Brief report: Use of an antecedent procedure to decrease night awakening in an infant: A replication.

Abstract

Borowski, Hunter, and Johnson (2001) found that an antecedent strategy such as white noise could decrease sleep awakenings for infants in the natural home environment. This study attempts to replicate the findings using an ABAB reversal design. A five month and one week old child, who had difficulty with waking an average of four times per night, was placed on a white noise program. This program consisted of the parents placing a FamilyCare air purifier and ionizer next to the infants crib and turning the machine on just before the infant parents began to rock the infant and then place the infant in the crib for sleep. This antecedent procedure was successful in reducing the number of infant wakening to 1.3 episodes/ night. Keywords: Infant sleep, nightime wakening, stimulus/antecedent control procedure, behavioral intervention, replication. Introduction As a greater reliance on functional assessment is occurring in behavior therapy (Sturmey, 1996), behavioral interventionists are placing growing weight on neutralizing routines and antecedent control strategies as alternatives to contingency management strategies. As part of this trend, a greater emphasis is being placed on establishing positive routines (Adams & Rickert, 1989; Milan, Mitchell, Berger, & Peirson, 1981), neutralizing routines at the onset of problems (Cautilli & Dziewolska, 2004), and antecedent control strategies (Rolider & Axelrod, 1999; Cautilli & Tillman, 2004). This research stretches across many areas but one area of particular importance for new parents is that of sleep. Establishing a sleep wake cycle in infants is an important part of parenting (Novak & Pelaez, 2004) and typically one of parents' earliest challenges. Sleep problems for typical children are common (Kuhn & Weidinger, 2000). One of the earliest interventions tried was the use of white noise (Borkowski, Hunter & Merele, 2001; Schmidt, 1975). The white noise procedure is the simple use of continuous sounds to block out the occurrence of other sounds and to create an airy sound effect (For a complete theoretical analysis of white noise seeBorkowski and colleagues, 2001 but the producer builds on a combination of stimulus control in which sleep is seen as a reinforcer and respondent conditioning. Continued sleep is seen as a factor of behavioral momentum). Borkowski and colleagues (2001) explored the use of white noise as an antecedent for sleep time combined with scheduled bedtime routines for five infants, who were four months old. They found the intervention helpful in three infants who were bottle-fed but not helpful for the two infants who were breast-fed. This study attempted to replicate their findings in clinical practice with a five month, one week old child. Method Participant The participant was an only child in his family and typically developing. The child was mostly breast feed, however, due to hectic life schedules the parents fed formula at least three times/week. The child was fed between four and six ounces of milk during the last feeding before sleep. The participant was a five month and one week old child with a history of difficulty with waking during the night after his parents placed him in his crib for sleep. The participant was roughly averaging four instances of waking each night. The instances of problems sleeping reached the point of being so severe that the parents brought the participant to the hospital emergency room in order to determine if a physical problem was present. After the physician told the parents that waking during the night was common, the physician sent the parents and the participant home. Two days later, the infant's parents sought out the aide of the first author by email on the Internet. Setting The participant slept in parent's room. The setting was a standard 12x14 room. The room housed one standard crib for the infant and a queen-sized bed. …