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Bedtime difficulties 

We have an eight-year-old boy in residential care who has had on-going issues at bedtime (several demands to restlessness, aggression and disturbing others). The consequence has been early bedtimes but this doesn't seem to be correcting the problem. We have also done a lot of problem solving around bedtime routine and possible feelings that arise, but again this does not seem helpful. Any other suggestions to help remedy the problem? Most days he is able to follow the structure of the evening until bedtime.

Any suggestions would be greatly appreciated

Yours truly,
Residential treatment worker
...

Hi there,

I work in a residential program for very aggressive females. The girls also have hard times settling. We have done treat contracts, as they are gettng something they desire, but they need to follow through for a certain amount of time. For example: If they wanted a burned cd with their favorite songs, you sit down with them and discuss how they will achieve that. They will need to settle 3 nights in order to earn this, and if any time they do not settle, then the treat contract needs to be restarted. They can not earn this item till they follow through. The girls seem to respond well to this, but as well I work with females ages 12-18, so it might be different. But that is my suggestion.

Good luck,
Vickie Isnor

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Hi Jackie

I am sure you will have considered the possible reasons for difficulties at bedtime: previous abuse in bed/bedroom, a quiet time when he cannot help but think about why he is not at home and remember the scary things that led to him being in residential care.

Practically I would put a lot of effort into making his bed and bedroom a place where he wants to be. Is the decoration to his choice? Could it be repainted a color he likes? If not, maybe pictures or posters chosen by him. It needs to be personalized for him to feel that it is his own special place, not somewhere that other children can come and play and leave their mess. He needs to have his own stuff in there: toys, belongings, music, games, computer etc. It should be comfortable; not too hot or too cold. What about a really comfy armchair? Is the bed comfortable? Is it his own bedding, or the previous resident's?  Could you get him new bedding? Does the room reflect and stimulate his
interests? Make it a place he wants to be.

About routines: you must allocate sufficient time for a worker to spend with this boy every night. Having a bath and getting into pajamas can be rewarded by dedicated adult attention. Possibly sitting in his room with him while he has a drink of hot chocolate, reading a story or talking about the day's events or future plans. This is imperative: don't make him go to bed by himself. He needs help to get settled this should be a part of his care plan. Workers can personalize how they do it; some may read a story or tell a story, one may give him a back massage, one may play a game with him. In my experience, once you start this, any other children in the home will want it too. You may need to change the staff rota so that there are more people available at this important time.

By making him go to bed earlier as a consequence for the previous night's difficulties, you are reminding him of the bad time last night, and using bed as a punishment. Bed needs to be good, not somewhere you go when you're
bad. You may initially need to start the dedicated adult time later than you would wish. Once he sees the value, you can then start to put boundaries around it e.g. "I will spend time with you from 8.30 until 9.00, but then I need to go and see to the other children".

I hope this is helpful and possible for you to do. The boy clearly needs you at bedtime. Good luck, hope to hear how you get on.

John Gelling
UK

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Hi Jackie,

(A little more context, please.)

How long have you been working with this little guy? And, has there been specific detail of the behaviors documented in order to notice incremental shifts to the behavior desired or to measure if they increase? Depending on the time you have been working with this boy "no change" in behaviors may be an actual positive impact. The behaviors may need to exist as they are until a new way of "being" is learned and if you can document that they are "not" increasing, the approach you are using could actually be working - before noticing a decrease in his bedtime antics your treatment impact will likely need to stabilize his behaviors.(not increase). Without understanding the detailed context of the "root" of the behavior I can not guess at a respectively amount of time for change to occur.

Oh yes, I am reminded of 'The space we create controls us'  in Maier, Henry. (1987). Developmental Group Care of Children and Youth. New York. Haworth Press. p.153.

Ernie Hilton
Nova Scotia, Canada

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Hi Jackie

I have recently had the same issue at bedtimes. I devised a 'bedtime programme' for the young person in question. This insured he was occupied with a staff member for the last part of the evening, which was a good tool in itself for keeping his mind busy when he would usually begin to become quite unsettled. The 'programme' itself was very simple. We purchased some lavender scented products such as pillow spray, bubble bath, shower gel etc. We used a formal structure to schedule in bathtime using the lavender infused products (with a little time alloweed for play in the bath!). On other nights we schedule some one-to-one time with a staff member to watch a movie or dvd (no adventure movies, something more relaxing) followed by a shower (again using the lavender infused products). We have gradually built on this initial programme to incorporate ideas and suggestion from the young person involved.

This is by no means full-proof, but it has proved a good starting point for us. Hope this is helpful.

Angela Boyle
Residential Worker (Secure Care)
Scotland

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As a CYW and a mother of six it is difficult for the adult see the child restless for bedtime. Yes, some children have that problem. Sometimes I face with that situation and the only thing has helped me out is to engage the child with physical activities at least one hour before bedtime for at least 30 minutes. For e.g. going for a walk with the child or play a game that involves a lot of exercise will make the child tired for bedtime, then he/she will take a shower.

Another thing is to watch for what the child eats before bedtime, like cookies, juicies, chocolate milk these snacks contain enough sugar to makes the child hyper for a while.

I hope this will help, good luck!!!.

Leticia Nolasco
CYW
Hamilton, Ontario
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Sounds and looks very much like bad memories around bed time. Do you have that detail of information on him? We at present have a young lady of 15 who has to have her TV on not on a programme but just to have the flickering light
system on. Her history indicates physical abuse at or around bedtimes. This has been a long programme of just keep going at it in a consistent way with every member of staff approaching it in a planned intervention.

This may or may not help but it is a quite common problem.

Sandy
Scotland

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It is possible that he fears bedtime. Try having one staff assigned to the youth specifically for the hour before and after bedtimes. Always foreshadow the event with several lead-ins (it's an hour to bedtime in 15 minutes you need to brush your teeth) that kind of idea. Is he afraid of the dark? Ask him in a area away from others, he may not want to admit it. Does he wet the bed? If so that could be the problem. Just some ideas to try.

Linda Windjack
Canada

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Hi Jackie,
My first thoughts while reading your request was about fear and pain. What has occurred in this young boy's life that would make him fearful of his bed and or bedroom? Is it the darkness, the silence, is he feeling abandoned with his demons? Is there time for reading a bedtime story? Can the person that tucks him in at night sit silently at the door so he does not feel alone? How about the design of the room, does he have the ability to make some changes, maybe move the bed.

He is pretty little. Often our thoughts go to attention seeking behaviour and we don't want to "encourage" it; however,
we need to give this behaviour attention because it is our responsiblity to interpret what the behaviour is telling us. He has a story, but may not have the words to tell it, so he is acting it out for you, the audience.

Something right outlandish, but not totally crazy would be to buy a butterfly net and catch those night time monsters that lurk under the bed, in closets and behind curtains. His behaviour is pain driven, so investigating what is behind his pain will help him and the staff towards resolving his bedtime. You'll know when you get it.

Respectfully,
Monica Metzler
Edmonton, Alberta

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Hi,

I worked with an adult with Autism who had difficulty with bedtime. We had him a follow a visual schedule throughout the day. During the day it was very structured and in the evening a lot of choice was offered for activities. With giving him choice we did the fist and then "fist you get to choose a game then exercise". We found doing some gross motor activities in the evening help him relax when it was bedtime. I would suggest to provide more choice around bedtime, making it more structured in the sense of the same routine, or writing a social story about bedtime. If none of these work you could then try extinction. Without response cost: calculate average bedtime, add 1/2 hour to average bedtime, if asleep in 15 min. fade bedtime by 1/2 and if not sleeping in 15 min add 15 min to bedtime. Using Response cost: follow above steps and if not asleep in 15 min the child is taken out of bed and kept awake for 1 hour. You will fade the time back to normal bedtime.

Hope this helps. If you wish to look for more information on sleeping problems you can articles written by Kimberly A. Schreck, Ph.D Pennsylvania State University.

Tonya
Hamilton/Niagara Autism Initiative

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Hi Jackie,
I got very excited when I saw your question, as I beleive I can help to an extent as I have been there done that. You may have done this, but one of the first things that should be done is to make sure the safety needs of the child is being met (think Maslow). What I mean from this is there a night light in the client's room, tell the child that a staff will be checking on them, the doors of the cottage are locked, the client's room may be alarmed, etc - anything that you may feel the child needs to hear to make him or her feel safe so they are not continually thinking in their head that they are
unsafe and something is going to happen to them.

Once that is completed go on to coming up with a motivator system for the client when they do settle (reverse the ABC anylisis). For example when they do settle they will receive more adult attention (i.e. story time), earn incentives like quiet games to do at bedtime (i.e. cards, puzzles, books, games), earn a higher level or status or tokens (depending on your program design) and in turn they will feel more rested, safe, and may have a more positive outlook on
bedtime settling. Hope this help if you need more advice just let me know.

Regards
Dave Zimmerman

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You have probably already thought of this however, does anyone know this child's past experience with bedtime routines? I am specifically thinking trauma triggers...

Theresa Fraser

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Bedtime is such a vulnerable time for many of the kids in care. Many feel unsafe at this time from past history and it is our job to ensure the safety without condition. Having knowledge of specific behaviors that may indicate past abuse is important for staff members to know. Sometimes night lights, reading to the child or just checking in so they know you are there and taking care of them.

There so many opportunities to help a child have a successful bedtime. It comes from asking them what they need, anticipating what they need, trust and relationships between the staff members and the children and patience until they feel safe enough to relax and sleep.

CD players with headphones are helpful for some. We provide our kids with one upon admission. Some may need a book to read, some may want to talk for a while with a staff member. I remember one time a child needed us to read to her every night so she would settle. It worked great and then one night, we had a few problems and couldn't get in to read to her. A very creative staff member sat the girl's teddy bear in a chair next to her and he suggested she read to her teddy bear. It worked and she had a quiet and safe bedtime.

Find what works and keep consistency. We have dimmers on some of our lights so we can leave lights dimmed until they fall asleep.

Good luck.

Jean Dickson

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If you have not tried a specific tuck in routine for him that could be a start. It will take time to establish, but one-one with him in his room at bedtime with some form of settling activity (e.g. reading, cards, exploring activity for the next day are some ideas).

I know a boy who is now an adult and he explained that bedtime was a lonely fearful time for him as a child. His Dad drank and would often come home after the he and his siblings were alseep and then fight with his mother. They would be woken often. He began to equate bedtime with being the last stop of the day before the "bad stuff" happens, therefore he struggled with going to bed. Perhaps this young boy's story has a connection to disturbing events that are triggered by bedtime.

Geoff Levy
Nova Scotia

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Other then emotional issues have you looked at environmental or medical issues. Diet can lead to some of these behaviors. I have a foster son who cannot tolerate wheat, when he does eat something with wheat he is not able to cope and becomes restless and aggressive. Have you explored Sensory Dysfunction (easily diagnosed by an OT) or tried Melatonin supplements to help aid sleep.

Jennifer Elley

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