Behavioral treatment of bedtime problems and night wakings in infants and young children.
This paper reviews the evidence regarding the efficacy of behavioral treatments for bedtime problems and night wakings in young children. It is based on a review of 52 treatment studies by a task force appointed by the American Academy of Sleep Medicine to develop practice parameters on behavioral treatments for the clinical management of bedtime problems and night wakings in young children. The findings indicate that behavioral therapies produce reliable and durable changes. Across all studies, 94% report that behavioral interventions were efficacious, with over 80% of children treated demonstrating clinically significant improvement that was maintained for 3 to 6 months. In particular, empirical evidence from controlled group studies utilizing Sackett criteria for evidence-based treatment provides strong support for unmodified extinction and preventive parent education. In addition, support is provided for graduated extinction, bedtime fading/positive routines, and scheduled awakenings. Additional research is needed to examine delivery methods of treatment, longer-term efficacy, and the role of pharmacological agents. Furthermore, pediatric sleep researchers are strongly encouraged to develop standardized diagnostic criteria and more objective measures, and to come to a consensus on critical outcome variables.
Mindell
Jodi A
JA
Department of Psychology, Saint Joseph's University, 5600 City Avenue, Philadelphia, PA 19131, USA. jmindell@sju.edu
Kuhn
Brett
B
Lewin
Daniel S
DS
Meltzer
Lisa J
LJ
Sadeh
Avi
A
D001521:Behavior Therapy / Q000379:methods*; D002648:Child; D002675:Child, Preschool; D039563:Histamine H1 Antagonists, Non-Sedating / Q000627:therapeutic use; D006801:Humans; D007223:Infant; D010290:Parents / Q000193:education; D015995:Prevalence; D020178:Sleep Disorders, Circadian Rhythm / Q000188:drug therapy / Q000453:epidemiology / Q000628:therapy*; D007319:Sleep Initiation and Maintenance Disorders / Q000188:drug therapy / Q000453:epidemiology / Q000628:therapy*; D014291:Trimeprazine / Q000627:therapeutic use; D014851:Wakefulness
D039563:Histamine H1 Antagonists, Non-Sedating; D014291:Trimeprazine