Description of behavioural treatments2

Positive routines A 20 minute winding down bedtime routine close to the child’s bedtime, which was brought forward by 5–10 minutes per week to an appropriate bedtime. After completion of the routine, any resistance from the child was dealt with by parents saying “It’s time for sleep” and placing the child back in bed if necessary.
Graduated extinctions Parents ignored bedtime tantrums for preset time intervals, the duration of which increased each week. At the end of the interval, parents entered the room, put the child back in bed if necessary, and told them it was “time for sleep” before leaving the room again after a maximum of 15 seconds.
Scheduled waking Parents were instructed to wake their child 15–60 minutes before the child usually woke spontaneously and to resettle them to sleep in their usual manner. Number and timing of scheduled wakes were modified on a semi-weekly basis, depending on the child’s sleep patterns during the previous few nights.
Extinction or systematic ignoring Parents went to their children when they were first heard to cry, checked that they were not ill, and changed nappies in the cot if necessary but did not pick the children up or soothe, feed, or interact with them in any way. Once reassured that the child was not ill, parents left the room and did not return for the duration of that crying episode. Further crying episodes each night were dealt with in the same way.
Modified extinction This involved parents ignoring their child for 20 minutes, and then checking that the child was not ill, but they did not pick up, soothe, interact with, or feed the child. Having reassured themselves, parents left the room and returned only after the child had displayed a settling problem or night waking for a further 20 minutes. This 20 minute checking interval was maintained throughout treatment. “Support visits,” used in conjunction with modified extinction, consisted of a visit from the therapist every 2 or 3 days during the first 3 weeks of treatment.
Educational booklet General information about children’s sleep, described the advantages and disadvantages of the range of treatments for children’s sleep problems, and emphasised that there was no 1 solution. Supportive visits, used in conjunction with the booklet, consisted of non-directive discussion with an untrained counsellor about the children’s sleep.
Sleep programme Individually tailored behavioural programmes (using a variety of techniques which were also described in the accompanying booklet) with daily support telephone calls at first, decreasing in frequency over time, accompanied by a behavioural advice booklet.