Developing Independent Sleep Initiation Skills and Decreasing Night Wakings: A Case Study
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Transcript of Developing Independent Sleep Initiation Skills and Decreasing Night Wakings: A Case Study
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Developing Independent Sleep Developing Independent Sleep Initiation Skills and Decreasing Initiation Skills and Decreasing
Night Wakings: Night Wakings: A Case StudyA Case Study
Holly J. ZumpfeHolly J. Zumpfe
Munroe-Meyer Institute Munroe-Meyer Institute
12-19-0312-19-03
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Pediatric Sleep ClinicPediatric Sleep Clinic
Brett Kuhn, Ph.D. DirectorBrett Kuhn, Ph.D. DirectorTreat common sleep problemsTreat common sleep problems– Bedtime ResistanceBedtime Resistance– BedwettingBedwetting– NightmaresNightmares– Night-time fearsNight-time fears– Night-time wakingNight-time waking– Sleep Terrors/Sleep WalkingSleep Terrors/Sleep Walking– Sleep-Wake Schedule problemsSleep-Wake Schedule problems– Compliance for medical Compliance for medical
proceduresprocedures
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The 2-Second A to ZZZZ’sThe 2-Second A to ZZZZ’s
20 to 30% of Children experience sleep 20 to 30% of Children experience sleep disturbancesdisturbances
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The ClientThe Client
11 year old female 11 year old female Mild Mental RetardationMild Mental RetardationMedicationsMedications– MethylphenidateMethylphenidate– ClonidineClonidine
Referral Concern: Referral Concern: – Requires parental presence to initiate and Requires parental presence to initiate and
reinitiate sleepreinitiate sleep– Experiences night time awakeningsExperiences night time awakenings
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Assessment of Sleep ProblemsAssessment of Sleep Problems4 Major Areas4 Major Areas
Bedroom EnvironmentBedroom Environment Sleep ScheduleSleep Schedule
Daytime BehaviorDaytime Behavior Independent Sleep Independent Sleep Onset SkillsOnset Skills
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Client assessmentClient assessmentMeasures for pre-treatment packetMeasures for pre-treatment packet– Background Information FormBackground Information Form– Sleep Disturbances Scale for Children (Bruni et Sleep Disturbances Scale for Children (Bruni et
al., 1996)al., 1996)– Parenting Stress Index-Short Form Parenting Stress Index-Short Form
(Psychological Assessment Resources, 1995)(Psychological Assessment Resources, 1995)– Pre-Treatment Sleep DiaryPre-Treatment Sleep Diary– Sutter-Eyberg Child Behavior InventorySutter-Eyberg Child Behavior Inventory– Child Behavior ChecklistChild Behavior Checklist
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Results of Pre-Treatment DataResults of Pre-Treatment Data
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Changes in Total Sleep Time
0
2
4
6
8
10
121 5 9 13 17 21 25 29 33 37 41
Nights
Ho
urs
TST
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3 Phases of Data Collection3 Phases of Data Collection
Baseline (TST=7.77 hours/night)Baseline (TST=7.77 hours/night)
Behavior Intervention (TST= 9.06 Behavior Intervention (TST= 9.06 hours/night)hours/night)
Elimination of Clonidine (TST= 7.57 Elimination of Clonidine (TST= 7.57 hours/night)hours/night)
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Changes in Night Wakings
0
1
2
3
4
5
1 6 11 16 21 26 31 36 41
Nights
Nu
mb
er
of
Wa
kin
gs
Night-wakings
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ResultsResults
BaselineBaseline Behavior Behavior InterventionIntervention
Discontinue Discontinue Clonidine Clonidine
TSTTST 7.777.77 9.069.06 7.577.57
TIBTIB 8.778.77 9.699.69 8.468.46
Sleep Sleep EfficiencyEfficiency
88%88% 94%94%
WakingsWakings 1.21.2 00 00
LatencyLatency
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Sample Data sheetsSample Data sheets
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Why collectedWhy collected
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Any Problems with dataAny Problems with data
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How were used to make clinical How were used to make clinical decision?decision?
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Previous ResearchPrevious Research
Empirical basis for treatmentEmpirical basis for treatment
Research studies to support our treatmentResearch studies to support our treatment
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TreatmentTreatment
Steps involvedSteps involved
Tx integrityTx integrity
If changes made, how used to make If changes made, how used to make changeschanges
Problems encountered in implementationProblems encountered in implementation
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EvaluationEvaluation
How were outcomes empirically verify?How were outcomes empirically verify?
Question/problems colleagues should Question/problems colleagues should considerconsider