Behavioral Treatment of Pediatric Sleep Disturbance: Ethical Considerations for Pediatric Psychology Practice

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Abstract

Delayed sleep onset and problematic night wakings are common during the infant and toddler years. Such sleep disturbances typically develop as the result of learned associations with specific cues needed for sleep initiation and/or maintenance that are not consistently available at bedtime or immediately available to the child after night wakings (e.g., rocking, feeding, being held). Effective empirically supported behavioral treatments for these common sleep problems exist. Despite the research evidence supporting the effectiveness of these behavioral treatments, widespread dissemination of unsubstantiated concerns about the appropriateness and theorized negative impact of behavioral sleep treatments persists. Some researchers have even raised concerns about the ethics of health providers providing behavioral sleep treatments, particularly extinction-based treatments. As a result, providers of pediatric behavioral sleep services routinely encounter parents who raise concerns about the use of extinction-based behavioral treatments. Unwarranted parental concerns may prevent some families from seeking services that could lead to positive health outcomes. This article discusses important ethical considerations for pediatric psychologists who provide behavioral sleep medicine services. Recommendations for evidence-based clinical practice are made considering American Psychological Association Ethical Principles of Psychologists and Code of Conduct, American Academy of Pediatrics guidelines for safe sleep practices, and current research on behavioral sleep treatment outcomes.

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