Telehealth-delivered parent-based sleep-focused intervention for insomnia in preschool children with autism spectrum disorder: A randomized controlled study

Internet-Delivered Parent-Child Interaction Therapy and Sleep Quality in Children With Developmental Delay: Examining the Mediating Role of Bedtime Resistance Behaviors

OBJECTIVE

Sleep problems are frequently reported and associated with externalizing behavior problems in young children, especially those with developmental delay (DD). Parent-child interaction therapy (PCIT) led to improved sleep in young children with DD, but research has not examined the effect of internet-delivered PCIT (iPCIT) on sleep quality or changes in bedtime resistance behaviors as a mediator. This study examined iPCIT's effect on sleep quality in young children with DD through its impact on bedtime resistance behaviors.

METHOD

Participants were from a previously completed randomized controlled trial and included 150 children with DD (M age = 36.2 months, SD = 1.0 months) and their caregivers who were randomized to iPCIT or referrals as usual (RAU). Path analyses examined links between treatment condition, post-treatment bedtime resistance, and sleep quality reported at 6-month follow-up.

RESULTS

Treatment condition significantly influenced bedtime resistance behaviors (β = 0.17, 90% CI, [0.04, 0.29], p = 0.01), and these changes, in turn, significantly affected sleep quality reported at 6-month follow-up (β = 0.18, 90% CI, [0.03, 0.33], p = 0.02). Caregivers receiving iPCIT reported fewer bedtime resistance behaviors after treatment and improved child sleep quality at 6-month follow-up than caregivers receiving RAU.

CONCLUSION

Although effects were smaller than in other studies examining PCIT's effect on sleep, these results highlight how iPCIT led to improved sleep quality in children with DD through changes in bedtime resistance. Further research is needed to explore differences in the effectiveness of in-person versus iPCIT, as well as other mechanisms (such as parenting behaviors) through which iPCIT affects child sleep quality.

Parent Training for Disruptive Behaviors in Referred Children with Autism Spectrum Disorder: A Randomized Controlled Trial

The purpose of this study was to investigate whether face-to-face and therapist-assisted online (i.e., blended) behavioral parent training are effective on reducing disruptive behaviors in children with autism spectrum disorder (ASD) in routine mental health care. Ninety-seven children with ASD (4-13 years; 76 boys) were randomized to face-to-face parent training, blended parent training, or a waitlist control condition. We assessed treatment effects on parent-rated child noncompliance (primary outcome) and irritability (secondary outcome). This involved comparing both formats separately to the control condition using linear regression models. Child behaviors at 6 months follow-up were also examined. Children in the face-to-face parent training condition improved significantly more on noncompliance and irritability than children in the waitlist condition and improvements sustained to 6 months follow-up. Children in the blended condition did not improve more than children in the waitlist condition and attrition was high. Our results extend findings from efficacy studies to routine mental health care and advocate the use of face-to-face parent training for disruptive behaviors in children with ASD. More research into blended parent training programs for children with ASD and disruptive behaviors in routine mental health care should be conducted to draw more definite conclusions about the value of blended parent training for these children. Trial registration number NL4712; date of registration 22-10-2014.