Method

1
The use of Social Stories to help bedtime
resistance in young school-aged children Liz
Smith, Julie A. Hadwin Cathy Hill
Method Participants Six children aged between 5
and 6 years old were recruited from 3 local
primary schools. Parents reported that their
child took over 30 minutes to settle at least
twice a week. To measure sleep, general
behaviour, language ability and perspective
taking, we completed the Childrens Sleep Habits
Questionnaire (CSHQ) the Strength and
Difficulties Questionnaire the British Picture
Vocabulary Scale and a series tasks to assess
perspective taking skills with each
child. Social Story Intervention A Social
Story was written for each child to help
establish and facilitate their understanding of
a bedtime routine and to provide specific
reassurance and explanations where necessary.
All stories followed Grays (2000) basic Social
Story format and included photos of the child
and parent at various stages in their bedtime
routine.8 The reward element included a daily
sticker chart. Design Participants were randomly
assigned to recieve either the Social Story
intervention (n 3) or a Social Story and
reward intervention (n 3). A multiple baseline
method with a 6-month follow-up was employed.
Participants had staggered start dates, one week
apart, with every child completing a baseline,
control, intervention and follow-up
phase. Measures Parental report
measures included a sleep diary, which recorded
the number of disruptive bedtime behaviours
displayed by the child each night and the CSHQ.
Actigraphy, an objective measure of sleep, was
also used throughout the duration of the study.
This involved the child wearing an actiwatc
movement monitor in the form of a small wrist
watch device.

• Introduction
• Why is this an important area for Educational
  Psychologists?
• Childhood sleep problems are highly prevalent and
  occur in around
• 101 to 372 of young school-aged children.
  Studies in development
• have highlighted links between disrupted and/or
  insufficient sleep and
• behavioural, learning, emotional and social
  problems in young
• children.3
• Social Stories and Bedtime Resistance
• Bedtime resistance is a term used to describe
  children who typically
• refuse to go to bed or who repeatedly make
  requests in an attempt to
• delay bedtime. It is the most common area of
  sleep-related difficulty
• for school-aged children.2,4
• Social Stories are short personalised stories
  designed to teach
• children how to manage their own behaviour in
  situations that they find
• particularly challenging or confusing. Social
  Stories were initially
• designed for use with children with an autistic
  spectrum condition
• (ASC). Recent studies have, however, found that
  they can also be

Baseline 3 days Control 7 days Intervention 7 days Follow-up 7 days
Parents completed a sleep diary and questionnaire Children wore an actiwatch Parents completed a sleep diary and questionnaire Parents read a control poem to children each evening Children wore an actiwatch Parent s completed a sleep diary and questionnaire Parents read the Social Story to children each evening. Children wore an actiwatch Parents completed a sleep diary and questionnaire Children wore an actiwatch

• Results
• Parent report measures
• Frequency of disruptive bedtime behaviours per
  night (from sleep diary)
• Total sleep disturbance score (from the CSHQ)
• Bedtime resistance score (subscale of the CSHQ)

• Actigraphy data
• Sleep onset time (time between lights out and
  sleep start)
• Actual sleep time (total time spent actually
  asleep)
• Sleep efficiency (the percentage of time in bed
  spent actually asleep).
• Note B Baseline phase, C control week, I
  intervention week (social story or social story
  and reward). The follow-up was one week in
  duration 6 months after the intervention week.
• Figure 2 Graphs depicting group mean scores from
  the actigraphy measure taken during baseline,
  control, intervention and 6 month follow-up.
• No significant main effects were found for any
  of the measures. There was also no significant
  difference between the two groups.

• Conclusions
• Parents report behavioural improvements for
  children in both groups,
• suggesting little difference in this area
  regarding the use of Social Stories
• when used alone or in combination with rewards.
• Objective sleep measures showed little change
  throughout the study for
• most children, with the notable exception of 2
  boys in the Social Story
• and reward group. These children had poorer
  perspective taking skills,
• supporting previous research which suggests that
  Social Storiesare
• particularly effective for children with some
  degree of perspective taking
• difficulties.5
• Implications for EP practice include further
  consideration of the wider use
• of Social Story interventions.

References 1 Stein, M. A., Mendelsohn, J.,
Obermeyer, H., Amromin, J., and Benca, R. (2001).
Sleep and behaviour problems in school-aged
children. Pediatrics, 107, 1-9 2 Owens, J. A.,
Spirito, A, McGuinn, M., and Noble, C. (2000b).
Sleep habits and sleep disturbance in elementary
school aged children. Journal of Developmental
and Behavioural Pediatrics, 21, 27-36. 3
Fallone,G., Acebo, C., Seifer, R., and Carskadon,
M. A. (2005) Experimental restriction of sleep
opportunity in children Effects on teacher
ratings. Sleep, 28. 1561-1567. 3 Touchette, E.,
Petit, D., Seguin, J., R., Bovin, M., Tremblay,
R., E., Montplasir, J. Y. (2007). Associations
between sleep duration Patterns and
behavioural/cognitive functioning at school
entrance. Sleep, 30. 1213-1219. 4 Blader, J.
C., Koplewiez, H. S., Abikoff, H., and Foley, C.
(1997). Sleep Problems of elementary school
children. A community survey. Archives of
Paediatric Adolescent Medicine, 151, 473-480. 5
Toplis, R., Hadwin, J.A. (2006). Using social
stories to change problematic lunchtime
behaviours in school. Educational psychology in
Practice, 22, 53-67. 6 Burke, R. V., Kuhn, B.
R. and Peterson, J. l. (2004) Brief Report a
storybook ending to childrens bedtime problems
the use of a rewarding social story to reduce
bedtime resistance and frequent night waking.
Journal of Paediatric Psychology, 29.
389-396. 7 Moore, M., Meltzer, and Mindell, J.
A. (2008) Bedtime problems and night waking in
children. Primary Care Clinics in Office
Practice, 35. 569-581. 8 Gray, C. (2000). The
New Social Story Book Illustrated Edition.
Arlington Future Horizons Inc