Abstract
This study examines the current practices of OTs in the treatment of sleep difficulties in children. The study used a survey design to explore assessment methods, interventions, and preparedness of pediatric OTs in addressing sleep. The study lays the foundation for the need for future research in effectiveness of sleep interventions in the pediatric population.
Primary Author and Speaker: Aimee Piller
Additional Authors and Speakers: Kimberly Lieberman, Abraham Kim, Erin Thrasher, and Theresa Guzaldo
Approximately 50% of all children will experience some type of sleep difficulty in their childhood. Lack of sleep can lead to difficulties in participation including behavioral problems and learning and academic difficulties (Carter et al., 2014). As an area of occupation and the foundation for peek occupational performance and participation, sleep is an important area for occupational therapists (OT) to consider (AOTA, 2017). Common OT interventions to address sleep include cognitive-behavioral therapy, modifications to the sleep environment, and modification of routine including physical activity (Tester & Foss, 2017). Although limited research exists on the use of sensory strategies to improve sleep, sensory processing differences have been linked to sleep difficulties in children (Vasak et al., 2015). While some research exists regarding OT related sleep interventions across the lifespan, little exists in the area of pediatrics. Further, there is little evidence to explore interventions therapist use, how therapists are assessing sleep, and if OTs are even addressing sleep in their intervention process for the pediatric population. The purpose of this study was to examine the current practices of pediatric OTs in regard to assessment and intervention methods for sleep. This study used a survey design to explore the current practices of pediatric occupational therapists in regard to sleep. Internet recruitment using snowball sampling was used to recruit 141 pediatric occupational therapists to complete an online survey using Qualtrics survey software. Survey questions were developed based upon literature review. Cognitive testing on questions was performed prior to survey distribution to determine if questions were interpreted as intended. Results were analyzed using descriptive statistics. Participants included occupational therapists of various years of experience and levels of education, with the majority working in an outpatient setting. Survey results indicated that most therapists sometimes addressed sleep within their practice. The majority of respondents reported they did not feel equipped to address sleep with their clients. Few therapists reported they used formal assessment methods to evaluate sleep and most reported they tended to rely on parent/client interviews. When providing interventions to address sleep participants reported that they tended to spend about 0-25% of their intervention time on sleep and used a sensory integration/sensory processing theory most often followed by behavioral and PEO theory. Common interventions included sensory strategies, structure bedtime routine, and environmental modifications. This survey provides initial data in regard to the evaluation and treatment of sleep difficulties in children. The survey indicates that therapists are seeing children with sleep difficulties, but they do not feel well equipped in addressing sleep issues. A variety of theories and interventions are being utilized to increase sleep participation and quality. This survey reflects that many pediatric OTs feel there is a lack of evidence of effective interventions in addressing sleep as an occupation of childhood. The results of this survey indicate that therapist have few evidence-based interventions but are addressing sleep in pediatric practice supporting the need for additional research in the most effective interventions to improve sleep performance.
American Occupational Therapy Association (2017). Occupational therapy’s role in sleep. Retrieved from: https://www.aota.org/About-Occupational-Therapy/Professionals/HW/Sleep.aspx
Carter, K. A., Hathaway, N. E., & Lettieri, C. F. (2014). Common sleep disorders in children. American Family Physician, 89(5), 368–377.
Tester, N. J.& Foss, J. J. (2017). Sleep as an Occupational Need. American Journal of Occupational Therapy, 72(1), 7201347010. https://doi.org/10.5014/ajot.2018.020651.
Vasak, M., Williamson, J. Gardner, J. & Zwicker, J. G. (2015). Sensory Processing and Sleep in Typically Developing Infants and Toddlers. American Journal of Occupational Therapy, 69(4), 6904220040. https://doi.org/10.5014/ajot.2015.015891