Promoting Independent Sleep Onset in Young Children: Examination of the Excuse Me Drill

Common Issues for General Practitioners in the Medical Management of Child and Adolescent Psychiatric Care

With a limited number of child and adolescent psychiatrists available to see youth patients, many common psychiatric problems in youth are managed by other providers. Clinical pearls from experts in child and adolescent psychiatry can help general practitioners with this management. Some common issues are discussed here for which practical guidance is offered, ranging from approaches to assessment and how to start and titrate medications for the treatment of attention deficit hyperactivity disorder, depression, and sleep problems.

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.