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Section 5
Behavioral Sleep Treatment for Children

Question 5 | Test | Table of Contents

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In the last section, we discussed a six step psychotherapeutic approach to treating type B night terrors. The six steps I used with Jerry were following sleep guidelines, validating trauma and evaluating family ties, exploring present circumstances, addressing resultant health problems, allowing solitude, and implementing the steps simultaneously.

In this section, let's shift from night terrors to other forms of sleep problems. We will discuss behavioral sleep therapy for children. As you know, when children have difficulty settling and falling asleep alone in their own beds, some parents are faced with conflicts about how to handle these situations. Dr. Richard Ferber, a leader in pediatric sleep medicine has devised a desensitization method for dealing with the problem.

In brief, Dr. Ferber recommends a scheduled progressive approach where the parent waits a specific amount of time before going into the bedroom to comfort the child. The amount of time the parent waits before entering is progressively lengthened until the child learns to fall asleep alone. For the purpose of this course, one method of behavioral sleep therapy for children will be explained in two parts. Behavioral sleep therapy for children consists of initial progression and subsequent progression. As you listen to this section, consider your client or clients if you are treating a couple. 

Could this technique help your client or clients who are trying to cope with sleep difficulties regarding a young child or infant?

2-Part Behavioral Sleep Therapy for Children

♦ Part #1:  Initial Progression
First, let’s discuss initial progression. Pamela and Brad, ages 24 and 27, were the parents of 13 month old Chelsea. Pamela and Brad were referred to me by their family therapist for Chelsea’s sleep problem. Chelsea was typical for a 13 month old child in that she tended to cry when she was put down for a nap. Brad stated, "Whenever Pamela tries to put Chelsea to bed, she cries and cries. We are up with her for half the night sometimes." 

How might you have responded to Brad and Pamela’s problem? Would you agree that Chelsea may have simply been receiving too much attention from her parents? 

To describe the initial progression of behavioral sleep therapy for children, I stated, "The idea is to desensitize Chelsea to the fear of being alone in her own bed by using a tapered separation schedule." Pamela asked, "What type of separation schedule?"  I responded, "For example, on the first day wait five minutes before going into Chelsea’s bedroom if she is crying and cannot sleep.  Comfort Chelsea for two to three minutes and then leave. If more visits are necessary due to continued crying, wait an additional five minutes for each of the next two visits before going into the room. After the third visit, wait at this level, fifteen minutes, before entering for each later visit until Chelsea falls asleep alone."

Brad stated, "Ok, but Chelsea wakes frequently during the night.  What do we do then?"  How might you have responded to Brad?  I stated, "If the child wakes during the night, begin again at the original level for the night, five minutes, and continue increasing time in five minute increments as before." What other information could your clients use to implement the initial progression of behavioral sleep therapy for children?  Perhaps sleeping tips as discussed on the rest of this course may benefit your client.

♦ Part #2:  Subsequent Progression
Next, I discussed subsequent progression with Pamela and Brad. As you know, after establishing behavioral treatments, the client must maintain the new behavior. I stated, "Each day thereafter begin the first waiting period with an increase of five minutes above the previous day’s first level.

"Thus, you will be waiting ten minutes on the second night before you comfort Chelsea. Continue with periodic increases as on the first day until the amount of wait time reaches the previous day’s high level plus the additional five minutes. Continue with gradual increases of five minutes each day for the initial level and for the maximum level for the night." 

Brad asked, "What is the maximum level for the night?"  I responded,  "You may not want to exceed three increases in any one night. If Chelsea continues in a state of wakeful crying until about 6:00 a.m., do not continue the program. Instead, keep the child up for the day."

Would you agree that, like sleep reduction therapy, this behavioral treatment for children could lead to Chelsea becoming accustomed to going to bed without her parent’s coddling and constant attention? Could playing this section benefit clients that you are treating who have a Chelsea? Of course you have eliminated other possible causes for the waking prior to implementing this timed method.

In this section, we discussed behavioral sleep therapy for children. For the purpose of this course, one method of behavioral sleep therapy for children will be explained in two parts. Behavioral sleep therapy for children consists of initial progression and subsequent progression. 

In the next two sections, we will discuss behavioral interventions for insomnia. Four behavioral interventions for insomnia that we will discuss are stimulus control therapy, sleep restriction therapy, relaxation therapies, and cognitive therapy. The focus of the next section will be on the first two interventions, stimulus control therapy and sleep restriction therapy.
Reviewed 2023

Peer-Reviewed Journal Article References:
Astill, R. G., Van der Heijden, K. B., Van IJzendoorn, M. H., & Van Someren, E. J. W. (2012). Sleep, cognition, and behavioral problems in school-age children: A century of research meta-analyzed. Psychological Bulletin, 138(6), 1109–1138.

Byars, K. C., & Simon, S. L. (2016). Behavioral treatment of pediatric sleep disturbance: Ethical considerations for pediatric psychology practice. Clinical Practice in Pediatric Psychology, 4(2), 241–248.

Fehr, K. K., Russ, S. W., & Ievers-Landis, C. E. (2016). Treatment of sleep problems in young children: A case series report of a cognitive–behavioral play intervention. Clinical Practice in Pediatric Psychology, 4(3), 306–317.

Klein, S. B. (2019). The phenomenology of REM-sleep dreaming: The contributions of personal and perspectival ownership, subjective temporality, and episodic memory. Psychology of Consciousness: Theory, Research, and Practice, 6(1), 55–66.

Mathes, J., Weiger, N., Gieselmann, A., & Pietrowsky, R. (2019). The threat simulation in nightmares—Frequency and characteristics of dream threats in frequent nightmare dreamers. Dreaming, 29(4), 310–322.

Miller, K. E., Micol, R. L., Davis, J. L., Cranston, C. C., & Pruiksma, K. E. (2019). Predictors of treatment noninitiation, dropout, and response for cognitive behavioral therapy for trauma nightmares. Psychological Trauma: Theory, Research, Practice, and Policy, 11(1), 122–126.

QUESTION 5
If the child wakes during the night, how should clients respond? To select and enter your answer go to Test.

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