Sleep Better!: A Guide to Improving Sleep for Children with Special Needs - Softcover

Durand Ph.D., Dr. V. Mark

Softcover

ISBN 10: 1557663157 ISBN 13: 9781557663153

Publisher: Brookes Publishing, 1997

Synopsis

When children have recurrent sleep problems, they and their families must deal with negative effects on behavior, mood, social interactions, physical stamina, and performance at school or work. This book offers step-by-step, "how to" instructions for helping children with disabilities get the rest they need. For problems ranging from bedtime tantrums to night waking, parents and caregivers will find a variety of widely tested and easy-to-implement techniques that have already helped hundreds of children with special needs—especially children with autism, Tourette syndrome, and cerebral palsy.

Written by a psychologist who was inspired by many sleepless nights with his own child, this book delivers proven techniques from the author's clinical and personal experience, making it a one-of-a-kind resource for families and professionals.

About this title

About the Author

V. Mark Durand, Ph.D., is known worldwide as an authority in the area of autism spectrum disorders. He is a professor of psychology at the University of South Florida St. Petersburg, where he was the founding Dean of Arts & Sciences and Vice Chancellor for Academic Affairs. Dr. Durand is a fellow of the American Psychological Association. He has received more than $4 million in federal funding since the beginning of his career to study the nature, assessment, and treatment of behavior problems in children with autism spectrum disorders. Before moving to Florida, he served in a variety of leadership positions at the University at Albany-State University of New York (SUNY-Albany), including Associate Director for Clinical Training for the doctoral psychology program from 1987 to 1990, Chair of the Psychology Department from 1995 to 1998, and Interim Dean of Arts and Sciences from 2001 to 2002. There he established the Center for Autism and Related Disabilities at SUNY-Albany. He received his B.A., M.A., and Ph.D. degrees — all in psychology—at Stony Brook University.

Dr. Durand was awarded the University Award for Excellence in Teaching at SUNY-Albany in 1991 and in 2007 received the Chancellor's Award for Excellence in Research and Creative Scholarship at the University of South Florida St. Petersburg. Dr. Durand is currently Co-editor of the Journal of Positive Behavior Interventions, is a member of the Professional Advisory Board for the Autism Society of America, and is on the Board of Directors of the international Association of Positive Behavioral Support. He serves on a number of editorial boards, has reviewed for dozens of journals, and has more than 100 publications on functional communication, educational programming, and behavior therapy. His books include several best-selling textbooks on abnormal psychology, Severe Behavior Problems: A Functional Communication Training Approach (Guilford Press, 1990), Sleep Better! A Guide to Improving Sleep for Children with Special Needs (Paul H. Brookes Publishing Co., 1998), and When Children Don't Sleep Well: Interventions for Pediatric Sleep Disorders, Therapist Guide (Oxford University Press, 2008). In his leisure time, he enjoys long-distance running and just completed his third marathon.

Excerpt. © Reprinted by permission. All rights reserved.

Excerpted from Chapter 2 of Sleep Better! A Guide to Improving Sleep for Children with Special Needs, by V. Mark Durand, Ph.D.

Copyright © 1998 by Paul H. Brookes Publishing Co.

Sleep Problems

O sleep! O gentle sleep! / Nature's soft nurse, how have I frighted thee / That thou no more wilt weigh my eyelids down / And steep my senses in forgetfulness? —William Shakespeare, King Henry IV, Part II

King Henry IV's longing for sleep seems at odds with modern-day society's desire to wring the most out of a day. Many of us are trying to do more with less sleep. Many more people yearn to sleep better, but, for a variety of reasons, they cannot. Some have difficulty falling asleep or have their sleep disturbed frequently throughout the night. Others feel tired even after what seems to be a full night's sleep. Still others may encounter a number of abnormal sleep experiences, such as frequent and disturbing nightmares, sleep terrors (which at first resemble nightmares but are a very different sleep disturbance), sleepwalking, or sleeptalking. This chapter addresses the many ways in which sleep can be disrupted, along with what is known about the causes of these problems.

How Common Are Sleep Problems?

You may be surprised to learn that as many as one of every four otherwise healthy adults experiences significant problems with sleep. At the same time, a similar ratio of children experience sleep problems. What is most alarming is that sleep problems seem to occur more often in people with special needs. As if life were not complicated enough, adding a sleep problem on top of all of the other difficulties can make getting through each day a greater challenge for people with special needs as well as for their families and friends.

People with autism may be among the most seriously affected when it comes to sleep problems; some research suggests that almost all of these individuals experience difficulty with sleep at some point in their lives. A survey of children with a range of developmental disabilities found that about 80% of parents reported some problem with their child's sleep and that one in four described the problem as severe. To make matters worse, the parents also indicated that, unlike children without disabilities, their children did not seem to grow out of these sleep problems and that their sleeping difficulties persisted into adulthood. Sleep problems commonly occur among children with a variety of disorders, including Tourette syndrome, Rett syndrome, and cerebral palsy.

Problems with sleep can be a sign of other problems. Nightmares, sleep terrors, and other problems with sleep are commonly reported among children and adults who have been victims of abuse or other traumatic events. Obviously, this does not necessarily mean that a sleep problem is a sign of past or current abuse but simply that these upsetting episodes can increase the likelihood of sleep problems in the affected person. Even something as apparently unrelated as marital discord can disrupt the sleep of the couple's children.

Sleep is often reported as a problem for children with attention-deficit/hyperactivity disorder (ADHD). ADHD affects an estimated 3% of all children and results in difficulties with attention; for many children, it also involves impulsivity and hyperactivity. The most common treatment for these children is a medical one — typically a stimulant medication such as Ritalin. Parents of these children often lament that their children develop sleep problems after being placed on this type of medication. (How to balance the medication needs of these children with their sleep needs is described in Chapter 12.) Research suggests that sleep problems among children with ADHD may be overreported by some parents, meaning that they may expect their children to have disturbed sleep because of the medication and therefore inaccurately relate these problems. It is clear, however, that many children with ADHD require assistance with their sleep.

How Serious Are Sleep Problems?

As you can see, many groups of people with special needs experience disturbed sleep. In addition to the sheer number of people who have difficulty with their sleep, the effects of sleep on behavior also contribute to the concern of families and professionals. For example, disturbed sleep has a negative impact on performance during certain tasks — motivation to work decreases, and the ability to concentrate becomes impaired. Similarly, people who have not had enough sleep often report feeling irritable or depressed. What can be said, then, about the effects on people with special needs — especially those who have difficulty learning and carrying out daily tasks?

Unfortunately, research that examines the effects of sleep problems on people with special needs is rare, so there is very little direct knowledge about how they may be affected. Some general conclusions can be made, however, based on research usually conducted on adults without disabilities. It is important to note that one night of disrupted sleep probably will have a minimal effect on a person's ability to carry out daily tasks. That is good news because, occasionally, all of us experience a night when, because of anxiety over a presentation that you have to give, the cup of coffee that you enjoyed too late at night, the excitement over a trip the next day, or even just being anxious about not falling asleep, we sleep very little. Despite being tired, we are able to get through the day relatively well. Should this disturbed sleep persist for more than a day or two, however, noticeable effects are likely. Persistent and chronic sleep disturbances will cause a decline in motivation or concentration as opposed to a loss of ability. As motivation decreases, concentration is impaired, and performance errors increase. People involved in boring, repetitive tasks will show the effects of a poor night's sleep more readily than will those involved in interesting and challenging tasks. Consider this in light of how we tend to treat children and adults with special needs. A person who has difficulty learning new skills (e.g., a person with mental retardation or learning disabilities) is usually given an easier and therefore sometimes boring and repetitive task until he or she is considered "ready" to move on to more challenging work. If the person also experiences sleep problems, then his or her difficulty at work will be made worse by performing the same unchallenging work over and over. You can see that we may mistakenly attribute errors on schoolwork or at a job to the person's cognitive difficulties, when this problem may be a result, in part, of sleep problems and our lack of understanding of its effects on a person's performance.

Sleep also affects our emotional well-being. In research with young children, it has been found that sleeping longer is associated with adaptability (being able to tolerate changes in routines) and positive mood, whereas sleeping less is associated with children described as "difficult" — those who get upset when you try to change routines and who always seem irritable5. One young boy with whom I worked was referred because he lacked motivation in class and was generally noncompliant of his teacher's requests. The boy had mental retardation requiring extensive supports, and the teacher seemed to assume that his difficulties were related to his diagnosis. After watching him at his desk in class for a few minutes, I turned to his mother, who also was watching, and said, "He doesn't sleep very well, does he?" His mother was astounded that I knew that without her having told me, and his teacher was even more astounded because she did not know herself that the boy slept only 3-4 hours each night. They both looked at me with awe at my remarkable clinical skills and asked how I knew this after seeing him for only a few minutes. I ruined the adulation when I said, "Well, he looks tired!" This story highlights not only how a lack of sleep can affect mood and behavior (which, fortunately, improved in this boy when his parents and I helped him sleep better — the full details of which are described in Chapter 3) but also how we tend to overlook sleep as an important influence on how we think, feel, and behave.

In some cases, the negative impact of poor sleep can be even more serious. My colleagues' and my own research on people who display self-injurious and aggressive behavior — too often observed among people with autism and other developmental disorders — has revealed that disrupted sleep can make these behavior problems worse6. Not sleeping well can make some people hit themselves or others more often. On a positive note, the occurrence of these very disturbing behaviors can be reduced by improving the affected person's sleep.

A final measure of how serious these sleep problems can be is easily seen in the families of people with disrupted sleep. In some cases, couples' marriages have been threatened because of their child's sleep problems. Depression among parents — especially mothers — also is common in these families. The cause of these problems at home can be traced to several factors. First, a child's disturbed sleep invariably means that the parents' sleep also will be disrupted. Getting up with your child each and every night for months and years means that both you and your child will be sleep deprived. You have just learned that your ability to concentrate and your mood will be affected in a negative way if you are not sleeping well yourself. In addition, the psychological research literature shows that depression can occur when people feel that they have no control over important parts of their lives. People begin to feel helpless, and they give up trying to improve this nighttime problem. My colleagues and I worked with one mother whose child awakened and cried each and every night for 7 years. She had long ago given up hope that anything could be done to help them get a good night's sleep and felt guilty that she could not help her child. Obviously, sleep disturbances can have negative consequences for everyone who is in some way touched by this vexing problem. Fortunately, we were able to help this family despite their long history of sleep problems.

When Does Sleep Become a Problem?

Chapter 1 mentioned that people have different sleep needs. Some people can sleep for only 3–4 hours per night and feel rested and refreshed. Others can sleep for 9–10 hours and still feel tired the next day. This issue of sleep differences raises an important question: If people have different sleep needs, then how do you know whether a child's inability to sleep more than a few hours per night is a sleep problem or just a normal difference? You might be surprised to learn that sleep experts rely heavily on the subjective impressions of the person with the sleep complaint. In other words, if a person sleeps for only 4 hours per night but is not bothered by this and can carry on daily activities, then it is not considered a sleep problem. Conversely, if a person sleeps for an average of 9 hours per night but is still tired during the day and is concerned about sleep, then it is considered a sleep problem. For children, this often translates into how well they function during the day and how disturbing the sleep difficulty is at night. If a child appears tired and irritable even after 8 hours of sleep, then he or she may have a sleep problem. Similarly, if bedtime is disrupted (e.g., the child cries for 20 minutes or more each night) or night waking is a problem (e.g., screaming out each night), then this too may signal a problem with sleep.

Common Sleep Problems

As we turn next to the common sleep problems experienced by people with special needs, bear in mind this subjective quality of sleep. If your child's sleep pattern adversely affects him or her or your family in any important way, then assume that it is significant enough to examine more closely. Keep in mind, too, that there are more than 80 different and distinct sleep problems recognized by sleep professionals — far too many to cover adequately here. Fortunately, only a handful of these problems are commonly experienced by people with special needs. Described next are the most frequently occurring sleep disturbances and some information on their causes.

Insomnia

What image does your mind conjure up when you think of a person with insomnia? Most people picture a person who never sleeps yet who functions well during the day. This is, however, just one more myth about sleep. It is not possible to go completely without sleep for very long. If you stay awake for more than a day or two, then you will begin having brief periods of sleep that last for several seconds — called microsleeps. People with severe insomnia often are unaware that they have these brief sleep episodes and, thus, believe that they never sleep. In addition to experiencing microsleeps, a person who is this sleep deprived will notice significant negative effects on his or her life. Sleep-deprived individuals often have substantial impairments in the quality of their lives and have difficulty getting through even the simplest of life's daily chores. As mentioned in Chapter 1, a complete lack of sleep is catastrophic. One sleep disorder that does involve not sleeping at all is called fatal familial insomnia. As the name implies, this progressive sleep disorder ultimately leads to death for those afflicted, but, fortunately, it is an extremely rare problem.

Insomnia is not one problem but encompasses instead a number of different problems with sleep. Sleep professionals break down insomnia into three different and distinct types:

• Difficulty falling asleep at night (called a difficulty initiating sleep)
• Waking frequently during the night or waking too early and being unable to go back to sleep (called a difficulty maintaining sleep)
• Not feeling rested even after a reasonable number of hours of sleep (called nonrestorative sleep)

As with all of the sleep problems described, a person is considered as having insomnia only when the cause of these sleep disturbances cannot be traced to some other medical or psychological problem. If, for example, a person is not sleeping well because he or she is experiencing pain, then this is not technically thought to be primarily a sleep problem. At the same time, a person who is anxious or depressed will often have difficulty sleeping. If the anxiety or depression is the primary cause of the sleep difficulties, then this is where clinical attention is first paid.

Sleep deprivation, whether it is a result of not being able to fall asleep, of waking up too frequently, or of not receiving refreshing sleep, affects about one third of people with special needs and is the most common of the sleep complaints. It also appears that these sleep problems often will not go away on their own. Although many children do seem to grow out of their early sleep difficulties, many do not; and, as we have learned, these sleep problems can upset the lives of everyone in the family. Examining the different types of insomnia is important because it will lead directly to the causes of these problems and ultimately to their treatment.

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Edition details

• Publisher: Brookes Publishing
• Publication date: 1997
• ISBN 10: 1557663157
• ISBN 13: 9781557663153
• Binding: Paperback
• Language: English
• Edition number: 1
• Number of pages: 288