This paper reviews the evidence regarding the efficacy 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 findings indicate
that behavioral therapies produce reliable and durable changes.
Across all studies, 94% report that behavioral interventions were efficacious,
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 unmodified 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 efficacy, 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.