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VOLUME 29, ISSUE 10


Behavioral Treatment of Bedtime Problems and Night Wakings in Infants and Young Children

Jodi A. Mindell, PhD1,4; Brett Kuhn, PhD2; Daniel S. Lewin, PhD3; Lisa J. Meltzer, PhD4; Avi Sadeh, DSc5

1Department of Psychology, Saint Joseph’s University, Philadelphia, PA; 2University of Nebraska Medical Center, Omaha, NE; 3Children’s National Medical Center, George Washington University School of Medicine, Washington, DC; 4Children’s Hospital of Pennsylvania, Philadelphia, PA; 5Department of Psychology, Tel Aviv University, Tel Aviv, Israel



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This paper reviews the evidence regarding the effi cacy of behavioral treatments for bedtime problems and night wakings in young children. It is based on a review of 52 treatment studies by a task force appointed by the American Academy of Sleep Medicine to develop practice parameters on behavioral treatments for the clinical management of bedtime problems and night wakings in young children. The fi ndings indicate that behavioral therapies produce reliable and durable changes. Across all studies, 94% report that behavioral interventions were effi cacious, with over 80% of children treated demonstrating clinically significant improvement that was maintained for 3 to 6 months. In particular, empirical evidence from controlled group studies utilizing Sackett criteria for evidence-based treatment provides strong support for unmodifi ed extinction and preventive parent education. In addition, support is provided for graduated extinction, bedtime fading/positive routines, and scheduled awakenings. Additional research is needed to examine delivery methods of treatment, longer-term effi cacy, and the role of pharmacological agents. Furthermore, pediatric sleep researchers are strongly encouraged to develop standardized diagnostic criteria and more objective measures, and to come to a consensus on critical outcome variables.

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