1. Developing Independent Sleep Initiation Skills and Decreasing Night Wakings: A Case Study Holly J. Zumpfe Munroe-Meyer Institute 12-19-03

2. Pediatric Sleep Clinic Brett Kuhn, Ph.D. Director Treat common sleep problems –Bedtime Resistance –Bedwetting –Nightmares –Night-time fears –Night-time waking –Sleep Terrors/Sleep Walking –Sleep-Wake Schedule problems –Compliance for medical procedures

3. The 2-Second A to ZZZZ’s 20 to 30% of Children experience sleep disturbances

4. The Client 11 year old female Mild Mental Retardation Medications –Methylphenidate –Clonidine Referral Concern: –Requires parental presence to initiate and reinitiate sleep –Experiences night time awakenings

5. Assessment of Sleep Problems 4 Major Areas Bedroom Environment Sleep Schedule Daytime Behavior Independent Sleep Onset Skills

6. Client assessment Measures for pre-treatment packet –Background Information Form –Sleep Disturbances Scale for Children (Bruni et al., 1996) –Parenting Stress Index-Short Form (Psychological Assessment Resources, 1995) –Pre-Treatment Sleep Diary –Sutter-Eyberg Child Behavior Inventory –Child Behavior Checklist

7. Results of Pre-Treatment Data

9. 3 Phases of Data Collection Baseline (TST=7.77 hours/night) Behavior Intervention (TST= 9.06 hours/night) Elimination of Clonidine (TST= 7.57 hours/night)

11. Results Baseline Behavior Intervention Discontinue Clonidine TST7.779.067.57 TIB8.779.698.46 Sleep Efficiency 88%94% Wakings1.200 Latency

12. Sample Data sheets

13. Why collected

14. Any Problems with data

15. How were used to make clinical decision?

16. Previous Research Empirical basis for treatment Research studies to support our treatment

17. Treatment Steps involved Tx integrity If changes made, how used to make changes Problems encountered in implementation

18. Evaluation How were outcomes empirically verify? Question/problems colleagues should consider