Association for Behavior Analysis International

Sleep problems are ubiquitous among children and adolescents diagnosed with autism spectrum disorder (ASD). These problems are unlikely to abate without treatment, resulting in adverse long-term effects on the daytime functioning and wellbeing of people with ASD and their siblings, parents, and others. To effectively address sleep problems, it is important to first identify the variables controlling relevant behavior. Functional Behavior Assessment (FBA) is a process that can help facilitate an understanding of the reinforcement contingencies that either disrupt or facilitate bed preparation, sleep onset, self-soothing behavior following night wakings, and waking at an appropriate time in the morning. From this process, caregivers and clinicians are more equipped to devise individualized and function-based treatment programs for individuals diagnosed with ASD whose sleep is chronically disturbed. This symposium contains a series of presentations as follows: (a) discussion of the core behavioral model of sleep with specific considerations of how this needs to be adapted for individuals diagnosed with ASD, (b) efficacy evaluation of function-based treatments with and without melatonin for sleep problems of children diagnosed with ASD, (c) effectiveness of adolescent-led or combined parent/adolescent-led behavioral treatments for sleep problems in 7, 9-15 year old participants diagnosed with ASD, and (d) outcome data for 40 participants diagnosed with ASD who have received function-based treatments for their sleep problems.

Board Certified Behavior Analysts, Graduate Students of Behavior Analysis, BCaBA, RBT, Clinical Psychologists, Psychiatrists, Pediatricians

Sleep is essential to health, wellbeing, and development and chronic sleep disruption has many adverse consequences. Children and adolescents with a diagnosis of Autism Spectrum Disorder have high rates of sleep disturbance. For typically developing children Blampied and France (1983; JABA, 26, 477-92) proposed a bio-social-behavioral model of pediatric sleep disturbance for typically developing children that explains sleep disturbance in terms of (a) stimulus control (or its lack) for sleep-interfering and facilitating behaviors, and (b) related contingencies of reinforcement for the behaviors. Going to sleep is a state transition supplying primary reinforcement for a terminal link in a concurrent chain, where choice of sleep facilitating or interfering behaviors is dynamically influenced by the salience of the stimuli for the concurrent chains and the associated schedules of reinforcement. This model guides functional behavioral assessment of sleep disturbances and the design of remedial interventions. This talk will outline the model and elaborate on those aspects that need particular attention to adapt it for children and adolescents with ASD, such as the impact of extended device use, stereotypic behavior and or high-intensity challenging behavior. This is intended to provide background information for papers to follow in the symposium.

Sleep problems are prevalent and persistent in young children, especially children diagnosed with Autism Spectrum Disorder (ASD). These problems negatively impact the health and development of young children and are often challenging to address for caregivers and clinicians. Pharmacological interventions, such as melatonin, are commonly recommended for pediatric sleep problems despite limited research on their efficacy and social acceptability. Function-based behavioral interventions shows merit as a promising alternative but has yet to draw to focus of mainstream treatment providers. This present study evaluated the efficacy of personalized and assessment-based behavioral intervention with and without melatonin on the sleep problems of children diagnosed with ASD. Nighttime infrared video and sleep diary were used to measure sleep interfering behaviors, sleep onset delay, night and early wakings, the total amount of sleep, as well as other relevant variables in the participating children. Parents and caregivers were encouraged to assist with treatment development during the assessment process and served as interventionists at home following behavioral skills training. A multiple-baseline-across-subjects designed was used to evaluate the treatments. Parents also provided feedback on the acceptability of each treatment and on their satisfaction with the outcomes. The relative advantages and disadvantages of each treatment option, their comparative efficacy, and the extent to which parents can implement the strategies with integrity are discussed.

Young people with autism spectrum disorder (ASD) often exhibit significant sleep problems e.g., delayed sleep onset latency, and frequent and prolonged night wakings throughout their life, but there is little research into effective interventions for them. Previous research has largely focused on sleep problems in non-verbal preschool or school-aged children with autism, where parents are the primary intervention agents. We illustrate how behavioural sleep interventions can be adapted to include young people with ASD, who are verbal and have various levels of functioning, in therapy. The current study used a single-case multiple baseline design to evaluate the effectiveness of adolescent-led or combined parent/adolescent-led behavioral treatments for sleep problems in 7, 9-15 year old participants with ASD. Selected participants displayed sufficient communication abilities to participate in therapy, assessed by clinical judgement and the Communication domain of the Vineland Adaptive Behavior Scales; inclusion was not limited by IQ. Preliminary analysis indicates both young person-led and combined parent/ young person-led treatment approaches resulted in a reduction in target sleep variables for 6/7 participants. Parent and young person treatment fidelity and social validity data will also be presented. The process and implications of including young people with ASD within the therapeutic process will be discussed.

Sleep problems in children and adolescents with autism are often maintained by antecedent variables and reinforcement contingencies unique to the individual. Functional Behavioural Assessment (FBA) is a tool used identify this unique combinations of variables for each individual. To date, few large N studies replicating the evaluation of function-based interventions for sleep problems in people with autism exist. This presentation reports the outcomes of a series of single-case multiple baseline design studies evaluating the effects of function-based, parent-implemented interventions for 40 children and adolescents with ASD. Data was gathered using a combination of daily parent-reported sleep diaries, videosomnography and actigraphy and was used to calculate a Sleep Problem Severity score for baseline, treatment, and short- and long-term follow-up. Treatment fidelity, reliability and social validity data were also collected. Preliminary analysis indicates that FBA-based interventions led to a reduction in some or all sleep problems for all children who completed intervention. These gains were generally maintained at short- and long-term follow-up. The implications of these findings for clinical practice and future research will be discussed.