Reducing Toddlers Bedtime Tantrums : snoozeforkids.com

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REDUCING BEDTIME TANTRUMS THE BOSS OF MY SLEEP
BOOK (BomS) IN A TODDLER WITH TRAUMA
Sarah Blunden Appleton Institute of Behavioural
Science, CQUniversity, Adelaide, South Australia
Background
Results

• Sleep problems occur in 20 to 30 of toddlers
  aged 3-5 years include bedtime refusal multiple
  exits from the bedroom and/or calling out
  resulting in delayed sleep onset. Often these are
  accompanied by numerous overnight wakings.
• As these problems are behaviourally based,
  behavioural sleep interventions are effective.
• Behaviour change is particularly effective if
  parents follow the principles of authoritative
  parenting which encourage and support the
  development of childrens responsibility to learn
  positive behaviour (1).
• The Boss of my Sleep Book (BomS) works on those
  principles, by accessing the intrinsic motivation
  of young children to want to behave well, be in
  control of their own behaviour and be part of
  the decision making without fear of
  repercussions.
• However, most existing interventions such as this
  require personal contact with a trained
  professional, and unfortunately many children
  remain untreated.
• In order to resolve this problem an online
  version of the successful clinic based Boss of My
  Sleep Book www.snoozeforkids.com.au was created.
• Whether the BomS book is effective online without
  guidance from a trained professional and whether
  it is effective in children with excessive
  fear/anxiety are currently unknown.

LLs mother completed a 7 day sleep diary
retrospectively from January 19th-25th 2015,
directly after an access visit to LLs biological
mother. Sleep variables were compared to a two
day post sleep diary completed between August
30th-31st 2015 and results are shown below. The
BomS improved LLs sleep patterns considerably
within two nights. LLs foster parent reported on
the website I downloaded "boss of my sleep"
book it is amazing, I got results instantly..he
has only tried to come in my bed once. We all
getting very good quality sleep he asks for the
book every night.
Variable Mean (Range) Pre 7 day sleep diary Mean (Range) post 2 day sleep diary
Bedtime (24 hour clock) 1940 (20 45- 1910) 1910 (1910 1911)
Wake time (24 hour clock) 0505 (0415-0615) 0620 (0620-0630)
Total hours /mins time in bed 9hrs 20mins (805-1118) 11 hrs 05mins(1105-1118
Sleep Onset latency 35mins (10-95mins) 10mins (10mins-10min)
Wake after sleep onset (mins) 5.5mins 0mins
Sleep location /environment His bed/parent patting to sleep His bed alone
Refreshment score ( 1 5 , 1 least refreshed) 1 5
Case study of LL

• LL was a 3 year old male living with his foster
  mother since he was 20 months of age, after
  having been twice withdrawn from his birth mother
  due to neglect and abuse. At that time, he
  displayed signs of trauma, had behavioural
  problems and was slightly delayed in reaching
  developmental milestones although this had never
  been formally diagnosed.
• He had never had guidance to follow rules, had no
  bedtime routine and had behavioural problems both
  during the day and at night.
• When he entered foster care, he continued to show
  signs of trauma, fear and anxiety and had
  difficulty following rules. Separating from his
  foster mother was difficult, especially at night
  and he was never able to sleep alone.
• For the purposes of the Child Protection
  Agencies, LLs foster mother had kept detailed
  records of his sleep and behaviour, on which the
  current case study has been based.
• LLs foster mother downloaded the pdf Boss of My
  Sleep Book from the host website , dedicated to
  toddler sleep (www.snoozeforkids.com.au) in
  August 2015 and subsequently posted positive
  feedback onto the website.
• In the same month, the author contacted her to
  ask permission to anonymously use LLs case to
  demonstrate the effectiveness of the online
  version of the Boss of My Sleep Book. Consent was
  subsequently gained in accordance with ethical
  requirements of the Australian Psychological
  Society. LLs mother then completed a post sleep
  diary on August 30th 2015 and provided family
  history and demographic data.

The Boss of My Sleep Book

• The BomS book was developed by the author at the
  Paediatric Sleep Clinic, a private sleep
  psychology clinic in Adelaide South Australia in
  2007.
• The BomS book aims to improve problematic bedtime
  behaviour in children aged 3-8 years, which may
  include bedtime resistance, continued exits from
  the bedroom, difficulty in initiating sleep
  without parental presence and co-sleeping.
• Based on psychological learning theory and
  intrinsic motivation, a sticker is received for
  choosing and undertaking a bedtime routine. The
  immediate first rewards encourages the child to
  work hard for the second sticker which is awarded
  for waiting quietly in bed, and is received
  only the following morning. Two stickers each
  night receive a daily prize and eight prizes earn
  the title of Boss of my Sleep with a certificate
  awarded from the clinic.
• Initially the BomS book was a simple printed
  document utilised in clinic during individual
  sessions only and the sleep therapy system it
  entails was guided by a clinical psychologist.
• Subsequently, the BomS system was adapted into a
  formal illustrated book about bedtime routines
  in Australian animals, and includes a rewards
  chart.
• To maximise the potential for the BomS book to be
  effective without direct therapeutic and personal
  intervention, a parent manual that assists
  parents in understanding how to best achieve
  compliance through rewards systems is also
  included.

Conclusions

• The BomS system, which had already shown success
  in clinical practice, was effective in reducing
  problematic sleep behaviours
• Without the presence of a specialist sleep
  psychologist
• In a child who was particularly and unusually
  fearful and anxious due to a history of abuse and
  neglect.
• This suggest that the BomS book may have a broad
  appeal for parents of children who are both
  typically developing and those with special
  emotional needs. Furthermore, due to its online
  availability, the BomS book can be accessed in
  areas that may not offer specialist sleep
  services.

Spilsbury, J.S.-I., A. Drotar, D. Rosen, CL.
Kirchner, H. Redline, S. , Effects of the home
environment on school-aged children's sleep.
Sleep, 2005. 28(11) p. 1419-1427. Acknowledgement
s Associate Professor Kirrilly Thompson,
(Co-author the Boss of My Sleep Book) Mr Daniel
Maung, (website design and production) Jeff West
(Book design and illustrations).
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