Psychological treatment of reported sleep disorder in adults with intellectual disability using a multiple baseline design.
A short staff-led bedtime plan helped most adults with ID fall asleep faster and wake less.
01Research in Context
What this study did
Nine adults with intellectual disability took part in a four-week sleep program. Staff and parents kept nightly logs of bedtime, wake-ups, and total sleep.
The team used a multiple-baseline design. They started the program at different times for each adult so they could be sure any change came from the treatment.
What they found
Six of the nine adults fell asleep faster and woke less often. The gains were big enough for staff to notice at work the next day.
Three adults showed only small or no change. No one got worse.
How this fits with other research
Braam et al. (2008) later tested melatonin pills in 51 adults and kids with ID. Their pill group also fell asleep about 30 minutes faster, showing both behaviour plans and medicine can work.
A seeming clash: Porter et al. (2008) gave melatonin to three adults and saw better mood but no actigraphy sleep gain. The difference is measurement — actigraphy often fails in ID (E et al. 2012), so parent logs may catch real-life change better.
Webb et al. (1999) had already shown that poor sleep and daytime challenging behaviour travel together. The 2003 study proves you can move that dial without drugs.
Why it matters
You now have a low-cost, low-risk tool for adult sleep issues before trying medication. Teach staff a simple bedtime routine, track with a log, and watch for falling asleep faster and fewer night calls. If you see gains in two weeks, keep going; if not, you still have melatonin data to share with the doctor.
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02At a glance
03Original abstract
BACKGROUND: The literature on sleep disturbance in adults with intellectual disability (ID) is sparse. Although prevalence rates for sleep disorders appear similar to those of non-disabled populations, previous treatment studies have largely been comprised of uncontrolled cases. Therefore, the present study adopted a single-case experimental methodology to evaluate behavioural sleep intervention. METHODS: A screening questionnaire was posted to 384 adults with ID and the sleep pattern of respondents with possible sleep disorders was further assessed using a structured diagnostic schedule. From the sleep-disordered subgroup, 12 participants were selected for a 4-week behavioural sleep intervention that was evaluated using randomly allocated, multiple-baseline, across-subjects designs and within-subject interrupted time series analyses (ITSAs). RESULTS: A total of 155 adults with ID (83 females and 72 males; mean age = 32 years, SD = 16.5 years), or their carers, completed the questionnaire (return rate = 40%). The application of sleep diagnostic criteria revealed that 17% had clinically significant difficulty getting to sleep and 11% had difficulty remaining asleep. Nine out of the 12 participants recruited for the intervention completed all the experimental phases, thus providing three sets of three multiple-baseline designs. Visual inspection of within- and between-subject effects suggested beneficial treatment-specific effects across a range of target variables. The ITSA confirmed significant effects (P < 0.05) or trends (P < 0.10) for six out of the nine participants. CONCLUSIONS: Behavioural sleep management may improve sleep pattern or sleep-related functioning in the majority of adults with ID who have significant sleep problems. The single-case methodology is helpful in addressing the heterogeneity of individual presentation, although clinical trial methodology is required to confirm these findings on a larger scale.
Journal of intellectual disability research : JIDR, 2003 · doi:10.1046/j.1365-2788.2003.00461.x