Night Terrors in Children and Toddlers–Behavioral Interventions

Overactive nocturnal imaginations are a common occurrence among children. The rise in children with behavioral disorders has resulted in an increase in night terrors: late night awakenings by crying, screaming toddlers. Children with autism, ADD, and schizophrenia, for example, experience more sleeping problems.

Definition of Night Terrors

Children face two kinds of night terrors—nightmares and sleep terrors. Nightmares involve dreams and occur during REM (rapid eye movement) or the dream stage of sleep. Sleep terrors, on the other hand, involve a sudden arousal—marked by emotional upset and often crying and screaming—during the slow wave, deep sleep phase. More disconcerting for the parent, it is harder to awake a child from a sleep terror, which does not involve dreams. Some children are genetically predisposed to experience them.

Behavioral Interventions

Given the strong preference for behavioral over drug interventions, there is a lot of good information on how to stop or reduce night terrors using behavioral interventions. The type of night terror and source can help determine the best treatment.  An often easily treatable form of night terrors is caused by detachment from the parents at bedtime. These nocturnal disruptions can be reduced by not attending to the child each time he cries out for attention. A related approach is to allow for increasingly longer intervals before attending to the child and shorter comforting visits. Scheduled awakenings have long been used to reduce nightmares, sleep terrors, and sleepwalking in children.

Play Therapy and Guided Imagery

When mothers wish their children “sweet dreams,” they initiate guided imagery into this world of dreams. This can be an effective way of easing your child into a peaceful sleep, in place of a story book about monsters or dragons. Dream rescripting is another creative tool which involves the child recreating a scary dream in a positive context, often through painting or drawing. The Association for Play Therapy provides an overview of creative approaches for The Treatment of Nightmares and Night Time Fears that can be easily adapted by parents.

Cognitive Behavioral Therapy

Increasingly, parents are seeking to provide stable environments for children who have faced war, disasters, terrorism, and sexual abuse. These victims are more likely to experience night terrors. These post-impact night terrors must be dealt with in the child’s day-to-day life.  Here, a psychologist can be most helpful. Play therapy and children’s literature are two methods that have been successfully used to help a child deal with trauma and lessen fear and anxiety. For real progress to be made, it is paramount to create a safe and secure world for the child.

Acting Up Before Bedtime

The greatest challenge for a parent is outsmarting a child who is determined to charm his way into another half an hour of playtime. Dr. Brett R. Kuhn offers good advice in Sleep Review’s Behavioral Treatment of Sleep Disorders for lessening anxiety at a “high risk time in disruptive behavior”.

–          Maintain a calm, relaxing bedtime routine

–          Do not use early bedtime as a punishment for misbehavior

–          Avoid sibling teasing

–          Do not discuss bedtime misbehavior in front of the child

Daily Routine

It is important to stabilize the child’s daily routine, maintaining consistent schedules, including nap times and bedtime. Late nights and early mornings will disrupt her biological clock.   The occurrence of sleep terrors has a high correlation with sleep deprivation.

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