学前儿童睡眠问题与语言障碍的关系

睡眠是个体身心健康发展的重要保障。学前期的睡眠问题可能会对儿童的行为、认知、语言和健康等诸多方面产生负面影响。研究表明, 睡眠呼吸障碍、夜间睡眠不足以及入睡困难等睡眠问题是学前儿童语言障碍的潜在威胁性因素。学者们提出了睡眠记忆巩固假说、警觉性假说和突触稳态假说来解释睡眠问题影响学前儿童语言发展的内在机制。这些研究结果为语言障碍的早期干预提供了一种新思路, 即通过行为干预、药物治疗、手术治疗和游戏干预等睡眠问题干预方式来提高学前儿童的语言能力。未来的研究可以进一步深入分析睡眠问题与语言障碍相关联的内在机制, 了解不同年龄段儿童睡眠问题与语言能力的关系, 以及探究融合教育背景下有效的游戏干预方式。     

Relationship between sleep disturbance,depression and anxiety in the 12 months following a cardiac event

We aimed to assess the prevalence of sleep disturbance in a cardiac patient population over a 12-month period and assess its relationship with treatment adherence, self-efficacy, anxiety and depression. A total of 134 patients consecutively admitted to two Australian hospitals after acute myocardial infarction (31%), or to undergo bypass surgery (29%) or percutaneous coronary intervention (40%) were interviewed at six weeks and four and 12 months. Sleep disturbance was measured using a recode of the Beck Depression Inventory (v.2) item 16. Anxiety and depression were assessed by the Hospital Anxiety and Depression Scale. Sleep disturbance was highly prevalent (69%) at 6 weeks but was not associated with 12-month psychological outcomes. Path analysis revealed that sleep disturbance at 4 months was, however, associated with reduced treatment adherence and self-efficacy, and higher anxiety and depression scores at 12 months. The high prevalence of sleep disturbance in this study and its association with psychological outcomes may have adverse prognostic implications and possibly impede cardiac rehabilitation efforts.     

Heart-rate variability during nocturnal sleep in mentally retarded children.

Heart-rate variability in four normal and 30 mentally retarded children was investigated during nocturnal sleep. In four normal and 25 mentally retarded subjects, a high frequency component defined as spectral activity between 0.15 and 0.5 Hz was found in the compressed spectral array of the power spectra. A periodic change was seen in the high frequency component which corresponded precisely to the sleep cycle. However, four children with mental retardation did not show normally expected changes in the high frequency components specific to the sleep stages: a quantity of the high frequency component in only one sleep cycle (n=2; 6 mo. and 3 yr., 8 mo.), a decreased quantity and discontinuity of the high frequency component in only the second sleep cycle (n=1; 1 yr., 2 mo.), and no high frequency component in any sleep cycle (n=1; 3 mo.) These findings suggest that some mentally retarded children have an abnormal parasympathetic nervous activity.     

Behavioral treatments for sleep problems in autism: empirically supported or just universally accepted?

With health maintenance organizations and insurance companies requiring proof of treatment efficacy, clinicians must determine whether research supports commonly used treatment methods. To determine the effectiveness of applied behavior analysis (ABA) for treating sleep problems in children with autism, a computer search of all relevant literature was conducted. The resulting articles revealed four basic themes of behavioral techniques for treating sleep disorders for children with autism: bedtime routines, extinction, stimulus fading, and faded bedtimes. Research on each technique was evaluated based on the Chambless criteria of treatment efficacy (Chambless and Hollon, 1998 ; Lonigan, Elbert, and Johnson, 1998 ). Of the ABA methods, only research on extinction provided sufficient evidence for a possibly efficacious intervention for sleep problems in children with autism. However, the lack of available research indicates significantly more research must be conducted before endorsing other ABA methods. Copyright © 2001 John Wiley & Sons, Ltd.     

An interest‐based intervention package to increase peer social interaction in young children with autism spectrum disorder

The literature suggests that children with autism spectrum disorder (ASD) educated in inclusive settings generally do not interact with typically developing classmates during social activities. This study assessed whether an intervention package consisting of interest‐based structured play activities involving adult instruction, modeling, and response to child questions would result in an increase in social interaction with typically developing peers. A multiple baseline design across four participants with an embedded reversal was used to demonstrate the effects of the intervention on social interaction during structured play sessions. Initiations, responses, and interactive play increased for all participants. Generalization to novel peers was observed, and treatment gains were maintained during 6‐week follow‐up sessions. Recommendations for practitioners working with children with ASD in inclusive settings and potential areas of future research are discussed.     

An extension of commonly used toilet-training procedures to children with autism spectrum disorder

The current study evaluated a toilet-training treatment package described by Greer et al. (2016) with children diagnosed with autism spectrum disorder (ASD). Most of the current research on toilet-training interventions for children with ASD are replications and modifications of Azrin and Foxx (1971) or (more recently) LeBlanc et al. (2005). However, these procedures are composed of components that are not included in studies with typically developing (TD) children. For example, Greer et al. evaluated the effectiveness of three typical components within a toilet-training package, mostly with TD participants: a 30-min sit schedule, placing participants in underwear, and differential reinforcement. The primary purpose of the current study was to replicate and extend the treatment package described by Greer et al. to children with ASD. A secondary purpose was to evaluate modifications necessary for individualized toilet training when the commonly used components were ineffective. The results of Greer et al. were replicated for 11 participants with ASD in the current study, suggesting that intensive toileting interventions (e.g., interventions requiring overcorrection, reprimands, and dense sit schedules) may only be necessary for a subset of individuals with ASD.     

PEER-MEDIATED PROCEDURES TO INDUCE SWALLOWING AND FOOD ACCEPTANCE IN YOUNG CHILDREN

Two studies demonstrated a functional relationship between a peer modeling procedure and the treatment of feeding disorders with 2 young children. In the first experiment, the use of a peer model treatment package was shown to induce swallowing in a child with dysphagia who had never swallowed food or liquid. In the second experiment, a child who consistently declined food was induced to increase food acceptance as a function of the same peer modeling package. In the latter experiment, a peer-mediated procedure, consisting of rotated opportunities to consume food with a peer, was found to increase consumption more than did modeling alone. The first experiment used a multiple baseline design across solids and liquids, and the second used a multiple treatment design. The results of both experiments are discussed as new and nonaversive treatments for feeding disorders of young children who are imitative.     

Targeting Co-Sleeping in Children With Anxiety Disorders Using a Modified Bedtime Pass Intervention: A Case Series Using a Changing Criterion Design

Children with anxiety disorders experience high rates of sleep-related problems, with co-sleeping and resistance to sleeping independently being among the more frequent problems reported. Although extinction-based behavioral sleep interventions have repeatedly been shown to be highly effective for treating bedtime resistance, the primary obstacle to their implementation is parent discomfort with these procedures. The bedtime pass intervention was developed to minimize extinction bursts when implementing extinction procedures for childhood sleep problems. Several studies have found this intervention to be effective for treating bedtime resistance behaviors, but not co-sleeping specifically, in nonclinical samples of children. The current paper describes the use of a modified bedtime pass procedure to target problematic co-sleeping and related bedtime resistance behaviors in two children with anxiety disorders who presented for treatment at an outpatient pediatric anxiety specialty clinic. A changing criterion, single subject methodology was used to evaluate the effectiveness of this procedure. Data indicate that both children were able to transition from co-sleeping with parents every night, to sleeping independently, with relatively limited need for contact with parents at night during the intervention. These findings extend the data for the bedtime pass procedure to both co-sleeping and children with anxiety disorders. Clinical implications of these findings are discussed given the limited guidance for treating comorbid sleep problems in anxious children. Strengths and limitations of the data being drawn from a clinical treatment setting are also discussed.     

Parent‐implemented treatment for automatically maintained stereotypy

Automatically maintained stereotypy is common among children with autism spectrum disorder. The purpose of this study was to evaluate the effect of a multicomponent parent‐implemented intervention on the reduction of motor stereotypy for a child with autism. A 2‐year‐old child and her father participated in this study. The effect of a parent‐implemented intervention was evaluated using an alternating treatment design. The results indicated that the parent‐implemented treatment package including differential reinforcement, response blocking, and a competing stimulus decreased automatically maintained motor stereotypy.     

Treatment of sleep-maintenance insomnia in older adults: sleep period reduction, sleep education, and modified stimulus control

We evaluated a behavioral treatment package consisting of sleep period restriction, sleep education, and modified stimulus control in the treatment of sleep-maintenance insomnia in older adults. A multiple baseline design was used with 4 chronic insomniac subjects, ages 59, 65, 65, and 72. Sleep diaries and an objective behavioral measure of sleep were used to monitor improvement. Results revealed clinically significant reductions in time awake after sleep onset in 3 subjects, coincident with the initiation of treatment. These improvements were maintained at 2- and 6-month follow-ups. The 4th subject showed little improvement; however, a polysomnogram conducted on this subject at the end of the study revealed a fragmented sleep pattern secondary to periodic movements of sleep (nocturnal myoclonus). These encouraging but preliminary results call for further controlled evaluations of the efficacy of this behavioral treatment package for sleep-maintenance insomnia. The importance of conducting polysomnographic studies on elderly insomniacs is discussed.     

Using a flipped spoon to decrease packing in children with feeding disorders

We evaluated the effects of redistribution and swallow facilitation with a flipped spoon on packing in 2 children with a feeding disorder. For both participants, packing decreased when we implemented the flipped spoon treatment package. Mechanisms responsible for behavior change and areas of future research are discussed.     

Brief cognitive behavioral intervention for children and adolescents with persistent post-concussive symptoms: A pilot study

This study aims to evaluate the efficacy of a brief cognitive behavioral intervention program for children and adolescents experiencing persistent post-concussion symptoms. A total of 31 patients aged 10 to 18 years participated in the intervention. The median time since injury at treatment onset was 95 days though the range was large (23–720 days). Treatment was on average four sessions in duration. Sessions included concussion education, activity scheduling, sleep hygiene relaxation training, and cognitive restructuring. Outcomes were measured using symptom reports on the Sports Concussion Assessment Tool – Third Edition (SCAT-3) and parent-reported quality of life on the Pediatric Quality of Life Inventory (PedsQL). Mixed-effects models revealed that symptom reports did not decrease prior to the initiation of this treatment, though significant symptom improvement occurred following treatment. Quality of life scores significantly improved across domains, with the largest gains made in the emotional and school domains. Participant characteristics including age, sex, maternal education, and previous mental health problems were not found to be significantly related to treatment outcomes. Contrary to predictions, length of time since injury was not related to symptom changes. The primary limitation of this study is that it lacks randomization and an experimental control group. The results suggest that brief cognitive behavioral intervention may be a promising treatment for children and adolescents experiencing persistent post-concussive symptoms and warrants further investigation.     

Life skills instruction for children with developmental disabilities

The Preschool Life Skills program is an intervention package designed to teach functional skills to prevent problem behavior in typically developing children. The purpose of the current study was to evaluate the effects of the instructional package (renamed “Life Skills”) with children with developmental disabilities. The program involved teaching 12 life skills to nine participants across four instructional units. The units were instruction following, functional communication, tolerance of denial and delay, and friendship skills. Teachers provided instruction through a three-tiered instructional approach, starting with class-wide instruction followed by small group and one-to-one instruction as necessary. We extended previous research by using visual prompts during all three tiers and progressively increasing intertrial intervals during one-to-one instruction. Results indicated that the intervention led to skill acquisition with all nine participants. The skills maintained 4 weeks after instruction ended.     

An Experimental Analysis of the Effects of Reading Interventions in a Small Group Reading Instruction Context

The current study examined the effects of several combinations of instructional and motivational interventions on oral reading fluency in the context of small group reading instruction. A treatment package consisting of acquisition, fluency, and motivational components was examined and then dismantled. Results were evaluated individually for each participant using a multiple-probe design in order to identify the most effective, yet efficient reading intervention package for each member of the group. The results indicated that, although all potential combinations of the package were effective, the experimental analysis was able to identify an effective yet more efficient package that produced substantial increases in performance across all students. Results are discussed in terms of effective instructional components in small group instruction and how to adapt methods for the experimental analysis of behavior to make decisions about the effectiveness of small group instruction in reading.This study is based on a dissertation submitted by the first author in partial fulfillment of requirements for the doctoral degree.     

A translational evaluation of renewal of inappropriate mealtime behavior

The term renewal describes the recurrence of previously extinguished behavior that occurs when the intervention context changes. Renewal has important clinical relevance as a paradigm for studying treatment relapse because context changes are necessary for generalization and maintenance of most intervention outcomes. The effects of context changes are particularly important during intervention for pediatric feeding disorders because children eat in a variety of contexts, and extinction is an empirically supported and often necessary intervention. Therefore, we used an ABA arrangement to test for renewal during intervention with 3 children diagnosed with a feeding disorder. The A phase was functional reinforcement of inappropriate mealtime behavior in a simulated home setting with the child's caregiver as feeder, B was function‐based extinction in a standard clinic setting with a therapist as feeder, and the return to the A phase was function‐based extinction in a simulated home setting with caregiver as feeder. Returning to Context A resulted in renewal of inappropriate mealtime behavior across children, despite the caregivers' continued implementation of function‐based extinction with high levels of integrity.     

EFFECTS OF A VIDEOTAPE FEEDBACK PACKAGE ON THE PEER INTERACTIONS OF CHILDREN WITH SERIOUS BEHAVIORAL AND EMOTIONAL CHALLENGES

Peer interactions are among the greatest challenges experienced by children who have severe emotional and behavioral problems. This study evaluated an intervention package designed to increase the ratio of these children's desirable to undesirable interactions. The package included three principal components: (a) observation of videotapes following regularly scheduled peer activity sessions; (b) self-evaluation of the children's peer interactions observed on the videotapes; and (c) delayed feedback and reinforcement for desirable peer interactions. Five students from two elementary schools participated. Multiple baseline designs and one reversal were used to evaluate the effects of the intervention package. The results showed that the intervention produced lower levels of undesirable peer interactions and higher ratios of desirable to undesirable interactions for all participants. The results are discussed in regard to their conceptual and applied implications and in terms of specific directions for future research.     

Rationale and principles for early intervention with young children at risk for anxiety disorders

Anxiety disorders are one of the most prevalent categories of disorder among adults and children. Children of parents with anxiety disorders are known to be at higher risk for anxiety disorders themselves, with manifestations of this risk often appearing in toddlerhood or early childhood. Yet because affected parents are often unskilled in anxiety management, they often have difficulty in helping their young children learn to manage anxiety. Literature on the course of anxiety disorders through childhood and on effective cognitive-behavioral interventions suggests that preventive interventions even with very young children could potentially be of benefit in mitigating the course of these often debilitating disorders. This paper outlines the rationale for offering early or preventive interventions to preschool-age children at risk and their parents and discusses means of identifying children to target for intervention and the importance of parental involvement. Drawing upon the literature on parental factors in childhood anxiety disorders as well as on effective intervention strategies with preschool-age children, it delineates principles for intervention with parents and effective components of intervention with youngsters in this age range.     

Brief Behavioral Intervention for Young Children with Disruptive Behaviors

Parent reported behavioral difficulties in young children are relatively common. Without adequate intervention, some children will later present with more severe problem behaviors. Parent management training is one of the best methods of treatment for behavior problems; however, existing treatments can be lengthy and difficult to conduct outside of a research setting. The Brief Behavioral Intervention was designed as a briefer version of a manualized parent management training treatment package. Thirty-one parents of children aged 2–6.5 presenting with behavior problems were included in this initial study of treatment effectiveness. Based on parent and teacher report, treatment was effective in a mean of 7.2 sessions.     

The sleep patterns and problems of clinically anxious children

Childhood sleep problems have been associated with a range of adverse cognitive and academic outcomes, as well as increased impulsivity and emotional disorders such as anxiety and depression. The aim of the study was to examine subjective reports of sleep-related problems in children with anxiety disorders during school and weekend nights. Thirty-seven children with clinically-diagnosed anxiety disorders and 26 non-clinical children aged 7-12 years completed an on-line sleep diary to track sleep patterns across school nights and weekend nights. Anxious children reported going to bed significantly later (p = 0.03) and had significantly less sleep (p = 0.006) on school nights compared to non-anxious children. No significant differences in sleep onset latency, number of awakenings or time awake during the night, daytime sleepiness, or fatigue were found between the two groups. On the weekends, anxious children fell asleep quicker and were less awake during the night than on weeknights. School-aged anxiety disordered children showed a sleep pattern that differs from their non-anxious peers. Although the mean 30 min less sleep experienced by anxious children may initially seem small, the potential consequences on daytime performance from an accumulation of such a sleep deficit may be significant, and further investigation is warranted.