Date of interview/workshop:
Child’s name: Child’s birth date: Check one: Male Female
Name(s) of caregiver(s) who puts the child to bed:
Phone: Address:
Email:
Child medical or educational diagnoses:
Does your child engage in severe problem behavior like aggression towards adults or self-injury? Yes No
If yes, please describe:
Please provide a description of your child’s sleep problem(s):
How long have these problems occurred?
If your child taking medication(s) for sleep? Yes No
If yes, list the medication(s), dosage, and time of administration here:
What have you done in the past to address your child’s sleep problems?
Sleep Assessment and Treatment Tool
Developed by Gregory P. Hanley Ph.D. BCBA-D (2005)
Step 1: Basic Information
Step 2: Sleep Problem and History
Describe your goals regarding your child’s sleep:
(e.g., be able to fall asleep within 15 min and stay asleep throughout the night; be able to sleep independently without
the presence of parents; be able to sleep without medication; be able to follow bedtime instruction etc…)
1.
2.
3.
4.
5.
(A) Nighttime Routine Noncompliance
Does your child have difficulty going into the bedroom at night when instructed to do so or brought in to go to sleep?
Yes No
Does your child have difficulty following other bedtime-related instructions (e.g., change into pajamas, brush teeth)
Yes No
If yes, your child’s behavior pattern is referred to as Nighttime Routine Noncompliance
If yes, please provide some details:
If yes, what do you usually do to help your child to go to bed?
If yes, what usually works to get your child to go to bed?
(B) Sleep Interfering Behavior
Once in bed, does your child have difficulty staying in bed or remaining still in bed when instructed to do so? Does
your child repeatedly call out or engage in other behavior that requires you to return to his or her bedroom?
Yes No
If yes, your child’s behavior pattern is referred to as Interfering Behavior
(Check type: leaving bed call outs crying playing in bed stereotypy other )
If yes, please provide some details:
Step 3: Sleep Goals
Step 4: Identifying the Specific Problems
If yes, what do you do to help your child to stay in bed?
If yes, what usually works to get your child to stay in bed?
If yes, what usually works to get your child to stop the “crying or the call outs etc…?”
(C) Delayed Sleep Onset
Once in bed, does your child have difficulty falling asleep (i.e., it typically takes more than 15 min for him or her to fall
asleep?
Yes No
If yes, your child’s behavior pattern is referred to as Delayed Sleep Onset
If yes, please provide some details:
If yes, what do you do to help your child to fall asleep?
If yes, what usually works to get your child to fall asleep?
(D)Night Awakenings
Once asleep, does your child wake in the middle of the night?
Yes No
If yes, your child’s behavior pattern is referred to as Night Awakenings
If yes, how many times per night on average? If yes, how many nights per week on average?
If yes, please provide some details?
If yes, what do you do to help your child fall back asleep?
If yes, what usually works to get your child to fall back asleep?
(E) Early Awakenings
Does your child routinely wake too early in the morning?
Yes No
If yes, your child’s behavior pattern is referred to as Early Awakenings
If yes, how many times per week on average?
If yes, do you try to help your child go back to bed? Yes No
If yes, what do you do to help him or her go back to bed?
If you do not try to help your child back to sleep, in what activities does your child engage at those early hours?
Now
Step 5: Sleep Schedule
At what time is your child typically bid goodnight? AM PM
At what time does your child typically fall asleep? AM PM
Sleep Onset Delay = min = (time from bidding goodnight to falling asleep)
At what time does your child wake in the morning? AM PM
Total Night Sleep = hr = (time from falling asleep to waking)
At what time does your child typically go down for a nap?
From: AM PM To: AM PM Total Nap = hr
Total Sleep = hr = (total night sleep + total nap)
Now
When does your child need to wake up in the morning? AM
Subtract total hours of sleep needed (based on developmental norms or your goal) from the morning wake time:
PM (this is the bedtime you should reach by the end of treatment)
Add one hr to when your child typically falls asleep right now:
AM PM (this is the new bid goodnight time at the start of treatment)
Add total hours of needed (based on developmental norms or your goal) to the new bid goodnight time:
AM (this is the child’s wake time at the start of treatment)
***Instructions for bedtime fading: If your child falls asleep within 15 min, put your child to bed 15 min earlier the
next night and wake your child 15 min earlier the next morning. Continue to do so until you reach the desired
bedtime at the end of treatment. If the child does not fall asleep within 15 min, stay at the current bedtime.
End of Treatment
Start of Treatment
Step 6: Pre-Sleep Routines
Describe what takes place during ½ hr prior to the child
going to bed for sleep:
Do the pre-sleep activities typically vary each night or
are they relatively routine? Please describe:
Describe what takes place between the time when the
child is in bed initially and when you leave the
bedroom:
Now
Describe what will take place during the ½ hr prior to
the child going to bed for sleep:
Describe what may vary and what will be fairly routine:
Describe what you will do in the time between placing
your child in bed and leaving the room:
With Treatment
(A) Lighting
What is the lighting like in the bedroom when the child sleeps? (e.g., nightlight or lamps turned on, direct or indirect
lighting, brightness level etc…)
Does the lighting change? (e.g., do you turn off the light only after the child falls asleep)
Do the curtains shut when the child sleeps and does it block lights from the street, cars, or the sun?
(B) Temperature
What is the temperature like in the bedroom when the child sleeps? (e.g., cool or hot)
Does the temperature change at night?
Can the child manage his or her temperature?
(C) Sound
What is the sound environment like in the bedroom when the child sleeps? (e.g., loud noises, very quiet)
Are there a lot of changes in the noise level when the child sleeps? (e.g., TV or music turned off after a few hours)
(D)Bed
What type of bed does the child sleep in (e.g., bunk bed, bed with rails etc…)
What is the mattress quality? (e.g., could it cause discomfort?)
(E) Other
Is there anything else about the child’s ambient sleep environment that can influence his or her sleep? (e.g., odor,
humidity etc…)
Step 7: Ambient Sleep Environment
1. Be sure to capitalize on sleep pressure by sending the child to bed at the beginning of their sleep phase.
2. Teach your child to be compliant during the day. See these 10 steps to gain compliance.
3. Make sure there is a clear discrepancy in the quality of the end of the routine: high quality routine (e.g., choice
of bedtime stories) should follow compliance or better listening and low quality routine (e.g., not providing rich
social interaction) should follow noncompliance.
With Treatment
Step 8: Nighttime Compliance with Routine-Related Instructions
Step 9: Sleep Dependencies
Do you lay in bed with your child to help him or her fall
asleep? Yes No
If yes, please describe what you do to help your child
fall asleep:
If yes, please see Step 10 for ways to address this
dependency.
Please check any of the following things/stimuli that
your child goes to bed with: (check all that apply)
TV If checked TV or Radio, is it off prior to
Radio waking or does it stay on continuously?
Pacifier
Lights
Bottle
“Full belly” (i.e. large snack within ½ hr of
Stuffed animal going to bed?)
Blanket
Preferred object
If you check any above, please provide some details
here:
Is there anything else that your child’s sleep seems to be
dependent upon? Yes No
If yes, please describe here:
Now
My child will go to bed with:
Add a sound machine:
a. Choose white noise or vacuum
b. Noise should be continuous with no disruption
c. Start out at an imperceptible volume and
gradually increase the volume each night until
conversational level is reached
d. The machine should be turned on just prior to
bidding goodnight, stay on throughout the night,
and turn off upon waking
e. Consider putting in the hallway for all family
member to benefit
Recommended sound machines:
Can be purchased at www. .com
With Treatment
Tranquil Moments White
Noise Sound Machine for
Baby for $69.99
Step 10: Sleep Interfering Behavior
List the interfering behaviors and their possible reinforcers:
Interfering behavior(s) Possible reinforcer(s)
Now
How will you provide the reinforcer(s) before it is time for your child to fall asleep?
What physical barriers or limits can you put in place to restrict access to the reinforcer(s) after you bid the child
goodnight?
Choose the strategies below that you will use to withhold and/or provide the reinforcer(s) in alternative ways:
Bedtime Pass Time-based Visiting Extinction Progressive Waiting
Quiet-based Visiting Quality Fading Parent Fading
Describe how you will carry out the strategies here:
Use the table below to sketch out a plan for changing the schedule on which you will visit the child:
Night\Time
1st
night
2nd
night
3rd
night
4th
night
5th
night
6th
night
7th
night
8th
night
9th
night
With Treatment
Step 11: Nighttime and Early Awakenings, Confusional Arousals, and Nightmares
First determine whether the child is experiencing Night or Early Awakenings, and distinguish it from Confusional
Arousals and Nightmares
If Night or Early Awakenings occur regularly without experiencing confusional arousals or nightmares, there is
probably a problem with the child’s sleep schedule or with an inappropriate sleep dependency, so eliminating
excessive night awakening can be accomplished by adjusting the child’s sleep schedule or sleep dependencies.
Other Variables that can possibly lead to awakenings at night:
Is the bedroom warmer when the child wakes than when the child is asleep? Yes No
If yes, please describe:
Is it possible that the child is hungry when he or she wakes? Yes No
If yes, please describe:
Is it possible that any light is hitting the eyes when the child wakes? Yes No
If yes, please describe:
Is it possible that the child is wet or soiled? Yes No
If yes, please describe:
Is there anything occurring in the middle of the night or early in the morning that is motivating kids to wake?
Yes No If yes, please describe:
Is there anything in the environment that is waking up the child? (e.g., garbage man, sibling coming in, dog barking)
Yes No If yes, please describe:
If Confusional Arousals occur,
a. Help your child develop good sleep habits (see above)
b. Let episode run its course (do not interfere or try to talk the child out of it), then, when over, assist back in bed
c. Eliminate nighttime “jobs” that your child must do before going back to sleep; she should not have to call for
something, look for something, or check her surroundings to get back to sleep
d. If possible, remove materials that result in compulsive behavior from bedroom
If Nightmares occur:
a. Help your child develop good sleep habits (see above)
b. Avoid developmentally inappropriate TV, movies, magazines, and video games
c. Soothe your child’s fears by listening to them, but show them that you are in control and that they are safe
d. Do not feel obligated to grant all requests (e.g., keep lights on, check for monsters, etc.) following repeated
nightmares
e. Help them with their anxieties during the day hours
f. Address nighttime fears by teaching child relaxation techniques and reward “bravery” in the morning
Submit
Ten Compliance Strategies for Use in the Home by Parents of Young Children (1 to 12 years of age)
(Prepared by Gregory Hanley [ghanley@wne.edu] and Lauren Beaulieu of Western New England University, 7-28-11)
1. Decrease the amount of instructions per day.
2. Eliminate instructions from play-based (free play, child-led) interactions. During these play times, focus simply on
watching your child, commenting on their play when you are genuinely impressed by what they are doing or have done,
and being available for when they want you to see their accomplishments.
3. Only provide instructions with which you can follow through (e.g., motor-based instructions). In other words, eliminate
instructions to eat, sleep, pee/poop on the toilet, talk (e.g., say they are sorry). These are skills that require some sort of
shaping if they are not occurring at developmentally appropriate times.
4. Provide many choices during the day outside of instructional situations to give the child some degree of control (e.g.,
choosing which of several outfits to wear, what to have for snack from an array of choices, the order in which to complete
chores or academics).
5. Always call the child’s name prior to an instruction, pausing, and then only deliver the instruction after the child has
stopped what they were doing, said “yes,” and is looking at you. Teach this skill by:
a. Letting the child know that you expect him or her to stop, look, say, “yes,” and wait for further instruction
when they hear their name being called.
b. Calling the child’s name just prior to giving compliments, snacks, preferred activities. In other words, we
would like them to perk up when their name is called, so make sure that when they hear their name, it is not
always followed by an instruction; make sure good things happen after their name is called.
6. Deliver clear, concise, and direct instructions (“Billy, …. put all of the blocks in the bucket”); avoid vague (e.g., “Shape
up”), wordy, or indirect instructions (e.g., “It would be nice if somebody cleaned up stuff”).
7. If your child does not yet engage in the name response, try to get close to child and on their level, touch their shoulder or
forearm, and provide some brief attention (e.g., a compliment) before delivering the instruction, then frame the instruction
as a “do” as opposed to “don’t” instruction, and place your hands on their hands if their hands are still “busy.”
8. Deliver instructions using 3-step prompting (tell, show, help) and always follow through with that which was instructed.
a. Once you have the child’s attention, deliver a specific and clear instruction (e.g., “Pick up the toy”).
b. If the child does not comply within 5 s to your clear and concise instruction, repeat the instruction, this time
modeling the specified action (e.g., instruct him/her to pick up the toy, while showing him the action of
picking up the toy).
c. If the child still does not comply following 5 s, repeat the instruction, while physically guiding the child to
complete the instruction (e.g., use hand-over-hand guidance to have the child pick up the toy). Always use the
least amount of physical assistance when guiding the desired response while maintaining a positive to neutral
tone of voice; it is important not to complete the instruction for the child once an instruction has been
delivered, or provide any attention to inappropriate behaviors during the instructional sequence.
d. If the child complies with an instruction following the first (verbal) or second (verbal plus model) prompt,
praise the child while describing the instructed behavior (e.g., “Thank you for picking up the toy” or “Good
job picking up the toy”). If you have to use physical assistance with the instruction (third prompt), do not
provide praise, simply move on to the next instruction or activity.
9. Provide authentic praise and acknowledgement (and sometimes “upgrades” or rewards) when your child complies with
your instructions. By contrast, withhold quality attention (both positive and negative types of attention) following
noncompliance (and ensure that follow through is provided).
10. If the child becomes aggressive or highly disruptive following an instruction, implement a safe and effective time-out
period (e.g., 1 to 2 min without access to any reinforcers); once the time out period is over, re-issue the same instruction
that occasioned the aggressive behavior.