Multicomponent treatment for child insomnia and its effects on patterns, habits and sleeping routines
DOI:
https://doi.org/10.15448/1980-8623.2020.4.34034Keywords:
sleep, children, bedtime routine, behavioral interventionAbstract
Sleep problems are common in childhood and are associated with behavioral problems. The aim of this study was to evaluate the effect of a multicomponent treatment for childhood insomnia on children’s patterns, routine and sleep habits. 57 children with behavioral problems related to sleep and their mothers participated. The mothers were educated on their child’s sleep, received guidance on the establishment of sleeping schedules and routines and on the use of extinction and positive reinforcement techniques. The data were evaluated before and after the intervention by sleep diaries and by the Escala UNESP de Hábitos e Higiene do Sono – Versão Crianças. Our results showed that children with sleep problems mostly present inadequate habits and routines before bedtime and that an intervention that focused on changing these habits, added to extinction strategies for inappropriate behaviors and positive reinforcement for adequate behaviors at bedtime may have contributed to improved sleep. It is hoped that this work can stimulate the production of national research on the subject, serving as an incentive for the development of preventive and interventional measures for childhood sleep problems.
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References
American Academy of Sleep Medicine. (2005). International classification of sleep disorders: diagnostic and coding manual (2 ed.). Westchester, IL: American Academy of Sleep Medicine.
Adams, L. A. & Rickert, V. I. (1989). Reducing bedtime tantrums: Comparison between Positive routines and Graduated Extinction. Pediatrics, 84(1), 756-761. (Doi inexistente).
Allen, S.L., Howlett, M.D., Coulombe, J.A., & Corkum, P.V. (2016). ABCs of SLEEPING: A review of the evidence behind pediatric sleep practice recommendations. Sleep Medicine Reviews, 29(1), 1-14. doi: 10.1016/j.smrv.2015.08.006.
Blunden, S. (2011). Behavioural treatments to encourage solo sleeping in pre-school children: an alternative to controlled crying. Journal of Child Health Care, 15, 107-117.
Bolinger, E., Born, J., & Zinke, K. (2018). Sleep divergently affects cognitive and automatic emotional response in children. Neuropsychologia, 117(1), 84–91. doi:10.1016/j.neuropsychologia.2018.05.015
Brambilla, P., Giussani, M., Pasinato, A., Venturelli, L., Privitera, F., … Chiappini, E. (2017). Sleep habits and pattern in 1-14 years old children and relationship with video devices use and evening and night child activities. Italian Journal of Pediatrics, 43(1). doi:10.1186/s13052-016-0324-x
Chaput, J. P., Gray, C. E., Poitras, V. J., Carson, V., Gruber, R., Birken, C. S., et al. (2017). Systematic review of the relationships between sleep duration and health indicators in the early years (0-4 years). BMC Public Health, 17(5), 855. doi: 10.1186/s12889-017-4850-2
Cohen, J. (1988). Statistical power analysis for the Behavioral Sciences. Hilsdale: Erlbaum.
Crabtree, V. M., Korhonenb, J. B., Montgomery-Downs, H. E., Jones, V. F., O’Brien, L. M. & Gozala, D. (2005). Cultural influences on the bedtime behaviors of young children. Sleep Medicine, 6(1), 319-324. doi: 10.1016/j.sleep.2005.02.001
Didden, R., Sigafoos, J. & Lancioni, G.E. (2011). Unmodified Extinction for Childhood Sleep Disturbance. In: M. Perlis, M. Aloia & B. Kuhn (Orgs.). Behavioral Treatments for Sleep Disorders: A Comprehensive Primer of Behavioral Sleep Medicine Interventions. (pp. 257-263). London: Elsevier. (Doi inexistente).
Durand, V. M. (2008). When Children Don’t Sleep Well. University Press, Oxford. (Doi inexistente).
Ferber, R. (2006). Solve your child’s sleep problems. New York: Fireside Edition. (Doi inexistente).
Gruber, R., Carrey, N., Weiss, S. K., Frappier, J. Y., Rourke, L., Brouillette, R. T., et al. (2014). Position statement on pediatric sleep for psychiatrists. J Can Acad Child Adolesc Psychiatry, 23(3), 174-195. (Doi inexistente).
Hill, C. (2011). Practitioner Review: Effective treatment of behavioural insomnia in children, Journal of Child Psychology and Psychiatry, 52(7), 731-741.
Hirshkowitz, M., Whiton, K., Albert, S. M., Alessi, C., Bruni, O., DonCarlos, L., et al. (2015). National Sleep Foundation's sleep time duration recommendations: methodology and results summary. Sleep Health, 1(1), 40-43. doi: 10.1016/j.sleh.2014.12.010
Iglowstein, I., Jenni, O. G., Molinari, L. & Largo, R. H. (2003). Sleep Duration From Infancy to Adolescence: Reference Values and Generational Trends. Pediatrics, 111(2), 302-307. (Doi inexistente).
Khan, M.K.A., Chu, Y.L., Kirk, S.F.L., & Veugelers, P.J. (2015). Are sleep duration and sleep quality associated with diet quality, physical activity, and body weight status? A population-based study of Canadian children. Can J Public Helath. 106(5):E277-82. doi: 10.17269/cjph.106.4892.
Kuhn, B. R. (2011). Behavioral Protocol to Promote Independent Sleep Initiation Skills and Reduce Bedtime Problems in Young Children. In: M. Perlis, M. Aloia & B. Kuhn (Orgs). Behavioral Treatments for Sleep Disorders: A Comprehensive Primer of Behavioral Sleep Medicine Interventions. (pp. 299-309). London: Elsevier. (Doi inexistente).
Meltzer, L. J. & Mindell, J. A. (2011). Graduated Extinction: Behavioral Treatment for Bedtime Problems and Night Wakings in Young Children. In M. Perlis, M. Aloia & B. Kuhn. (Orgs). Behavioral Treatments for Sleep Disorders: A Comprehensive Primer of Behavioral Sleep Medicine Interventions. (pp. 265-273). London: Elsevier. (Doi inexistente).
Meltzer, L. J. & Mindell, J. A. (2014). Systematic Review and Meta-Analysis of Behavioral Interventions for Pediatric Insomnia. Journal of Pediatric Psychology, 39(8), 932-948. doi: 10.1093/jpepsy/jsu041.
Mindell, J. A., Kuhn, B., Lewin, D. S., Meltzer, L. J. & Sadeh, A. (2006). Behavioral treatment of bedtime problems and night wakings in infants and young children – an American academy of sleep medicine review. Sleep, 29(1), 1263–76. (Doi inexistente).
Mindell, J. A., Meltzer, L. J., Carskadon, M. A. & Chervin, R. D. (2009). Developmental aspects of sleep hygiene: Findings from the 2004 National Sleep Foundation Sleep in America Poll. Sleep Medicine, 10(1), 771-779. doi: 10.1016/j.sleep.2008.07.016.
Mindell, J. A. & Moore, M. (2014). Bedtime Problems and Night Wakings. In: S.H. Sheldon, R. Ferber, M.H. Kryger & D. Gozal (Orgs). Principles & Practice of Pediatric Sleep Medicine. (pp. 105-110). London: Elsevier. (Doi inexistente).
Mindell, J. A., Mond, C. E., Sadeh, A., Telofski, L., Kulkarni, N. & Gunn, E. (2011). Efficacy of an Internet-Based Intervention for Infant and Toddler Sleep Disturbances. Sleep, 34(4), 451-458. (Doi inexistente).
Mindell, J. A., Sadeh, A., Kohyama, J. & How, T.H. (2010). Parental behaviors and sleep outcomes in infants and toddlers: A cross-cultural comparison. Sleep Medicine, 11(1), 393-399. doi: 10.1016/j.sleep.2009.11.011.
Mindell, J. A., Telofski, L. S., Wiegand, B. & Kurtz, E. S. (2009). A Nightly Bedtime Routine: Impact on Sleep in Young Children and Maternal Mood. Sleep, 32(5), 599-606. (Doi inexistente).
Mistry, K. B., Minkovitz, C. S., Strobino, D. M. & Borzekowski, D. L. G. (2007). Children's Television Exposure and Behavioral and Social Outcomes at 5.5 Years: Does Timing of Exposure Matter? Pediatrics, 120(4), 762-769. doi: 10.1542/peds.2006-3573
Moreira, G.A, & Pradella-Hallinan, M. (2017). Sleepiness in Children: An Update. Sleep Medicine Clinic, 12(3), 407-413. doi: 10.1016/j.jsmc.2017.03.013. Epub 2017 May 23.
Foundation National Sleep. (2016). How much sleep do we really need? https://www.sleepfoundation.org/how-sleep-works/how-much-sleep-do-we-really-need. Accessed 19 out 2018.
Owens, J. A. (2007). Classification and epidemiology of childhood sleep disorders. Sleep Medicine Clinics, 2(1), 353-361. doi: 10.1016/j.pop.2008.06.003.
Pires, M. L. N., Vilela, C. B. & Câmara, R. L. (2012). Desenvolvimento de uma medida de hábitos de sono e aspectos da prevalência de problemas comportamentais de sono na infância: uma contribuição. In N. S. Filho, D. P. S. A. Ribeiro & H. R. Rosa (Orgs.). Processos Clínicos e Saúde Mental. (pp. 167-192). São Paulo: Cultura Acadêmica Editora & Vetor Editora. (Doi inexistente).
Rafihi-Ferreira, R.R., Pires, M.L.N., & Silvares, E.F.M. (2019). Behavioral intervention for sleep problems in childhood: a Brazilian randomized controlled trial. Psicologia: Reflexão e Crítica, 32(5), doi: https://doi.org/10.1186/s41155-019-0118-3
Rafihi-Ferreira, R., Silvares, E. F. M., Pires, M. L. N., Assumpção-Jr, F. B. &Moura, C. B. (2016). Sono e Comportamento em Crianças Atendidas em um Serviço de Psicologia. Psicologia: Teoria e Prática, 18(1), 159-172. doi: 10.15348/1980-6906
Reid, G. J. Huntley, E. D. & Lewin, D. S. (2009). Insomnias of Childhood and Adolescence. Child and Adolescent Psychiatric Clinics of North America, 18(1), 979-1000. doi: 10.1016/j.chc.2009.06.002.
Sadeh, A. Tikotzky, L. & Scher, A. (2010). Parenting and infant sleep. Sleep Medicine Reviews, 14(1), 89-96. doi: 10.1016/j.smrv.2009.05.003.
Salti, R., Tarquini, R., Stagi, S., Perfetto, F., Cornélissen, G., Laffi, G., Mazzoccoli, G. & Halberg, F. (2006). Age-dependent association of exposure to television screen with children's urinary melatonin excretion? Neuroendocrinology Letters, 27(1), 73-80. (Doi inexistente).
Scharf, R. J., Demmer, R. T., Silver, E. J., & Stein, R. E. (2013). Nighttime sleep duration and externalizing behaviors of preschool children. J Dev Behav Pediatr, 34(6), 384-391. doi:10.1097/DBP.0b013e31829a7a0d
Sheldon, S. H. (2014). Development of Sleep in Infants and Children. In: S. H. Sheldon, R. Ferber, M.H. Kryger & D. Gozal. (Orgs). Principles & Practice of Pediatric Sleep Medicine. (pp. 17-24). London: Elsevier. (Doi inexistente).
Short, M. A., Blunden, S., Rigney, G., Matricciani, L., Coussens, S., M. Reynolds, C., & Galland, B. (2018). Cognition and objectively measured sleep duration in children: a systematic review and meta-analysis. Sleep Health, 4(3), 292–300. https://doi.org/10.1016/j.sleh.2018.02.004
Thomas, J. H., Moore, M., & Mindell, J. A. (2014). Controversies in Behavioral Treatment of Sleep Problems in Young Children. Sleep Medicine Clinic, 9, 251-259. https://doi.org/10.1016/j.jsmc.2014.02.004
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