Applied behavior analysis measurement, assessment, and treatment of sleep and sleep-related problems

Behavioral Treatment of Sleep Problems using Wake-Time Fading with Individuals with Autism: A Brief Report

Difficulties with sleep, such as delayed onset, night waking, and early waking, are pervasive among individuals with developmental disabilities and autism. Interventions that seek to improve sleep outcomes are particularly useful when these individuals have experienced extended hospitalizations where low activity levels and decreased exposure to light-dark cycles maintain or increase disturbance in sleep patterns. The current study examines the effects of wake-time phase advances on the sleep patterns of a 16-year-old male and 17-year-old female, both of whom presented with significant sleep disturbance, autism, developmental delays, and severe problem behavior in a hospital-based setting. For both individuals, clinically significant increases in appropriate sleep and decreases in latency to sleep were observed throughout the course of their admission as a result of wake-time phase advances. Together, these results replicate and extend limited research in this area by using behavioral interventions to decrease disrupted sleep in inpatient contexts.

Parent-Mediated Home Intervention for Delayed Sleep-Onset and Night Waking in a Child With Autism Spectrum Disorder

We report the case of a 10-year-old boy with autism spectrum disorder who had difficulty initiating and maintaining sleep. Through home consultation, his parents were trained to implement a multicomponent sleep intervention that included (a) faded bedtime, (b) regimented pre-bedtime routines, and (c) elimination of positive social consequences contingent on sleep problems including unwanted co-sleeping. A critical element in the case was functional assessment of the conditions associated with poor sleeping and matching intervention to parent preferences. Compared to a baseline phase, intervention reduced night waking frequency and duration as well as the time required for the boy to fall asleep. Follow-up results one and 2 months post-intervention documented sustained improvement.

Behavioral assessment and faded bedtime intervention for delayed sleep-onset in an adult with autism spectrum disorder

Faded bedtime has been evaluated as a behavioral intervention for delayed sleep-onset principally with children and youth who have intellectual and developmental disabilities in hospital and home settings. The present case report describes behavioral assessment and faded bedtime intervention in a 21-year old adult man with autism spectrum disorder at a community-based group home. The study also documented the effects of family home visits on the man's sleep when he returned to the group home. Compared to a pre-intervention (baseline) phase, faded bedtime was associated with increased intervals of recorded sleep and a decrease in sleep-onset latency over several months of implementation. We discuss clinical implications of the case and generality of findings across populations and settings.