Neville M Blampied

Emeritus Professor

School of Psychology Speech & Hearing |Te Kura Mahi ā-Hirikapo

University of Canterbury|Te Whare Wananga o Waitaha

Christchurch, Aotearoa New Zealand

Abstract

Sleep is one of the pillars of lifelong wellbeing, yet throughout life many individuals experience various sleep disturbances. Children present sleep onset delay, frequent/prolonged night wakings, and early morning waking. Older children may exhibit bed resistance and curtain calls (post-bedtime demands). Bed sharing may be problematic where it is unwanted. If chronic these have negative effects on development and on other family members. Working first with neurotypical infants (6 mo to 2 years) the Canterbury Sleep Project demonstrated that common sleep disturbances could be resolved by helping parents place sleep-interfering behaviour on extinction, and then investigated how extinction could be modified to reduce post-extinction response bursts. Building on this we developed a behavioural model of childhood sleep disturbance using concepts from behaviour analysis. Iterations of the model have incorporated developmental factors and extended it to cover the lifespan. The model is now integrated with Functional Behavioural Assessment of sleep disturbance and used to generate individualised case conceptualizations and intervention plans. The Good Nights project extended this to sleep disturbance in children with autism and those with rare genetic neurodevelopmental conditions (RGNC; e.g., Angleman syndrome), adapting the model for the associated challenges. Parent-implemented interventions (most via telehealth) address circadian (motivational) factors, antecedent stimulus control, bedtime behavioural chains, contingencies of reinforcement for sleep compatible/incompatible behaviours and extinction, ordered using the principle of least restriction. In addition to evaluating the primary intervention outcomes (reductions in sleep disturbance) research has also considered possible collateral benefits to the child and his/her parents, and acceptability.

Learning Objectives

Note the importance of good sleep to lifelong wellbeing and the epidemiology of sleep disturbance in various populations.
Understand how behavioural extinction can be used to address sleep disturbance in typically developing children and describe several modifications to extinction procedures that reduce the risk of post-extinction response bursts.
Be able to conceptualize sleep disturbance using behaviour analysis principles and how Functional Behavioural Assessment (FBA) combined with the behavioural model generates case formulations and behavioural sleep intervention plans.
Understand how behavioural sleep interventions based on this model and FBA can be used to treat sleep disturbance in neurodiverse children.
Be able to describe the outcome of the research at the level of single-case analyses (directly adaptable to clinical practice) and using aggregate methods based on relevant effect size measures.

Target Audience

Professionals working with families with neurotypical children with chronic sleep disturbance.
Professionals working with families with neurodiverse children and adolescents with chronic sleep disturbance.
Anybody who is (or anticipates becoming) a parent of a child with sleep disturbance.

Duration: 1hr 15 min

ABAA PDU/BACB CE: 1.5

Key references

Book

McLay, L.K., France, K.G., & Blampied, N.M. (Eds.). (2022). Clinical Handbook of Behavioral Sleep Treatment in Children on the Autism Spectrum. Springer Nature.

Journal Articles

Blampied, N. M., & France, K. G. (1993). A behavioral model of infant sleep disturbance. Journal of Applied Behavior Analysis, 26(4), 477-492. doi:10.1901/jaba.1993.26-477

Blampied, N. M. (2013). Functional behavioral analysis of sleep in infants and children. In A. R. Wolfson, & H. E. Montgomery-Downs (Eds.), The Oxford Handbook of Infant, Child, and Adolescent Sleep and Behavior (pp. 169-188). New York: Oxford University Press.

Blampied, N. M., & Bootzin, R. R. (2013). Sleep: A behavioral account. In G. J. Madden (Ed.), APA Handbook of Behavior Analysis Vol 2: Translating Principles into Practice (pp. 425-453). Washington D.C.: American Psychological Association. doi:10.1037/13938-017

Blampied, N.M., & van Deurs, J. (2022). A conceptual framework for understanding and designing behavioral interventions for sleep problems in children on the Autism spectrum. In L. McLay et al. (2022). Clinical Handbook of Behavioral Sleep Treatment in Children on the Autism Spectrum (pp 59 – 74). Springer Nature.

Clarke, M., McLay, L., France, K. et al. (2023). Telehealth-Delivered Supports for Daily Living Skills for Autistic Children: A Systematic Review. Review Journal of Autism & Developmental Disorders. Published on-line on 20 July 2023. https://doi.org/10.1007/s40489-023-00389-z

France, K., & Blampied, N. (1999). Infant sleep disturbance: Description of a problem behaviour process. Sleep Medicine Reviews, 3(4), 265-280. doi:10.1053/smrv.1999.0071

France, K. G., & Blampied, N. M. (2005). Modifications of systematic ignoring in the management of infant sleep disturbance: Efficacy and distress. Child & Family Behavior Therapy, 27(1), 1-16. doi:10.1300/J019v27n01_01

Henderson, J. M. T., France, K. G., Owens, J. L., & Blampied, N. M. (2010). Sleeping through the night: The consolidation of self-regulated sleep across the first year of life. Pediatrics, 126(5), e1081-e1087. doi:10.1542/peds.2010-0976

Henderson, J.M.T., Blampied, N.M., & France, K.G. (2020). Longitudinal study of infant sleep development: Early predictors of sleep regulation across the first year. Nature & Science of Sleep, 12, 949 – 957.

McLay, L., France, K.G., Blampied, N.M., Hunter, J.E., van Deurs, J.R., Woodford, E.C., Gibbs., R., & Lang, R. (2021). Collateral child and parent effects of function-based behavioral interventions for sleep problems in children and adolescents with autism. Journal of Autism & Developmental Disorders, Published on-line 10th June, 2021. Doi. 10.1007/s10803-021-05116-3

McLay, L., France, K., Blampied, N., van Deurs, J., Hunter, J., Knight, J., Hastie, B., Carnett, A., Woodford, E., Gibbs., R., & Lang, R. (2021). Function-based behavioural interventions for sleep problems in children and adolescents with sleep problems: Summary of 41 clinical cases. Journal of Autism and Developmental Disorders,51, 418–432. https://doi.org/10.1007/s10803-020-04548-7

Woodford, E. C., McLay, L. K., France, K. G., & Blampied, N. M. (2024). The lighter touch: Less-restriction in sequentially implemented behavioral sleep interventions for children with rare genetic neurodevelopmental conditions. Journal of Autism and Developmental Disorders. https://doi.org/10.1007/s10803-024-06234-4