The Sleep Train Program: Efficacy of a Behavioral Sleep Intervention for Children with Externalizing Problems

Objectives: The study objective was to examine the impact of a brief behavioral sleep intervention (The Sleep Train Program) on sleep and behavior in children with externalizing behavior problems. Method: Children (3–8 years) presenting to a behavioral health clinic for externalizing problems were randomized to receive a behavioral sleep intervention or a mealtime intervention (active control). Families then completed parent management training followed by the cross-over intervention. Outcomes included parent-reported child sleep and behavior and actigraphic sleep, and were examined in the full sample and in a subsample of children with comorbid sleep difficulties. Results: In a subsample of children with both externalizing and sleep difficulties, children randomized to behavioral sleep intervention showed reduced externalizing problems (t = –2.75, p <.05), reduced night wakings (t = –2.21, p <.05), and improved parent-child interactions (t = 2.99, p =.01) and child behavior (t = –2.42, p <.05) at bedtime, compared to active control. In the full sample, in which some children did not present with sleep difficulties, behavioral sleep intervention, compared to active control, did not yield significant improvements in most sleep and behavior outcomes. Comparing sleep and behavior before and after behavioral sleep intervention across groups, children had fewer externalizing behaviors (t = 4.98, p <.001), improved sleep habits (t = –3.24, p <.05) and improved parent-child bedtime interaction (t = –3.24, p <.01), but no changes in sleep patterns. Conclusion: A brief behavioral sleep intervention was efficacious in improving both sleep and behavior outcomes for children with comorbid sleep and externalizing difficulties, but not for children with only externalizing difficulties.