Behavioral parent-training approaches for the treatment of bedtime noncompliance in young children.

Abstract

Abstract Bedtime is one of the most common and treatable types of child sleep problems. Children who are noncompliant at are more likely to exhibit daytime somnolescence, which may in turn lead children to exhibit daytime misbehavior, impaired social functioning and poorer school achievement. In addition, these problems can have a number of negative consequences for members of the child's family, including parental sleep deprivation and depression. Behavioral parent-training approaches are considered the treatments of choice for in young children. In this paper, we describe the evidence supporting a number of such approaches. We highlight several gaps in the treatment literature and we make recommendations for future research. Keywords: Bedtime Noncompliance, Parent Training, Sleep Problems ********** Bedtime in preschool and elementary-school school aged children is typically characterized by stalling, whining, or tantruming when approaches. Almost all children will exhibit these behaviors at some point in their young lives. Most parents have the skills to handle milder forms of noncompliance. However, when the intensity, duration, or frequency of these behaviors leads to disruptions in a family's functioning, mental health professionals can offer substantial help. These behaviors are best classified diagnostically as Behavioral Insomnia of Childhood, Limit-setting Type (2005 revision of the International Classification of Sleep Disorders; American Academy of Sleep Medicine). In this paper we will use the less awkward term bedtime noncompliance to describe this set of behaviors. Although some of the studies we will mention include infants, we will focus primarily on preschool and school aged children. For an excellent review of the entire class of sleep problems in children, including parasomnias, fears, and nightmare disorders see Sadeh (2005). There is evidence that is one of the most common childhood behavior problems. While many surveys of sleep problems in children lump sleep problems together, a few studies have examined prevalence rates of noncompliance. Estimates vary widely, but most studies suggest that 5-10% of school-aged children display significant (e.g. Blader, Koplewics, Abikoff, & Foley, 1997, Mindell, 1993). Sleep problems as a class account for almost 10% of presenting concerns in child and adolescent outpatient mental health centers (Meisbov, Schroeder, & Wesson, 1993). There is no doubt that many other families experience these problems and do not seek professional help. Research on Effects of Sleep Problems There is an increasing amount of clinical observation and research demonstrating that sleep problems, including noncompliance, can lead to insufficient sleep in children, which can, if chronic, lead to emotional, physical, behavioral, and cognitive problems (Dahl, 1996; Gais, Philal, Wagner, & Born, 2000; Kuhn, Mayfield & Kuhn, 1999; Lavigne, et al., 1999; Mindell, Kuhn, Lewin, Meltzer, & Sadeh, 2006; Owens, 2004; Sadeh, Gruber, & Raviv, 2002). While not all children who are noncompliant with are sleep deprived, having nightly battles with parents (which often include delaying and moving from one bed to another in the middle of the night) leads many children to experience compromised sleep quality and reduced total sleep time. Mood problems associated with daytime sleepiness in children include exacerbation of negative mood, compromised mood regulation, and a decrease in positive affect (Dahl, 1996; Kuhn, Mayfield & Kuhn, 1999; Owens, 2004). Chronic sleep problems may also have deleterious effects on the cardiovascular, immune, and metabolic systems (Mindell et al., 2006; Owens, 2004). Behavioral correlates of decreased night sleep include hyperactivity, aggressiveness, oppositionality or noncompliant behavior, and poor impulse control (Lavigne, et al. …