Child Behavior and Sleep Disorders Quiz

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Questions and Answers

What is one of the most popular and effective behavioral treatments for thumb sucking?

Contingency contracting

Electric shock

Bitter substance application (correct)

Clomiprimine administration

Which medical problem can exacerbate feeding disorders in children?

Chronic thumb sucking

Gastroesophageal reflux disease (correct)

Neurological disorders

Metabolic syndrome

Which of the following is a behavioral treatment evaluated for nail biting?

Aversive conditioning

Surgery

Self-monitoring (correct)

Medication therapy

What percentage of feeding disorders in children is due to behavioral causes?

43% Signup and view all the answers

What is the only medical intervention attempted for nail biting?

Clomiprimine Signup and view all the answers

Which step is NOT part of the individualized and comprehensive treatment for sleep problems?

Increase Screen Time Before Bed Signup and view all the answers

What is a recommended initial approach for using bedtime passes?

Provide more than one pass initially and fade them out Signup and view all the answers

Which of the following is a method to help address night awakenings in children?

Teach the child when it is okay to get up using moon/sun clocks Signup and view all the answers

In the Parent Fading strategy, what is the final step in the process?

Sit outside the door not visible to the child Signup and view all the answers

Which condition is NOT specifically addressed when resolving sleep problems related to night awakenings?

Child’s diet during the day Signup and view all the answers

What is a recommended condition for optimizing a child's bedroom for sleep?

Cooler temperature Signup and view all the answers

What should be prioritized in the daytime to promote compliance at nighttime?

Starting the bedtime routine earlier than normal Signup and view all the answers

Which of the following is considered a 'good' dependency for helping a child transition to sleep?

Stuffed animal Signup and view all the answers

Which behavior is categorized as Sleep Interfering Behavior (SLIB)?

Playing and calling out in bed Signup and view all the answers

What approach should be taken after bidding goodnight to a child exhibiting Sleep Interfering Behavior?

Eliminating access to presumed reinforcers Signup and view all the answers

What is the first step in developing a sleep treatment plan for a child?

Develop an ideal sleep schedule Signup and view all the answers

What is a key consideration when optimizing bedroom conditions for sleep?

Minimizing ambient noise and light Signup and view all the answers

How should parents respond if their child falls asleep within 15 minutes of bedtime?

Move bedtime 15 minutes earlier on the next night Signup and view all the answers

What aspect of the nighttime routine helps facilitate the release of melatonin?

Progressively dimming ambient light Signup and view all the answers

What can result from scheduling a child's bedtime for too long?

Increased difficulty waking up in the morning Signup and view all the answers

What may be a consequence of chronic thumb sucking?

Dental malocclusion Signup and view all the answers

Which theory suggests that nail biting may be maintained by tension or anxiety?

Behavioral theory Signup and view all the answers

Which measurement method is preferred for assessing habit behaviors?

Direct observation Signup and view all the answers

Which of the following is thought to relate to trichotillomania according to some studies?

Serotonin deficiency Signup and view all the answers

What percentage of college-age adults reportedly engage in thumb or finger mouthing?

2.8% Signup and view all the answers

What is one of the key benefits of functional assessment in habit disorders?

It offers data to modify etiological theories. Signup and view all the answers

Which of the following medications is commonly used to treat tic disorders?

Clonidine Signup and view all the answers

What percentage of cases has habit reversal been found effective when presented in a group format for trichotillomania?

60% Signup and view all the answers

Which technique is part of awareness training to increase awareness of habit behavior?

Response detection Signup and view all the answers

What is a side effect of medications used to treat tic disorders?

Dry mouth Signup and view all the answers

What is a significant concern regarding the long-term use of soporific drugs for sleep issues in children?

Their therapeutic benefits often diminish once stopped. Signup and view all the answers

Which of the following is NOT a common sleep problem identified in children?

Sleepwalking Signup and view all the answers

What percentage of young children reportedly experience sleep problems?

35 - 50% Signup and view all the answers

Which statement accurately reflects the behavior associated with sleep assessments in children?

Behavioral quietude can be affected by environmental factors. Signup and view all the answers

What is a common outcome of pediatric visits for sleep problems?

Medications are frequently prescribed despite lack of FDA approval. Signup and view all the answers

Which behavior is a consequence of poor sleep in children?

Increased irritability Signup and view all the answers

Why do sleep problems tend to persist in children rather than resolve over time?

Sleep issues are often influenced by environmental factors. Signup and view all the answers

What are pediatricians likely to prioritize in managing childhood sleep issues?

Prescribing medications despite inconsistent efficacy signals. Signup and view all the answers

What is the first step recommended in developing a sleep treatment plan?

Develop Ideal Sleep Schedule Signup and view all the answers

Which factor influences a child's ability to sleep well when scheduling bedtimes?

The bedtime should not vary throughout the week. Signup and view all the answers

How should activities within a nighttime routine be structured?

Progress from active to passive activities. Signup and view all the answers

Why is it important to monitor ambient light during a child's nighttime routine?

To facilitate the release of endogenous melatonin. Signup and view all the answers

What should be the approach to transitioning a child's sleep phase?

Gradually adjust sleep times based on the child's sleep patterns. Signup and view all the answers

Which critical caution should be considered when managing a child's sleep schedule?

Adjusting nighttime activities to prevent overstimulation. Signup and view all the answers

Study Notes

Special Topics - Week #11

Topic: Habit Disorders
Presenter: Bev Graham, PhD, MPA, BCBA-D, LBA
Source: Austin & Carr, Chapter 6
Description: Habit disorders are repetitive responses with no apparent social function, but are maintained by operant contingencies.

Habit Disorders

Examples: Tic disorders, trichotillomania, thumb sucking, nail biting
Maintenance: Automatic reinforcement (self-stimulation or arousal reduction)
Consequences: Physical damage, social unacceptability

Tic Disorders

Prevalence: Approximately 1% of the population (motor tics); vocal tics are less clear, but 6.5% of college students engage in throat clearing at least 5 times per day; Tourette's syndrome is .04-.05%.
Characteristics: Rapid, repetitive, jerking muscle movements (motor tics) or sudden, rapid, recurrent, nonrhythmic vocalizations (vocal tics).
Concurrent Problems: Obsessive-compulsive behaviors, attention deficit/hyperactivity disorder, aggression management problems, and sleep problems

Development and Current Etiological Theories of Habit Disorders

Biological: Excess dopamine may be responsible for tics.
Behavioral: Heightened tension in specific muscle groups; tension reduction maintains tics; presence of an anxiety-provoking person reduces tension.
Genetic: 77% concordance rate for tic disorders in monozygotic twins.

Trichotillomania

Prevalence: Approximately 1-4% of the population; adult females are 3 times more likely to receive the diagnosis than males.
Characteristics: Chronic hair pulling that results in noticeable hair loss; accompanied by tension or anxiety that is relieved by pulling hair.
Consequences: Chronic hair follicle damage; severe gastrointestinal difficulties if hair is ingested.

Thumb Sucking

Prevalence: Up to 46% of children under age 4; 19% over age 5; 2.8% of college-age adults.
Characteristics: A learned behavior in infancy to modulate arousal.
Consequences: Dental malocclusion, atypical root resorption, increased risk of accidental poisoning.

Nail Biting

Characteristics: Placing any digit in the mouth and biting nails or skin around nails.
Consequences: Tissue damage or inflammation around nails, possible infection, and shortening of tooth roots.

Development and Current Etiological Theories of Habit Disorders - Nail Biting

Biological: Biological processes affected by clomipramine; clomipramine is effective in treating OCD.
Behavioral: Maintained by tension/ anxiety or increased arousal in understimulating situations.

Assessment of Habit Behaviors

Duration measures are best for longer behaviors like thumb sucking, nail biting, and hair pulling.
Physical trace measures may not always directly correlate with the behavior's level of occurrence (damage).

Measuring Habit Behaviors

Direct observation (live or videotaped) is preferred for habit behavior assessments.
Physical trace procedures (e.g., measuring nail length) can be used for particular habit behaviors.

A Functional Approach to the Assessment of Habit Disorders

Purpose: Provides data for modifying etiological theories and treatment plans.
Method: Functional analysis that identifies functions of behavior through antecedent and consequence manipulation.

Treatment of Habit Disorders (Tic Disorders Medical Treatments)

Medications: Haloperidol, clonidine, and pimozide
Side Effects: Dry mouth, constipation, sedation, possible risk of developing permanent movement disorders like tardive dyskinesia

Behavioral Treatments

Massed/Negative Practice (MP): Deliberately engaging in the target behavior rapidly and intensely for a set time or frequency.
Habit Reversal (HR): Multi-component procedure for nervous habits and motor tics; increases awareness of the behavior via response description, detection, early warning, and situation awareness training.
Competing Response (CR) Training: Client engages in a behavior incompatible with the target habit behavior.
Motivation Training: Method to increase motivation, including habit inconvenience review, public display, social support procedure, and symbolic rehearsal.
Relaxation Training: Useful for tics; functions as a dissimilar competing response.

Trichotillomania - Medical Treatments

Medications: Fluoxetine, clomipramine, imipramine, haloperidol, and lithium.

Trichotillomania - Behavioral Treatments

Habit reversal: Most effective in group settings (60% success rate).
Simplified HR package: Consists of awareness training and reinforcement training with parental social support.
Self-monitoring: Also shows positive results.
Other Treatments: Aversive conditioning; elimination of co-occurring habits like thumb sucking; reinforcement/punishment procedures.

Thumb Sucking - Medical Treatments

No medications are used for chronic thumb sucking.

Thumb Sucking - Behavioral Treatments

Popular approaches: Bitter substance application, Habit reversal.

Nail Biting - Medical Treatments

Clomipramine is the only attempted medical intervention.

Behavioral Treatments - Habit Disorders

Self-monitoring: Demonstrated to be effective.
Habit reversal: Evaluated in several studies.
Other treatments: Electric shock (portable self-administered shock device), bitter substances, contingency contracting, covert sensitization.

Feeding Disorders

Prevalence: Over 60% of children
Causes: Neurological (62%), structural (53%), behavioral (43%), cardio-respiratory (34%), metabolic (12%).
Complication: Usually multiple causes.
Vulnerable groups: Children with autism spectrum disorder, cerebral palsy, and Down syndrome.

Causes of Feeding Disorders

Direct effects on digestive system (e.g., GERD)
Digestion problems (e.g., allergies, intolerances)
Food reactions (e.g., discomfort, pain)
Anxiety and reluctance to eat due to these causes.
Taste aversions (single or repeated negative experiences).

Maintaining Factors in Feeding Disorders

Access to adult attention or tangible items reinforce negative behaviors.
Escape from food presentation/mealtime demands.
Environmental events reinforce inappropriate behaviors.

Treatment of Feeding Disorders

Stimulus fading: Gradual introduction to new textures and eating methods.
Utensil manipulation: Increasing mouth cleanliness and decreasing food packing.
Applied Behavior Analysis (ABA): Treatment for feeding challenges, including increasing food variety, utensil use, restaurant eating, and improving swallowing, and reducing mealtime tantrums.
Chewing and swallowing coordination: Crucial for eating development; a mismatch can worsen issues.

Behavioral Pediatrics

Exploration of how children's behavior connects to their health needs.
Focus: Psychological and emotional well being alongside physical health.
Role: Early intervention and support.

Rates of Behavioral Disorders in Pediatrics

Prevalence: Approximately 25% of children exhibit symptoms of behavioral disorders in primary care.
Other symptoms: 40% or more of children display subclinical behavior concerns.

Key Principles of Behavioral Pediatrics

Behavior is influenced by current and past circumstances and contexts.
Interventions are tailored to the individual needs of each child and addressing issues like discipline, incontinence, sleep, and ADHD.

Bedtime Problems

Prevalence: 30% of families experience sleep issues.
Difficulties: Resistance, fussing, crying, night waking.
Treatment: Use of soporific drugs (but with side effects and limited long-term efficacy).

Understanding and Treating Sleep Problems of Children with Autism

Significance: Sleep disruption significantly impacts family dynamics and children's health and emotional stability.
Importance: Recognizing the needs of children with autism is crucial for treatment.
Factors: Irritability, fatigue, unintentional injuries, difficulty following instructions or learning concepts, problem behaviors.

How Prevalent Are Sleep Problems in Children?

Young children: 35-50%
Autism: 63-73%

Treatment Options for Children's Sleep Problems

Medication: Commonly prescribed without FDA approval for pediatric insomnia.
Issues: Inconsistent or limited effectiveness, often with noticeable side effects.

Common Sleep Problems

Nighttime routine noncompliance: Difficulty following instructions
Sleep-interfering behavior: Behaviors that hinder sleep.
Delayed sleep onset: Difficulty initiating sleep.
Night awakenings: Waking up during the night
Early awakenings: Waking up too early.

Assumptions Regarding Sleep

Sleep behavior is influenced by past and present events, motivation, environmental cues, and other competing reinforcers.
Assessment Methods: Open-ended, indirect assessment to identify factors influencing sleep.
Tool: Sleep Assessment and Treatment Tool (SATT).
Implementation: Support of parents in applying assessment-based treatment via communication.

Steps to Treat Children's Sleep Problems

Develop ideal sleep schedule
Routinize bedtime routine
Optimize bedroom conditions (e.g., cooler temperature, minimal noise, indirect lighting).
Regularize sleep dependencies (e.g., reduce reliance on specific stimuli).
Address sleep-interfering behavior (e.g., eliminate or reduce negative behaviors).
Age-based sleep averages (1-18)
Sleep Scheduling and Cautions: Adjusting bedtime slightly and making gradual transitions, considering sleep total, consistency.

Encopresis

Fecal retention: Primary driver of encopresis.
Contributing Factors: Gastrointestinal transit time, dietary choices, pain during stool passage, negative reinforcement.
Related conditions: Trauma, other neurological issues.

Encopresis - Medical Factors

Constipation: Major role in developing encopresis due to fecal impaction
Neurological conditions, such as Hirschsprung's disease.
Anatomical defects: May necessitate medical intervention.

Encopresis - Behavioral Assessment

Interviews: Identify factors related to constipation.
Essential questions:
- Length of intervals between bowel movements?
- Size and presence of foul odor in stools?
- Difficulty, pain, discomfort during bowel movements?
- Awareness of the urge to defecate?
- Hiding soiled underwear?

Incentive Programs

Structure: Breaks comprehensive regimens into smaller, manageable steps.
Rewards: Tokens/points earned for completing steps, creating clear links between effort and reward.
Consistency reinforcement: Removing tokens/points for non-compliance underlines the importance of consistency.

Rapid Toilet Training (Azrin & Fox, 1971)

Population: Incontinent males with profound disabilities.
Procedure: Treatment protocol (Appendix) and automated system for immediate reinforcement for successful toileting.
Apparatus: Moisture sensitive shorts, alarm system that sounds via urination/defecation, for immediate reinforcement to be successful.

Positive Reinforcement: Residents received significant positive reinforcement.
Noncompliance: Residents often resisted exiting the toilet area at the end of training sessions
Aggression/Disruptive behaviors: No reported instances.

Toilet Training

Prevalence: 30-50% of children with ASD.
Developmental milestone: Typically begins between 18-30 months.
Collaborating Roles: Childcare centers and pediatricians can help initiate the training program.

Comparison of Toilet Training Methods (Underwear, Dense Sit, Differential Reinforcement)

Detailed description of procedures used.

Toilet Training Participants

20 children across three classrooms with varied teacher-child ratios.
Training conducted by undergraduate students participating in a practicum course.

Toilet Training Procedures

Detailed reporting of assessments and procedures

Baseline Procedures

Subjects wore disposable diapers/pull-up training pants.
Prompted to sit on the toilet regularly, and rewarded with preferred items after successful bowel movements.

Conclusions

Implications for future research on toilet training
Discussion of areas for improvement, including specific behaviors and additional factors, to measure the success of the program and collect additional data

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Description

Test your knowledge on behavioral treatments for common childhood issues such as thumb sucking, nail biting, and sleep problems. This quiz covers effective strategies and medical factors that affect feeding and sleep disorders in children. Assess your understanding of these important child development topics.