Association for Behavior Analysis International

Sleep problems are often reported among children with developmental disabilities, such as autism spectrum disorder (ASD), and rare genetic developmental disorders, such as Angelman, Williams, and Rett Syndromes. Without treatment, these problems can cause cascading effects on the functioning and development of the child. The use of behavioral interventions is well founded in the literature for the treatment of sleep problems in these populations. Utilizing a functional behavior assessment can help determine the reinforcement contingencies that are prolonging the sleep problem and help guide the intervention selected for treatment. As such, this symposium contains a series of presentations that evaluate behavioral treatments for sleep problems as follows: (a) analysis the current literature on behavioral interventions to treat sleep problems in children with autism, (b) the efficacy of personalized and assessment-based behavioral intervention on the sleep problems of children diagnosed with ASD, and (c) the evaluation of circadian manipulations and function-based interventions for sleep problems in children with rare genetic developmental disorders.

BCBAs, BCBA-Ds

Sleep is an essential activity for human development. Often, children with autism spectrum disorder (ASD) are affected by a lack of sleep due to various types of sleep problems. We identified and analyzed studies that were aimed at utilizing sleep interventions for children with ASD. A systematic search of databases, reference lists, and ancestral searches identified 18 studies for inclusion. Studies were summarized in terms of (a) participants, (b) targeted sleep problem and measures, (d) intervention components, (e) research design and rigor, and (f) results. The aim of this review was to analyze the literature by evaluating the most commonly treated sleep problems, the various treatment components, and strength of the results using a between case parametric effect size estimate. The most commonly treated sleep problems were night wakings and bedtime disturbance. For interventions, all the studies incorporated multiple treatment components, most often including the use of a consistent bedtime routine. Effect size calculations indicated a moderate effect size, however, limited due to the small number of studies. Results suggest the overall effectiveness of behavioral interventions for the treatment of sleep problems for children with ASD. Based on our analysis, suggestions for practitioners regarding current practices and future directions for research are discussed.

The prevalence of sleep problems in children with Rare Genetic Neurodevelopmental Disorders (RGND) such as Angelman, Williams, and Rett Syndromes, far exceeds that observed in typically developing children. These problems are commonly attributed to biological and circadian rhythm abnormalities and, consequently, are predominantly treated medically/pharmacologically. While biological and genetic factors are important, this should not preclude considering the role of the environment and learning in the etiology and maintenance of the sleep problem. We present the results of a single-case, multiple baseline design study that investigated the effectiveness of multi-component interventions for up to six children with RGND and sleep problems. Phase 1 of intervention consisted of the manipulation of sleep-wake times, including faded bedtime procedures. Phase 2 consisted of the introduction of function-based interventions following functional-behavioral assessment. Short- and long-term follow-up data is also reported. Preliminary analysis indicates that circadian manipulations alone may be sufficient to reduce sleep problems in children with RGND, though in some cases, function-based interventions were also required. The implications of these findings for clinical practice and research will be discussed.