Reducing Toddlers Bedtime Tantrums : snoozeforkids.com

1. 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 children’s 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. LL’s mother completed a 7 day sleep diary retrospectively from January 19th-25th 2015, directly after an access visit to LL’s 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 LL’s sleep patterns considerably within two nights. LL’s 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”. 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of LL • LL was a 3 year old male living with his foster mother since he was 20 months of age, after having been twice withdrawn from his birth mother due to neglect and abuse.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, LL’s foster mother had kept detailed records of his sleep and behaviour, on which the current case study has been based. • LL’s 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 LL’s 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. LL’s mother then completed a post sleep diary on August 30th2015and 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. Acknowledgements; 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). • 1.