Treatment of sleep problems in a toddler: a replication of the faded bedtime with response cost protocol.

Eisenmajer et al. (1998) worked with parents of a two-year-old girl who would not stay in bed. The team taught the parents to use two tools together: faded bedtime and response cost.

Faded bedtime means the child goes to bed only when she is very sleepy. Response cost means she loses a happy-face token each time she leaves the bedroom. The parents ran the whole plan at home.

The little girl’s sleep problems dropped fast once the parents started the plan. Night-wakings, leaving the room, and crying all fell to near zero within days.

The gains held for the full three-week follow-up. Mom and dad said the plan was easy to keep doing.

Lippold et al. (2009) later used the same bedtime ideas with adults who have intellectual disabilities living in group homes. Their case series also showed quick gains, showing the trick works across ages and settings.

Taylor et al. (2017) pooled many sleep studies and found large, fast gains for people with ID, but warned that sleep-maintenance problems often return. The toddler in R et al. kept her gains, maybe because parents stayed in charge at home.

Egan et al. (2020) looked only at Angelman syndrome and saw weaker results. The difference is not a true clash: Angelman brings severe genetic sleep issues, while the present child was neurotypical. Method, not madness, explains the gap.

You can teach parents to fix common bedtime battles in one visit. No pills, no devices, just a later bedtime and a small loss for getting up. Try it first before writing a referral.