaviour were reinforcing for the child. (Can be pos or neg) Extinction, or removing reinforcement (eg, drinks, parental presence, attention) maintaining the undesired behaviour (eg, crying, refusal to settle to sleep without the above) can be achieved gradually or abruptly. Shaping- A new behaviour can be encouraged by rewarding a series of responses that more and more closely resemble the desired behaviour. Punishment- Behaviour is less likely to occur if followed by a punishing consequence. (Can be pos or neg) Rewards Success