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Sleep Support – behavioural, transactional or just listening?

I have had some thoughts bubbling about the work that I do for a while now but I am no wordsmith so have not found the right words… but I think I am finally there.

It was prompted in part by some presentations at the British Sleep Society Conference which I attended recently, where eminent speakers spoke of their difficulty in engaging parents in sleep work for their children.

Mainly though it was prompted by the many online groups for parents of neurodivergent children which I am a member of. There are some absolutely amazing groups out there. Parents advocating for their children against seemingly intractable organisations, authorities and systems. Exhausted parents, on their knees from fighting, but still giving everything they have to give their children a voice.

I see a lot of discussion about Applied Behaviour Analysis (ABA) and how harmful it is for autistic children; changing ‘undesirable’ behaviour with the use of rewards. Trying to make neurodivergent children 'fit' into a neurotypical world.

It made me reflect on my journey as a nurse working with children. In the mid 2000’s I trained as an Incredible Years parent group leader; a globally recognised, evidence based parenting programme. I now look at elements of that programme and feel upset and uncomfortable that I believed it and delivered it as a solution to parents (rewards / planned ignoring). There are, however, other elements which I still think are really nurturing and help children feel heard (play, descriptive commenting).

How does this relate to sleep support you may ask? Well firstly sleep outside of the medical field is a totally unregulated profession. Anybody can call themselves a ‘sleep consultant’. There are some excellent training programmes out there and they all take slightly different approaches but there is no requirement after that initial training to ever update again and many practitioners don’t reflect on what they are doing.

I have been working as a sleep practitioner now for 7 years and before that I had been a nurse for 33 years; reflective practise is in my DNA. My work is mainly with parents of neurodivergent children and young people and I have learned more from these wonderful, creative, smart, resourceful parents than I have ever been able to teach them. My whole practise has been (and continues to be) shaped by autistic and ADHD voices and I have realised that it boils down to two words.

‘Why?’ and ‘What’?

Why are they not sleeping? What is happening to cause the sleep issue? What is your child’s behaviour telling us? What is their unmet need?

I truly believe that all behaviour is communication. Very often sleep issues are because children do not feel safe (anxiety, overwhelm) or they do not feel comfortable (illness, pain, sensory processing differences). If we find out why they are not sleeping we have the answers to helping them sleep better.

I listen to the child’s voice. I don’t try and modify their behaviour by offering rewards because that does not address the root cause of the sleep issue. It silences the only way that children have of communicating their needs to us. It tells them that their needs are not important.

The darker side of rewarding desired behaviour is that it teaches children that if they do what an adult tells them they get something nice…….for any children, but particularly vulnerable children, this is absolutely not a good idea.

So I don’t use reward charts or bedtime passes (unless the parent asks for advice on these). I don’t make star charts or charts starring their favourite characters. I ask the ‘why’ question. And importantly, if possible, we ask the child what is stopping them sleeping. We find out that bedrooms are sometimes scary, noises are frightening, they would prefer to have plain curtains rather than bright ones, that they prefer to sleep on the floor, that when they get into bed with you they are seeking safety and the comfort of being close to you. We find out that someone was mean to them at school, that they can’t switch off, that their constipation makes their tummy hurt. And so on……. because rewarding children for staying in bed won’t change any of those things, and won’t help them sleep. Parents then lose confidence in the sleep practitioner (and other professionals) because standard sleep advice that does not take account of the child’s voice does not work.

We need to address the ‘why’.

It makes my work challenging but always eye opening and exciting. I have never written the sleep plan twice because every child is different and has different needs. And because parents feel heard as well, they know that I am not going to dish out standard ‘sleep hygiene’ advice. They stay, they keep turning up to appointments and trying my suggestions. They trust me to help them. I stop being ‘just another professional’ and start being someone who meets them on a level playing field and totally gets that parents are the experts on their own children.

I listen to the child’s voice. And I shall carry on because this approach works.

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