631 Sleep SMART in Adolescents with Neurodevelopmental Disorders

Introduction: Introduction Sleep disturbances are common in adolescents with neurodevelopmental disorders (NDDs). Inclusion of vulnerable populations such as adolescents with NDDs into sleep intervention efforts is essential as they are at high-risk for poor physical/mental health outcomes. The objective of this study is to pilot a sequential, multiple assignment, randomized trial (SMART) design to compare the impact of a sequence of sleep interventions, based on treatment response, to optimize sleep health in adolescents with NDDs. Methods: Methods Recruitment began June 2019 using convenience sampling. The SMART pilot feasibility study includes 1-week of baseline sleep data, and two 4-week periods of a sleep intervention (9-week total study enrollment). Interventions include exogenous melatonin, The Bedtime Bank, and their combination. Exogenous melatonin (liquid, immediate release, 3mg) is administered 30 minutes before bedtime. The Bedtime Bank, a behavioral sleep intervention, is based upon contingency contracting that relies on a credit- or debt-based system to hold adolescents accountable for maintaining a consistent bedtime. At baseline participants completed demographics, PROMIS pediatric sleep questionnaires, the Cleveland Adolescent Sleepiness Questionnaire (CASQ), salivary & urinary endogenous melatonin measurement, and one week of actigraphy. Upon enrollment, participants were randomly assigned to either melatonin or The Bedtime Bank. Participants who respond (nightly increase in total sleep time (TST) ≥18 minutes) remain on the assigned intervention; if non-responsive participants are re-randomized to a different sleep intervention or combination. Results: Results At baseline, participants (n=29, aged 10–18 years) had an average TST of 7 hours 11 minutes. PROMIS Sleep Disturbance (M=64.3, SE=2.5), PROMIS Sleep-Related Impairment scores (M=58.9, SE=2.2), and CASQ scores (M=40.0, SD= 10.5) were higher than reported normative values. Salivary DLMO & urinary 6-sulfatoyxmelatonin analysis is ongoing. For participants who completed the full 9-week trial, nearly 30% (n=7/24) were responsive (increased baseline TST ≥18 minutes) to one of the 4-week interventions. Conclusion: Conclusion Baseline data of the enrolled participants demonstrates poor indicators of TST, sleep disturbance, and sleep related impairment. Preliminary results of this SMART indicate some adolescents are responsive to sleep interventions aimed to improve their TST. Support (if any) Support: This clinical trial is funded by the National Institute of Nursing Research, National Institutes of Health (1K01NR017465-01A1).

Using Contingency Contracting to Promote Social Interactions Among Students With ASD and Their Peers

The purpose of this study was to evaluate the effect of peer training implemented alone and the effect of combining contingency contracting with peer training on promoting social interactions among students with ASD and their peers. Three students with ASD and six typically developing peers enrolled in an inclusive elementary school participated in the study. Ten-minute observations were conducted during recess time to collect data on the participants’ social interactions. The data obtained showed that peer training alone did not result in improvement in social interactions. However, upon the introduction of contingency contracting, which facilitated the use of prompting and reinforcement, the participants engaged in a significantly higher number of social interactions. The findings about the effect of peer training and contingency contracting were consistent across the participants. The study results suggest several implications for practice and directions for future research.

Contingency Contracting Untuk Menurunkan Perilaku Tertidur Di Kelas Pada Anak Sleep Disorder

Normal sleep patterns are very important for academic achievement and life of each child. This study aims to know the effect of Contingency Contracting to reduce sleep behavior in class and improve sleep patterns in children with Circadian-Rhythm Sleep Disorder. The study subjects were A, a boy aged 11 years, with ADHD-PI diagnosed with Circadian-Rhythm Sleep Disorder Delayed Sleep Phase Type. The design of this study uses multiple-baseline-across-behaviors design. Contingency contracting interventions are carried out using prompt techniques, fading, and economic tokens. The recording instrument used is sleep diary and behavior frequency recording sheet. The results of the study show that behavioral modification intervention programs carried out with contingency contracting have been shown to effectively reduce sleep behavor in the classroom in the morning and improve the pattern of nighttime sleep in children with Circadian-Rhythm Sleep Disorder.Keywords: sleep-disorder; circadian-rhythm; behavior modification; contingency contracting; prompt  AbstrakPola tidur yang normal sangatlah penting bagi prestasi akademik dan kehidupan setiap anak. Penelitian ini bertujuan melihat pengaruh Contingency Contracting untuk menurunkan perilaku tertidur di kelas dan memperbaiki pola waktu tidur pada anak dengan Circadian-Rhythm Sleep Disorder. Subjek penelitian adalah A, anak laki-laki usia 11 tahun, dengan ADHD-PI didiagnosa mengalami Circadian-Rhythm Sleep Disorder Delayed Sleep Phase Type. Desain penelitian ini menggunakan multiple-baseline-across-behaviors design. Intervensi contingency contracting dilakukan menggunakan teknik prompt, fading, dan token ekonomi. Instrumen pencatatan yang digunakan adalah sleep diary dan lembar pencatatan frekuensi perilaku. Hasil dari penelitian menunjukkan program intervensi modifikasi perilaku yang dilakukan dengan contingency contracting terbukti efektif menurunkan perilaku tertidur di kelas pada pagi hari maupun memperbaiki pola waktu tidur malam hari pada anak dengan Circadian-Rhythm Sleep Disorder.Kata Kunci: sleep-disorder; circadian-rhythm; modifikasi perilaku; contingency contracting; prompt