Clinical Handbook of Behavioral Sleep Treatment in Children on the Autism Spectrum

This handbook provides an overview of the nature, prevalence, and causes of sleep problems in children with autism spectrum disorder (ASD) and examines the process of using functional behavior assessment (FBA) to treat sleep disorders. It describes several evidence-based treatments and explores how these align with the outcomes of the FBA process, including case illustrations of the assessment and treatment process. The handbook discusses the application of FBA in family contexts, including:* The effects on children and families of successful interventions with sleep. * How to conduct FBA with clinically complex families. * Including the child in the intervention. * The evidence of efficacy of other treatment approaches. The handbook addresses sleep problems that are highly prevalent among children and young people with ASD, including sleep onset delay, frequent and prolonged night waking, and unwanted co-sleeping. It explores the profound secondary effects that sleep problems may have on children’s daytime functioning as well as child and parent health and wellbeing. The handbook discusses the causes of sleep problems in individuals with ASD, which may be multifaceted and complex and include physiological, environmental, cognitive etiologies yet almost always have a behavioral or learned component. It examines how FBA can be used to characterize challenging behaviors and identify the antecedents (e.g., environmental context) and consequences that affect such behaviors. The volume details the process of using FBA to assess and treat sleep problems in children with ASD. Clinical Handbook of Behavioural Sleep Treatment in Autism is a must-have resource for clinicians, therapists, and other practitioners as well as researchers and graduate students in clinical child and school psychology, behavioral therapy, social work, public health, developmental psychology, pediatrics, family studies, and child and adolescent psychiatry. Preface Acknowledgments Contents Part I: Professional Knowledge and Resources Needed to Work with Families 1: An Overview of Autism Spectrum Disorder, Sleep Problems, and Their Associations What Is Autism Spectrum Disorder? Co-occurring Conditions in Autism Sleep Difficulties in Autism Sleep Difficulties and Their Association with Other Co-occurring Conditions Impact on Families Treatment of Sleep Problems Collateral Benefits of Behavioral Sleep Intervention Conclusions References 2: Including Parents of Children with Autism and Sleep Problems as Co-therapists: A Guide to Assessment and the Guided Participation Model Therapist Background and Skills Working with Parents to Change Sleep Problems in Children on the Autism Spectrum: Drawing on the Guided Participation Model Forming a Collaborative Therapeutic Relationship Information Gathered from and Given to Families Information Obtained from the Family Assessing Parent Attitudes and Attributions Information Given to the Family Functional Behavior Assessment of Parent Behavior: Supporting Adherence Conclusion References 3: Intervening in Cases with Clinical Complexity Multifaceted Family Presentation of Children on the Autism Spectrum What Is Case Complexity? Complexity Factors and Sleep Presentation Complexity Factors as Predictors of Treatment Outcome Case Complexity, the Complexity Hypothesis and Treatment Outcome Complexity as a Predictor of Sleep Treatment Outcome in Children on the Autism Spectrum: The Good Nights Data Assessment of Complexity and Modification of Programs Case Example 1 Case Example Ben References 4: Direct and Indirect Sleep Assessment in Children with Autism Spectrum Disorder Introduction Screening Clinical Interview/Sleep History Objective Sleep Assessment Polysomnography Home Sleep Studies Multiple Sleep Latency Test (MSLT) Laboratory Tests Videosomnography Actigraphy Subjective Sleep Assessment Sleep Diary Standardized Rating Scales and Questionnaires Summary References 5: A Conceptual Framework for Understanding and Designing Behavioral Interventions for Sleep Problems in Children on the Autism Spectrum A Behavioral Model of Sleep Disturbance, Problems and Difficulties Historic Foundations of the Behavioral Model Key Assumptions of the Behavioral Model Implications of the Model for Treatment Planning Interventions During the Pre-bed and Initial Falling Asleep Period Interventions for Night Waking Interventions for Early Morning Waking Autism Spectrum Disorder: Implications for Behavioral Case Formulation and Treatment Conclusion References Part II: Overview of FBA and Treatment Processes 6: Functional Behavior Assessment of Sleep Problems in Children on the Autism Spectrum Introduction Functional Behavior Assessment Rationale for Conducting a FBA of Sleep Problems Conducting a FBA of Sleep Problems Understanding the History and Broader Context of the Sleep Problem Determining the Nature and Severity of the Sleep Problem(s) Objectively Defining the Sleep Problem Data Collection and Analysis of Antecedents and Consequences Indirect Measures Direct Assessment of the Sleep Problem Functional Analysis of Sleep Problems Developing a Hypothesis About the Function(s) of a Behavior Summary and Conclusion Case Example 1: Sophie Case Example 2: Ned References 7: Function-Based Interventions for Sleep Problems in Children on the Autism Spectrum Introduction Function-Based Interventions Using FBA Results to Design Function-Based Interventions Designing Function-Based Interventions Document Intervention Goals and Operationalize the Target Behavior Select Antecedent-Based Strategies Reducing Motivation to Engage in Sleep Problem Behavior Select Consequence-Based Modifications Select Replacement Behaviors to Be Taught Comprehensive Function-Based Interventions Implement Program and Monitor and Evaluate Progress Safety Plan Programming for Generalization and Maintenance Over Time Conclusion Case Example 1: Fergus Case Example 2: Cooper References Part III: Antecedent Interventions 8: Antecedent Factors: The Role of Stimulus Control and Motivational Variables in the Treatment of Sleep Problems in Children on the Autism Spectrum Stimulus Control and Discriminative Stimuli for Sleep Motivational Variables: Sleep Pressure and Motivational State Competition Functional Behavior Assessment of Antecedent Factors in Sleep Problems Antecedent Interventions: Stimulus Substitution Antecedent Interventions: Motivation Manipulation Evidence for Stimulus Control and Motivation Manipulation Procedures in the Sleep Literature Case Examples Case Example 1: Andy Case Example 2: Polly Case Discussion Conclusion References 9: Sleep Hygiene and Related Interventions: Their Impact on Sleep Recommendations About Sleep Hygiene and Related Interventions Daytime Activities Evening Activities Effective Implementation for Individuals on the Autism Spectrum Conclusion Case Studies References 10: Bedtime Fading and Bedtime Fading with Response Cost Sleep Needs and Expectations Sleep Hygiene and Bedtime Routines Faded Bedtimes Without Response Cost Procedures Step 1: Establishing Sleep Baselines Step 2: Beginning the Bedtime Routine Step 3: Starting the Faded Bedtime Step 4 (Asleep): Faded Bedtime Without Response Cost 15 min Sleep Onset Latency Check Step 4 (Awake): Faded Bedtime Without Response Cost 15 min Sleep Onset Latency Check Step 5: Faded Bedtime Without Response Cost Intervention Pattern Over Multiple Nights An Example of a Faded Bedtime Without Response Cost Procedure Faded Bedtimes with Response Cost Procedures Step 1: Sleep Baselines and Sleep Hygiene Bedtime Routines Step 2 (Asleep): Faded Bedtime with Response Cost 15 min Sleep Onset Latency Check Step 2 (Awake): Faded Bedtime with Response Cost 15 min Sleep Onset Latency Check Step 3: Faded Bedtime with Response Cost Intervention Pattern Over Multiple Nights Example Faded Bedtime with Response Cost Procedure The Effectiveness of Faded Bedtimes with and Without Response Cost Conclusion References 11: Self-Modeling: Falling Asleep Following a Picture-Based Plan Falling Asleep Following a Picture-Based Plan Bedtime Routines Taught with Video Essential Steps in the Creation of the Video or Storybook Using Videos and/or Social Stories Therapeutically Child Cooperation Self-Modeling References Part IV: Treatment of Sleep Problems in Children on the Autism Spectrum: Consequence-Based Interventions 12: The Role of Reinforcement in the Treatment of Sleep Problems Reinforcement Reinforcement-Based Sleep Intervention Forms of Reinforcement General Guidelines for Effective Reinforcement Reinforcement of Sleep-Conducive Behavior Differential Reinforcement Reinforcement for Using Sleep-Conducive Strategies Scheduled Access to Reinforcement Challenges in Use of Reinforcement in Sleep Intervention Reinforcement in the Treatment of Excessive Daytime Sleepiness Visual Systems to Support the Use of Reinforcers Token Systems of Reinforcement Parent Education Conclusion Case Example 1: Lucas Case Example 2: Anna References 13: Behavioral Extinction as a Treatment for Sleep Problems in Children on the Autism Spectrum Introduction Theory, Principles, and Terminology Extinction as a Treatment for Sleep Problems: The Research Evidence The Negative Side-Effects of Extinction Modified Procedures for Implementing Extinction How to Select Extinction Procedures Additional Considerations Summary and Conclusion Case Example 1: Bernard Case Example 2: Holly References 14: The Assessment and Treatment of Stereotypy in the Sleep Context Introduction Definition of Stereotypy and Its Underlying Functions The Relationship Between Stereotypy and Sleep Disturbance Assessment of Stereotypy Treatment of Stereotypic Behavior in Children on the Autism Spectrum Antecedent Interventions Consequence and Multicomponent Interventions Treatment of Sleep-Interfering Stereotypic Behavior Case Example: Emma Conclusion References Part V: Other Aspects of Treatment 15: The Treatment of Sleep Problems Using Melatonin Rationale for Melatonin as a Treatment for Sleep Problems in Children on the Autism Spectrum The Role of Melatonin in Sleep/Wake Regulation Melatonin and Autism Evidence for Melatonin as a Treatment for Sleep Problems in Children on the Autism Spectrum Research Evidence Considerations, Limitations, and Contraindication for Melatonin Treatment Approach to Melatonin as a Treatment for Sleep Problems in Children on the Autism Spectrum Guiding Principles for Parents Conclusion References 16: Unconventional Approaches to Enhancing Sleep in Children on the Autism Spectrum Methods Literature Searching Inclusion and Exclusion Criteria Data Extraction Certainty of the Evidence: Process Results Certainty of the Evidence: Outcome Participants Design, Dependent Variables, and Outcome Measures Acupressure and Acupuncture Aromatherapy Diet Dietary Supplements Exercise Massage Sound-Generating Sleep Technology Weighted Blankets Discussion References 17: Including Children and Adolescents on the Autism Spectrum in the Treatment of Sleep Disturbance Introduction Including Young People in Psychological Therapy Sleep Treatment Techniques Able to Be Modified for Young People on the Autism Spectrum Psychoeducation Cognitive Therapy Mindfulness Imagery Motivational Interviewing Comfort Items Bibliotherapy Bedtime Routine Stimulus Control Relaxation Exposure Therapy Bedtime Pass Reinforcement Overcoming Autism Symptomatology as a Barrier to Treatment Assessment and Treatment of Sleep in Young People on the Autism Spectrum Assessment Treatment Case Examples Conclusion References 18: Does This Treatment Work? Will It Benefit My Child?: Tools for Evaluating Interventions for Sleep Problems in Children on the Autism Spectrum Background Single Case Research Design and Data Analysis Common Sleep Problems and Their Measurement The Initial Phase of Therapy Planning The Logic, Procedures, and Data Analysis of Single Case Research Effect Size Measures for Single Case Designs Some Additional Research Quality Issues Challenges in Implementing and Evaluating FBA-Informed Treatments for Sleep Problems in Children on the Autism Spectrum Conclusion References Index