Severity of Sleep Problems in Children with Severe Learning-Difficulties - Description and Correlates

In this study we have examined the percentage occurrence of settling and waking problems and of sleeping in the parents' bed in a sample of children with sleep problems. We found that about two-thirds had settling problems, nearly nine-tenths had waking problems, and one-third slept regularly in their parents' bed. Parents of children with sleep problems were more likely to experience a range of family problems than were parents of children with problems, and they were more likely to report a range of symptoms of stress. Most children with settling problems took at least two hours to settle to sleep at night. This behaviour was mainly tolerated or accepted by the parents. Parents gave a variety of suggestions as to triggers for settling problems, from being upset during the day to fears, illness and alterations in routine. Most parents thought the underlying explanation was the child's intellectual impairment. Over half the children with waking problems woke up every night, while 85% woke up at least three nights a week. One-third woke up three or more times a night. About two-thirds took up to half an hour to resettle, with one-third taking up to an hour. Parents (mainly mothers) tended to get up to attend to the waking child. About half of the children were thought to need attention because of physical disabilities. Illness, alteration in routine, becoming 'overtired' and 'upset' were thought to trigger waking problems. Intellectual impairment was again seen as the more general underlying reason for waking problems. Very few children were receiving treatment for their problems-7% were receiving medication and one was receiving a behavioural programme. Few parents had a systematic bedtime routine for their child and few had a consistent agreed response to settling or waking problems. When we examined the relationship between certain family variables and severity of sleep problems a number of relationships were found. Sleep problem severity was related to maternal responsiveness, maternal stress, impact of the child on the family, maternal behaviour towards the child, maternal attitudes towards the child and marital satisfaction. Severity of sleep problems was also related to certain child characteristics. Children with more severe problems tended to present more problems in their daytime behaviour. Sleep problem severity was also found to be related to child communication skills. These findings, together with those from other pilot studies, suggest that using behavioural methods of managing sleep problems might prove a promising way forward.