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This study evaluated the effectiveness of Bedtime Fading with Response Cost (BFRC) in decreasing sleep disturbances in children with Autism Spectrum Disorder (ASD) using parents as change agents by implementing treatment in the home environment. A non-concurrent multiple baseline design across three participants was used. Results indicate that BFRC was effective in eliminating unwanted co-sleeping, frequent night awakenings, and dependent sleep onset. Secondary improvements include reducing sleep onset latency, bedtime resistance, and disruptive sleep-related behaviors. Follow-up data demonstrate gains were maintained. Parents reported high satisfaction with BFRC and sleep outcomes for their children. This study extends both the practice and science of parent-implemented behavioral interventions as treatment options for children with ASD and co-occurring sleep disturbances.

The purpose of this investigation was to evaluate the effectiveness of a behavioral treatment package to reduce chronic sleep problems in children with Angelman Syndrome. Participants were five children, 2-11 years-of-age. Parents maintained sleep diaries to record sleep and disruptive nighttime behaviors. Actigraphy was added to provide independent evaluations of sleep-wake activity. The treatment package targeted the sleep environment, the sleep-wake schedule, and parent-child interactions during sleep times. Treatment was introduced sequentially, across families, and evaluated in an interrupted time series, multiple baseline design. Data show that prior to treatment, baseline rates of nighttime disruptive behavior were stable or increasing and none of the participants were falling to sleep independently. With the introduction of treatment, all participants quickly learned to initiate sleep independently. Gradual reductions were reported in disruptive behaviors and these improvements were sustained over time. Results were replicated with two participants when treatment was withdrawn and reinstated. Changes in disruptive bedtime behaviors and in sleep onset were found to be statistically significant. Parents indicated high satisfaction with the treatment. A behavioral treatment package was found to be effective with five children with long histories of significant sleep-related behavior problems. These results suggest that behavioral treatment may be a reasonable way to address sleep problems in some children with Angelman Syndrome. (Contains 2 tables and 2 figures.)

This study estimates the causal effects of six corrective actions for children's problem behaviors, comparing four types of longitudinal analyses that correct for pre-existing differences in a cohort of 1,464 4- and 5-year-olds from Canadian National Longitudinal Survey of Children and Youth (NLSCY) data. Analyses of residualized gain scores found apparently detrimental effects of all corrective actions by parents and professionals on subsequent antisocial behavior and hyperactivity. In contrast, analyses of simple gain scores found only apparently beneficial effects. Temporally reversed analyses yielded the same pattern of results, consistent with selection biases and regression artifacts, not with unidirectional causal effects. The findings were similar for corrective actions by professionals (e.g., Ritalin, psychotherapy) and by parents (physical and nonphysical punishment, scolding/yelling, "hostile-ineffective" parenting). Longitudinal analyses should check for similar artifacts by implementing temporally-reversed analyses and by determining whether causally relevant coefficients would replicate without artifacts biased in their favor. (Contains 3 figures and 2 tables.)

This meta-analysis investigates differences between the effect sizes of physical punishment and alternative disciplinary tactics for child outcomes in 26 qualifying studies. Analyzing differences in effect sizes reduces systematic biases and emphasizes direct comparisons between the disciplinary tactics that parents have to select among. The results indicated that effect sizes significantly favored "conditional" spanking over 10 of 13 alternative disciplinary tactics for reducing child noncompliance or antisocial behavior. "Customary" physical punishment yielded effect sizes equal to alternative tactics, except for one large study favoring physical punishment. Only "overly severe" or "predominant" use of physical punishment compared unfavorably with alternative disciplinary tactics. The discussion highlights the need for better discriminations between effective and counterproductive use of disciplinary punishment in general.

Selection bias can be the most important threat to internal validity in intervention research, but is often insufficiently recognized and controlled. The bias is illustrated in research on parental interventions (punishment, homework assistance); medical interventions (hospitalization); and psychological interventions for suicide risk, sex offending, and juvenile delinquency. The intervention selection bias is most adequately controlled in randomized studies or strong quasi-experimental designs, although recent statistical innovations can enhance weaker designs. The most important points are to increase awareness of the intervention selection bias and to systematically evaluate plausible alternative explanations of data before making causal conclusions.

In recent decades, pediatric medicine has undergone a shift in focus from infectious diseases to the effects of behavior on the health and development of children. At the same time, behavior analysts have increasingly evaluated the direct application of their technology to the development and maintenance of child health behavior. Unfortunately, applied behavior analysts have developed their technology parallel to, rather than collaboratively with, pediatricians and, as a result, are not recognized as experts in the treatment of child health behavior. In addition, behavioral technology is not widely recognized as the treatment of choice by pediatricians. This paper provides a behavioral prescription for behavior analysts who wish to enter pediatrics as expert scientists and technicians. Specific recommendations are provided for stimulating collaborative rather than parallel development between applied behavior analysis and pediatrics in the promotion and maintenance of child health behavior. Strategies for maintaining this collaborative relationship and for strengthening the social relevance of behavior analysis are discussed.

Background: There is compelling evidence to support behavioral interventions as the first-line approach for bedtime resistance in young children. Among the behavioral treatment options, extinction ("cry it out") has the most extensive empirical support and tends to produce the most rapid gains. There are well known problems with the use of extinction, however, including side effects (extinction burst, spontaneous recovery) and poor acceptance, not to mention that extinction fails to teach children appropriate replacement behaviors (what "to do"). This study introduces a new behavioral sleep intervention, the Excuse Me Drill, designed to address some of the limitations of extinction. The EMD was formally evaluated for the first time using a multiple-baseline research design across four participants with sleep disturbance.Participants: Participants included four children who were clinically referred to outpatient pediatric psychology clinics for the treatment of behavioral insomnia of childhood, and included one 2-year-old female, two 7-year-old females, and one 7-year-old male. All participants had a history of dependent sleep onset at bedtime (i.e., parents remained in the child's bedroom upon sleep onset). Methods: A non-concurrent multiple baseline design across participants was used to experimentally evaluate the effectiveness of the EMD. During baseline, parents collected data on independent sleep onset and disruptive bedtime behaviors, but conducted the bedtime routine as usual. Immediately following baseline, parents implemented the EMD protocol until data indicated that children were consistently initiating sleep independently. Follow-up data were collected to determine the extent to which children continued to initiate sleep independently at bedtime in absence of the EMD. Results: Outcomes were promising as the EMD successfully taught all four children to initiate sleep independently and produced notable decreases in disruptive bedtime behavior. Results were maintained at follow-up for three of four participants. In addition, parents rated the EMD to be a socially acceptable procedure for their children. Conclusions: Results of this study indicate that the EMD was effective in promoting independent sleep onset and reducing disruptive bedtime behavior that maintained over time. The EMD should be considered to be a viable alternative to traditional extinction procedures for pediatric sleep disturbance. Implications for practice, limitations, and direction for future research are discussed. [ABSTRACT FROM AUTHOR]

Parents of young children with severe emotional and behavior problems have few services from which to choose if their child is expelled from preschool for aggressive and disruptive behavior. Two case studies provide an overview of a multicomponent, intensive, day-treatment program for children with moderate to severe behavior disorders. Proximal and distal program goals are to eliminate presenting problem behaviors and increase social competencies and to reintegrate children back to their school, preschool, or daycare, respectively. The cases presented in this study provide preliminary evidence that day treatment can be a viable option for young children with disruptive behavior disorders. [ABSTRACT FROM AUTHOR]

Discusses treatment guidelines for primary nonretentive encopresis and stool toileting refusal. Background on encopresis; Identification of potential medical, developmental or behavioral pathology; Addressing toilet refusal behavior; Incentives for appropriate bowel movements and self-initiation.