Brief sleep intervention to enhance behavioral parent training for noncompliance: Preliminary findings from a practice-based study

The purpose of this study was to conduct a preliminary evaluation of a brief behavioral sleep protocol for enhancing standard behavioral treatment for child noncompliance among children with behavior problems. Data were drawn from an archival analysis of pediatric cases treated for noncompliance or disruptive behavior problems in an outpatient behavioral health clinic. A total of 50 cases (mean age = 7.6 years) were identified in which the brief behavioral sleep protocol was delivered prior to behavioral parent training, and weekly parent ratings of child sleep and compliance were collected. Repeated-measures analyses indicated a significant immediate improvement in both child sleep and compliance ratings following the brief behavioral sleep protocol and prior to initiating behavioral parent training. Analyses examining changes from pretreatment to the end of all treatment (including both sleep and behavioral parent training) indicated large improvements in parent ratings of child compliance, with an effect size much larger than typical effect sizes in the literature for behavioral parent training alone. Treatment effects did not significantly differ across 3 clinicians delivering the interventions. Results of this preliminary evaluation suggest that the addition of a brief behavioral sleep protocol at the beginning of standard behavioral treatment for child noncompliance can substantially improve treatment outcomes. Further evaluation using rigorous clinical trial methods and norm-referenced measures is needed, but this study suggests that addressing sleep problems may be an important component of optimal treatment for child behavior problems.