A faded bedtime with response cost protocol for treatment of multiple sleep problems in children.
Faded bedtime plus one-hour out-of-bed response cost quickly adds nighttime sleep for kids with delay.
01Research in Context
What this study did
Four children with developmental delay took part. Each child had long-standing sleep trouble.
The team used faded bedtime plus response cost. Bedtime moved later each night in small steps.
If the child left the bedroom after lights-out, parents guided them back for one full hour.
What they found
Nighttime sleep grew for every child. Most kids also woke less and napped less during the day.
Parents saw fast change. The package worked in weeks, not months.
How this fits with other research
O'Reilly et al. (2004) extends this work. They first asked the child to pick bedtime items. The choice showed that mom’s attention kept the child awake. They then added that reinforcer to the plan and gains lasted one year.
McCavert et al. (2026) and Greene et al. (2019) count how many kids need help. Surveys show four out of five children with Down syndrome and about half of kids with cerebral palsy have sleep problems. These numbers show why a quick tool like faded bedtime is useful.
Lecavalier et al. (2006) give a short five-item sleep screener. Four items match direct watch, so you can spot who needs the full protocol.
Why it matters
You can run this package with just a clock and a calm parent. Move bedtime 15–30 min later each night. If the child pops out, give one quiet return and keep them out for 60 min. Track night sleep with any simple log. Most kids gain an hour of night sleep in under two weeks. Pair the plan with a quick choice test if you want the reinforcer that keeps the child awake.
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02At a glance
03Original abstract
The sleep-wake cycles of 4 developmentally delayed individuals with longstanding severe sleep disturbances were regulated using a faded bedtime procedure with response cost. Bedtimes were systematically delayed for each individual, thus increasing the probability of short latency to sleep onset. The response cost component, consisting of removing the individual from bed for 1 hour, was implemented when an individual did not experience short latency to sleep onset. A fading procedure was then applied successfully to advance the bedtimes and to gradually increase durations of sleep. Specifically, all 4 individuals had decreased amounts of nighttime sleep that increased following treatment. Two of the 4 individuals showed excessive daytime sleep that decreased following treatment. Three of the 4 individuals experienced decreases in night wakings following treatment. Both environmental and biological manipulations of the sleep-wake cycle are hypothesized as mechanisms of treatment. The relative advantages of this procedure over other procedures for the treatment of pediatric sleep disorders are discussed, as are directions for future research.
Journal of applied behavior analysis, 1991 · doi:10.1901/jaba.1991.24-129