Author: Roane, H.S., Piazza, C.C., Bodnar, L.E. & Zimmerman, K.L.
Source: Infants & Young Children, 2000; Vol. 13, No.2, pp. 1-8
This article is primarily a review of current literature on the prevalence, assessment and treatment of sleep disturbances in children with developmental disabilities. Research indicates that in general, children with developmental disabilities sleep less and have more sleep-related problems than do their typically developing peers. Sleep disturbances may include such things as difficulty settling, nighttime wakings, early wakings, excessive day sleep and inappropriate sleep/wake cycles. Results of sleep problems include increased psychological stress, both for the child and the caregiver, and impaired cognitive functioning. Some studies also show that sleep deprivation may be connected with an increased likelihood of destructive behavior. Though there are a number of hypotheses about the cause of sleep difficulties in children with developmental disabilities, the actual cause or causes remain unclear.
This article describes several methods of assessment, including interviews, behavioral rating scales, sleep diaries, direct observation of sleep behaviors, and measurement of brain activity (EEG) or motor activity (EMG). Advantages and disadvantages of each method are discussed, and clinicians are urged to assess carefully not only the child, and the child's motivations for any inappropriate behaviors, but also contextual and environmental issues, such as nighttime routines, toys or objects available in the room, presence of other people in the room at bedtime, etc.
Review of treatment literature in the article focuses on commonly used approaches, most of which are behavioral. Those reviewed included extinction, sleep scheduling, bedtime fading, positive routines, chronotherapy and the use of melatonin. The advantages and disadvantages of each of these treatment approaches are addressed, as are research outcomes. As with assessment, clinicians are urged to take a functional approach to designing treatment, taking into account caregiver and environmental factors, as well as recognition of the difficulty of implementing some of these interventions.
This article provides a concise, readable review of the literature on this topic, and takes a holistic, functional approach to this difficult issue. There is a good list of references for those who want to look at original sources and read direct research reports. Unfortunately, there is little identifying information about the authors other than their names, and the fact that two of them (at least) work for the Marcus Behavior Center in Atlanta, Georgia.
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