Summary of Evidence- Educational & Behavioral Strategies for Children with Disabilities with Sleep Problems 1.

Transcription

1 Summary of Evidence- Educational & Behavioral Strategies for Children with Disabilities with Sleep Problems 1. Author, Date Population Design Intervention Results Bartlett & Beaumont 1998 Bramble, 1997 Durand & Mindell Montgomery, et al 2004 Reed et al.2009 Stores & Stores, w/ several different disabilities including CP, SLD, Down s syndrome Ages 11 mo w/ several different disabilities including Angelman syndrome, SLD, Down s syndrome Ages 11 mo w/ ASD 66 SLD, ASD, Down s syndrome, global developmental delay, epilepsy Ages w/ ASD Ages 3-10 yrs 46 w/ Down s Syndrome Age 7 mo. - Multiple baseline design al s including extinction, positive reinforcement, graded change Multi- component Extinction Standard tx. Protocol included stimulus control, cueing and rapid extinction techniques Scheduled awakenings- waking child 30 min. prior to an expected sleep terror episode Multicomponent- Graduated extinction Two tx groups (1)face- to- face and (2) booklet with information on gradual extinction and reinforcement Three 2 hr. session conducted over 3 weeks. Providing both general information and addressing individual sleep concerns 90 minute instructional group Sleep behaviors improved Mother s psychological stress decreased Improvements in night settling and night- waking patterns occurred within a few days and were maintained at follow- up Children s daytime behavior improved Mothers reported improved sleep quality and reduced stress Reduced the frequency of night terrors in all 3 Effects similar in two tx groups with both groups demonstrating fewer sleep problems than control groups at post-. Tx effects maintained at 6 month followup Sleep behaviors, sleep hygiene, sleep- wake patterns significantly improved Hyperactivity, self- stimulatory and restricted behaviors improved Parent stress related to ease in establishing a sleeping or eating schedule improved significantly Improvement in behavioral sleep problems reported by mothers at 6- month follow- up Sleep related breathing problems persisted

2 Summary of Evidence- Educational & Behavioral Strategies for Children with Disabilities with Sleep Problems 2. Weiskop et al Wiggs & Stores, 2001 Wolf et al yr9mo session w/ illustrated booklet Mothers in the tx group more knowledgeable on sleep and behavioral principles related to s sleep 5 w/ ASD 5w/ Fragile X syndrome w/out ASD 30 w/ several diagnosis, Down syndrome, ASD CP ASD Concurrent multiple baseline design Single case studies Standard extinction Initial introduction of bedtime routines, rewards & partner support strategies. No improvements until extinction added 6 home visits- discussion of therapeutic techniques such as extinction, graded extinction, positive reinforcement. Progress phone calls Standard extinction Study in inpatient unit of hospital Improvements in night waking, self- settling and co- sleeping maintained at 12 months Benefit to mothers (1) reduced stress, (2) increased perceived control and (3) making them more satisfied with their sleep, their child s sleep and their ability to cope with their child s sleep. Improvement of night waking at 6 months for six Maureen Russell Maureen.russell@asu.edu

3 Summary of Evidence- Melatonin for Children with Disabilities Author, Date Population Design Intervention Results Garstang & Wallis, ASD ages 4-16 IR 5 mg/day 1 hr. bedtime for 4 weeks Shortened sleep latency, decreased night wakenings and increased total sleep time when compared to placebo Wirojanan, et al w/ ASD, 10 w/ fragile X,Ages 2-15 Wright et al Weiss, et al Van det Heijden, et al w/ ASD, Ages ADHD stimulant- treated Ages 105 ADHD medication- free Ages 6-12 Double- blind placebo controlled 30- day placebo controlled trial IR 3mg/day 30 minutes bedtime for 4 weeks IR 2 mg/day adjusted to clinical response up to 10 mg/day during tx. Period min. bedtime for 3 months 5 mg/day 20 minutes bedtime for 10 days 3-6 mg dependent upon body weight for 4 weeks Increase in total sleep time, decrease in sleep latency, no significant differences in numbers of night wakenings. Shorter sleep latency and longer sleep duration under melatonin compared to placebo. No differences in night wakenings, no difference in daytime behavior difficulties and general health of the parents. Decrease in sleep onset latency. More substantial overall decrease in sleep onset latency following 90 days of post- trial open- label melatonin treatment Improved sleep onset, increased total sleep time No adverse events associated with melatonin after mean follow up of 3.7 years. Discontinuation of melatonin in led to relapse of sleep onset insomnia. Improvement in behavior in 71% & mood 61% Coppola et al Total w/ intellectual disability, w/ & w/out epilepsy, 4 w/ Visual impairment Dodge & Wilson, Total with DD, 4 Visual impairment Ages 1-15 Wasdell, et al w/ neurodevelopmental disability Ages 2-18 Ross et al w/ neurodevelopmental disability Ages 1-13 control trial double blind controlled trial and open label follow- up Observational before- after treatment 3-12 mg. 5 mg. vs. placebo for 6 weeks Decrease in sleep latency, no effect on night waking Return to baseline values when melatonin was discontinued Both positive and negative effects seen in those with seizure disorders Decrease in sleep latency in all bit 2 when compared to placebo or baseline. Total sleep time improved in comparison to baseline but not in comparison to placebo, No differences in night wakenings 5 mg. Increase in sleep time and improvement in sleep latency in Sleep efficiency and longest sleep period improved in open label phase 4 mg controlled release, 10 days of tx washout period 1 wk. 74% improvement in sleep- total sleep time, sleep wakening, and sleep latency Maureen Russell Maureen.russell@asu.edu

4 Sleep Diary for Dates: to Mon Tues Wed Thurs Fri Sat Sun Time your child went to bed Activities the last hour before bedtime Activity level prior to bed (1=low to 5= high) Time he/she fell asleep Quality of sleep (1= appeared to sleep well, 5=very restless) # times child woke during the night Reasons for awakenings Mood upon awakening during the night (1=sleepy, 5= excited or agitated) Time your child woke up in the morning Time he/she got out of bed # of hours slept Time of daytime naps # of hours napping Energy level throughout the day (1=lethargic, 5= extremely energetic Time the following were consumed: - Medication - Caffeinated drinks Additional Comments you think would be relevant M. Russell Maureen.russell@asu.edu

5 M. Russell