The behavioural treatment of sleep difficulties in children with an intellectual disability

Reinforcement, instruction giving, partner support strategies, bedtime routine, and standard extinction were taught to the parents of three boys (aged 5-10 years) with an intellectual disability and sleeping difficulties. Sleep was measured using sleep diaries and actigraphy, and daytime behaviour was monitored using diaries and direct observation. At referral, all children needed a parent present to fall asleep, two had co-sleeping difficulties, and two had night waking difficulties. At post-intervention, all children were falling asleep independently, co-sleeping was eliminated for two children, and night waking was reduced in one child. An extinction burst was experienced by two children, with one family putting their child back to bed 259 times on the first night. Though one child still had night waking difficulties following intervention, actigraph recording demonstrated an improvement in his sleep quality. In addition to the children's independence, improvements were seen for sleep length, sleep latency, and morning wake time. However, improvements in daytime behaviour showed inconsistency across behaviours and settings. Improvement in sleep was maintained at a three month follow-up. It was concluded that using extinction to address sleep problems in children with an intellectual disability is effective and approved of by parents, but any impact on daytime behaviour is equivocal. Copyright (C) 2002 John Wiley Sons, Ltd.