Using paired-choice assessment to identify variables maintaining sleep problems in a child with severe disabilities.

A therapist visited a child with severe disabilities at home.

Bedtime was rough. The child cried, left the bed, and woke often.

The team ran a quick paired-choice test each night. They offered two options: mom stays in room or mom leaves.

The child always picked mom staying. That told the team attention was the payoff for wake-ups.

Mom’s attention kept the sleep problem alive.

The plan was simple. Mom gave hugs and chat only when the child stayed in bed.

Night waking dropped fast. Gains held one year later.

Duker et al. (1991) treated four kids with faded bedtime plus response cost. They never tested why the kids woke. O'Reilly et al. (2004) added the paired-choice step first, so the fix matched the real cause.

Eberhart et al. (2006) later used paired choices to boost leisure for adults in group homes. Same method, new age group and goal.

Lemons et al. (2015) and Livingston et al. (2018) used paired-stimulus tests to pick edible reinforcers quickly. F et al. moved that idea from snacks to sleep.

You can run a five-minute paired-choice test at bedtime tonight. Offer two clear options linked to suspected reinforcers. The item picked every time is your functional reinforcer. Build the sleep plan around that variable. No guesswork, no long interviews, just direct kid data.