Children

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Childrens sleepBehaviour management

• Dr Andrew Mayers
• amayers_at_bournemouth.ac.uk

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Behavioural model of psychology

• Overview
• How can we change unwanted behaviour?
• How can we keep wanted behaviour?
• We need to understand behaviourist psychology
• Conditioning
• Classical and operant
• Reinforcement and reward

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Behavioural model of psychology

• All behaviour is moulded by environment
• Stimulus and reinforcement explain behaviour
• Dominated by classical and operant conditioning
• Human behaviour is learned
• Events may condition behaviour
• Reactions can reinforce that behaviour
• Unwanted behaviour can be EXPLAINED by prior
  learning
• And can be ALTERED by CHANGING environmental
  conditions that maintained it

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Behavioural model

• Classical conditioning (e.g. Pavlov)
• Behaviour explained by unconditioned
  stimulus/response
• Moulds behaviour
• Pavlov experimented with dogs and food
• Presence of food (UCS) elicits salivation (UCR)
• Pavlov sounded bell (neutral stimulus) prior to
  feeding dogs
• Sound of bell paired with food on several
  occasions
• Bell not sounded when food not present
• So dogs salivated (CR) at mere sound of bell
  (now, CS)
• Even before food arrived
• Bell is ASSOCIATED with food

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Behavioural model

• Classical conditioning in childrens sleep
• Bedroom/bedtime NOT associated with sleep
• But associated with stress, tiredness, need to
  get up
• May have been classically conditioned for many
  reasons
• Unpleasant experience
• Lack of routine establishing bedtime with sleep
• Not learned to self-soothe
• Bad habits
• we will explore many more shortly

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Behavioural model

• Operant conditioning (e.g. Skinner)
• Desired behaviour is more likely to recur if it
  is reinforced
• Behaviour established and maintained by
  reinforcement
• Positive reinforcement
• Praising a childs first words
• Negative reinforcement
• Lifting restrictions if child does good work
• Extinction
• Behaviour can be eliminated by removing
  reinforcement
• Undesired behaviour is more likely to stop if it
  is ignored

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Behavioural model

• Operant conditioning with childrens sleep
• Desired bedtime/sleeping behaviour can be
  reinforced
• Praise
• Reward
• Sticker/star charts
• Promised activities
• Removal of unpleasant activity
• Self-reinforcement
• Feeling good/proud
• Not feeling tired
• Positive effects in home and at school

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Behavioural model

• So how can we use these principles for childrens
  sleep
• Understand how undesired became conditioned
• Help us to recondition
• How can we reinforce desired behaviour?
• How can we eliminate undesired behaviour?
• Consider the key principles
• Routine, consistency, perseverance

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Good sleep some tips for children

• Bedtime/wake-up time should be consistent every
  day
• Should not be gt 1 hour difference in bed/wake
  time
• School nights vs. non-school nights
• Have nightly bedtime routine
• Prepare child for bed
• Young children about 30 minutes before sleep
  time
• Older children about 3060 minutes
• Best to keep TV/Games consoles out of bedroom
• Or carefully restrict use
• Employ good sleep hygiene
• Excellent overview by Galland Mitchell, 2011

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Sleep hygiene

• Warm bath
• It worked for your baby
• Adults report better sleep after having bedtime
  bath
• So why not toddlers and children?
• Reading
• Can help solve problems of night-time fears
• Help child with improving reading
• Good bonding between parent and child
• Relaxing
• Reduce night-time fears
• Recommended routine for children of all ages

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Sleep hygiene

• Physical environment
• Childs bedroom should be a quiet, darkened, warm
  place
• Noise and light increases risk of problem sleep
• A room too hot (or cold) may disrupt sleep
• No hotter than 75F or 24C
• Lighting
• Lights out encourage sleep onset
• Lights on associate with getting up
• Reinforces sleep and wake times
• Many children will not sleep with the light off
• Use glow lights

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Sleep hygiene

• Spend time in daylight every day
• Daytime exercise
• Adult research ? physical exercise good for sleep
• But not within 3 hours of bed time
• So, probably good for children too!

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Sleep hygiene

• Daytime food/drink
• Avoid caffeine drinks 4 hours before bedtime
• Caffeine also in some foods so watch that
• Large quantities of food too near to bedtime
  should be avoided
• Main meal not less than 2 hours before bedtime
• Light snack just before bed OK, but use snooze
  foods
• Contain sleep-promoting chemicals
• Dairy products, meat, poultry, beans, rice
• Food high in carbohydrate and calcium also
  useful
• e.g. peanut butter sandwich, oatmeal biscuit,
  milk

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Working towards a family plan

• Parents often come expect immediate solutions
• Poor sleep habits may have taken years to become
  established
• It will take more than a few nights to resolve!
• Often start modification programmes with sleep
  history
• Child and family
• Explore environmental factors and changes
• Bedroom, family members, school changes, moving
  house
• Sleep diaries for at least one week
• See example here
• Star charts also useful helps reinforce new
  behaviour
• See example here

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Behavioural methods

• Reinforcement and extinction
• Reinforcing and rewarding good bedtime behaviour
• Cuddles, praise etc
• Some therapists encourage star charts
• Great evidence of helping maintain desired
  behaviour
• Ignoring bad behaviour helps it go away!
• We call this extinction
• Behaviours tend not to repeated if not reinforced
  

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Behavioural methods

• Unmodified extinction
• Child left to cry self to sleep
• Can be very stressful (for child and parent)
• Graduated extinction (controlled crying)
• Rather more acceptable than unmodified extinction
• Parent progressively increases time taken to
  respond
• Brief intervention say 15 seconds with minimal
  interaction
• Extinction with parental presence
• Parent remains in room during extinction
  procedure
• Can incorporate fading out
• Parent gradually removes themselves from bedroom
• Presence more reassuring to child

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Summary

• Lots more information on my website
• http//www.andrewmayers.info/children-sleep.html
• Follow me on Twitter _at_DrAndyMayers