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Section 2
Behavioral Interventions for Adolescents with Sleep Disorder

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In the last section, we discussed type ‘A’ night terrors.  Our discussion included a description of incidence of type ‘A’ night terrors, characteristics of type ‘A’ night terrors, and symptoms of night terrors.

In this section, we will discuss ways of treating type ‘A’ night terrors.  I have found that for parents with children or adolescents suffering from type ‘A’ night terrors, three effective behavioral interventions are behavior documentation, assisted recall, and associative connections. As you listen to this section, you might consider the child or adolescent you are treating for night terrors. How do the characteristics of type ‘A’ night terrors as discussed in the last section effect these strategies as related to your client? 

3 Effective Behavioral Interventions

♦ #1  Behavior Documentation
First, let’s discuss behavior documentation.  Do you remember Nadine from section one?  After her parents Beth and Tom acknowledged that Nadine was suffering from type ‘A’ night terrors, I stated, "You may find it helpful to use behavior documentation in the form of a ‘terror log’ to observe and note Nadine’s actions as well as words.  Over time, this may give some hint as to exactly what Nadine’s fear entails.  Enough clues may be given over time to enable you to address this fear or circumstance directly."

In a session several weeks later, Nadine’s father Tom stated, "I’m not seeing any patterns in Nadine’s behavior, so we don’t feel like we are getting anywhere with this ‘terror log’."  How would you have responded to Tom?

I stated, "Diligent documentation will become more detailed and more filled with patterns or conclusions over time. Additionally, your calm, controlled understanding can only benefit Nadine. By giving thought to her night terrors and remaining observant, you and Beth may be able to shorten the time it takes for the night terror to resolve itself."  Beth asked, "Isn’t there something else we can do?" 

♦ #2  Assisted Recall
I responded, "Sure. Next, let’s discuss Assisted Recall. You might try casually talking to Nadine if she wakes up after an attack, or on the morning following an episode, to see if she remembers anything. Consider not pressing the issue too strongly or for too long, though, as this can lead to apprehension. Simply ask, ‘Nadine, do you remember anything about your dreams last night?’ Or, ‘Nadine, could you draw your dream from last night using these crayons?’ Tom asked, "When I asked her about her dreams about a month ago, Nadine told me she couldn’t remember anything." 

How might you have responded to Tom?  I stated, "Children have very selective memories.  Nadine may go for months with no recall whatsoever and then begin to remember faint details. Or she may suddenly remember the entire dream." Think of your Nadine. Can the child or adolescent you are treating recall details from night terrors?  Research indicates that careful assisted recall can produce results in about fifty percent of children. Therefore, it becomes clear that careful interviews with the child or adolescent will result in a higher percentage of recall. 

I continued explaining how Tom and Beth could implement assisted recall with Nadine by stating, "Any information that you get from Assisted Recall can be included in Nadine’s behavior documentation. That way, additional information in the behavior documentation will help add up to a more recognizable analysis of the cause of Nadine’s night terrors." Think of your Nadine.  Could your client’s parents’ use of assisted recall be combined with behavior documentation to benefit the child or adolescent?

♦ #3  Associative Connections
The third cognitive intervention treatment I discussed with Tom and Beth was associative connections. I stated, "It also might not be a bad idea to allow Nadine to spend some time around younger children." Beth asked why. I responded, "You mentioned that Nadine’s night terrors started at around age two. Therefore, she might benefit by interaction with two-year-olds. Now that Nadine’s older, some valuable connections could be made in her mind. Nadine may see that at two years old, children are more afraid of events they don’t understand."

Tom asked, "What are we supposed to do? Take her to a day care and drop her off with the toddlers?" How would you have responded to Tom?  I stated, "You’re right, Tom. Having Nadine spend time with younger children should be handled discreetly so that she does not lose self-esteem by getting the idea that you think she is a ‘baby’. Rather, can you think of ways to encourage Nadine to feel that she is perhaps taking care of the younger children?" 

Beth mentioned that her friend ran a daycare and that she felt Nadine could be convinced to ‘help out’ there for a while.  I responded, "Great, because if handled properly, Nadine could thereby gain some insight into her own fears by making connections with the more mundane childhood fears that she observes in the younger children." 

By helping a child or adolescent who is suffering from type ‘A’ night terrors make connections regarding unreasonable fears, parents can speed up the same process that the child’s subconscious is trying to accomplish by dreaming. Can you think of ways to implement one of the three cognitive intervention strategies in this section with your client?

In this section, we have discussed ways of treating type ‘A’ night terrors. Three effective cognitive intervention treatments for children or adolescents suffering from type ‘A’ night terrors are behavior documentation, assisted recall, and associative connections. 

In the next section, we will discuss type ‘B’ night terrors. Three factors involved with type ‘B’ night terrors that we will examine in this section are extreme trauma, complications resulting from type ‘B’ night terrors, and personality characteristics.
Reviewed 2023

Peer-Reviewed Journal Article References:
Blake, M., Waloszek, J. M., Schwartz, O., Raniti, M., Simmons, J. G., Blake, L., Murray, G., Dahl, R. E., Bootzin, R., Dudgeon, P., Trinder, J., & Allen, N. B. (2016). The SENSE study: Post intervention effects of a randomized controlled trial of a cognitive–behavioral and mindfulness-based group sleep improvement intervention among at-risk adolescents. Journal of Consulting and Clinical Psychology, 84(12), 1039–1051.

Law, E. F., Dufton, L., & Palermo, T. M. (2012). Daytime and nighttime sleep patterns in adolescents with and without chronic pain. Health Psychology, 31(6), 830–833.

Maia, A. P. L., Sousa, I. C. d., & Azevedo, C. V. M. d. (2011). Effect of morning exercise in sunlight on the sleep-wake cycle in adolescents. Psychology & Neuroscience, 4(3), 323–331.

Reznik, D., Gertner-Saad, L., Even-Furst, H., Henik, A., Ben Mair, E., Shechter-Amir, D., & Soffer-Dudek, N. (2018). Oneiric synesthesia: Preliminary evidence for the occurrence of synesthetic-like experiences during sleep-inertia. Psychology of Consciousness: Theory, Research, and Practice, 5(4), 374–383.

Richardson, C., Micic, G., Cain, N., Bartel, K., Maddock, B., & Gradisar, M. (2019). Cognitive “insomnia” processes in delayed sleep–wake phase disorder: Do they exist and are they responsive to chronobiological treatment? Journal of Consulting and Clinical Psychology, 87(1), 16–32.

Walters, E. M., Jenkins, M. M., Nappi, C. M., Clark, J., Lies, J., Norman, S. B., & Drummond, S. P. A. (2020). The impact of prolonged exposure on sleep and enhancing treatment outcomes with evidence-based sleep interventions: A pilot study. Psychological Trauma: Theory, Research, Practice, and Policy, 12(2), 175–185.

QUESTION 2
What are three effective cognitive intervention treatments for children or adolescents suffering from type ‘A’ night terrors? To select and enter your answer go to Test.

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