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Children’s sleep Behaviour management Dr Andrew Mayers

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1 Children’s sleep Behaviour management Dr Andrew Mayers

2 2 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

3 3 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

4 4 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

5 5 Behavioural model  Classical conditioning in children’s 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

6 6 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 child’s 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

7 7 Behavioural model  Operant conditioning with children’s 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

8 8 Behavioural model  So how can we use these principles for children’s 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

9 9 Good sleep – some tips for children  Bedtime/wake-up time should be consistent every day  Should not be > 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 30–60 minutes  ‘Best’ to keep TV/Games consoles out of bedroom  Or carefully restrict use  Employ good ‘sleep hygiene’  Excellent overview by Galland & Mitchell, 2011

10 10 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

11 11 Sleep hygiene  Physical environment  Child’s 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 75°F or 24°C  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

12 12 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!

13 13 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

14 14 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 herehere  Star charts also useful – helps reinforce new behaviour  See example herehere

15 15 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

16 16 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

17 17 Summary  Lots more information on my website   Follow me on Twitter @DrAndyMayers

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