Treatment of Infant Sleep Disturbance by Graduated Extinction

Abstract

Chronic disturbed sleep is a common problem in preschool children. Treatment by extinction is successful but may be accompanied by side-effects such as post-extinction response bursts which make the treatment aversive to parents and which impairs their compliance. This study evaluated a modified procedure, graduated extinction, which required parents gradually to reduce attention to bedtime disturbance and night waking from average baseline levels to zero over 28 days. Baseline measures of frequency and duration of night waking, sleep-onset latency, and bedtime delay were made for six children (6- to 14-months-old). Parents were then instructed to use graduated extinction using a multiple-baseline-across-subjects design. Following treatment, three out of six children showed clinically significant reductions in the frequency and duration of night waking, and a fourth child substantially reduced the duration of her wakings. These gains were maintained at followup. Lack of improvement was associated with parental noncompliance with treatment and childhood illness. Two subjects showed some evidence of post-extinction response bursts despite the gradual withdrawal of parental attention. Parents reported high satisfaction with the procedures but half found the procedure mildly to moderately stressful. While graduated extinction was an effective treatment, regular extinction offers practical and clinical advantages in most cases.