Please note that this paper was intended to be published as part of the Special Issue of Behavioral Sleep Medicine 54(1), but due to an administrative oversight it was not included Treatment efficacy in behavioral pediatric sleep medicine Brett R. Kuhn a, * , Amy J. Elliott b a Department of Psychology, Munroe-Meyer Institute, 985450 University of Nebraska Medical Center, Omaha, NE 68198-5450, USA b Center for Disabilities, University of South Dakota School of Medicine, Vermillion, SD, USA Abstract Behavioral interventions have been identified as the treatment of choice for many forms of pediatric sleep disturbance. We adopt criteria established by the Task Force on Promotion and Dissem- ination of Psychological Procedures (1996) to evaluate the literature base describing behavioral interventions for pediatric sleep distur- bance. Three well-established interventions, one promising inter- vention and one probably efficacious intervention, have emerged for bedtime refusal and frequent nighttime awakenings. Only one intervention for sleep terrors and sleepwalking has sufficient em- pirical support to be considered promising. Behavioral interventions targeting circadian rhythm disorders (e.g., delayed sleep phase), nightmares and rhythmic movement disorder (RMD) have not been researched sufficiently to be considered empirically supported. D 2003 Elsevier Inc. All rights reserved. Keywords: Behavior management; Children; Parenting; Pediatric; Sleep; Treatment Introduction Disturbed sleep has been identified consistently among the most common concerns presented in clinical settings for children [1–3]. Recent evidence indicates that a good night’s sleep plays a critical role in early brain development, learning, and memory consolidation [4,5], while disrupted sleep has been linked to behavior problems and poor emotional regulation [6,7]. Although some pediatric sleep disorders demand medical attention (e.g., obstructive sleep apnea, narcolepsy), the majority require clinical assessment and intervention skills that specialists in behavioral medicine are ideally suited to provide. The purpose of this article is to evaluate the efficacy of behav- ioral interventions for common pediatric sleep disturbances, specifically bedtime resistance, night waking, sleep sched- ule disorders and parasomnias. In 1996, an American Psychological Association task group developed specific criteria, frequently referred to as the Chambless criteria, to evaluate psychological treatments based on the weight of the empirical support behind an intervention [8]. These criteria have become the ‘gold standard’ for evaluating the efficacy of an intervention. The Chambless criteria outline the type of support necessary for a research study to be considered ‘well-established’ or ‘probably efficacious.’ The primary distinction between these two categories is that a ‘well-established’ intervention has been shown to produce benefits that exceed another treatment or placebo condition that controlled for attention and expectancy variables. We also included a category of ‘promising’ interventions that the Society of Pediatric Psy- chology Task Force recently added to the Chambless criteria [9]. These interventions have shown some initial empirical support and make sense conceptually, but they lack the methodological rigor necessary to meet the standards of the Chambless criteria. Bedtime resistance and frequent night waking Sometimes referred to as pediatric ‘‘insomnia,’’ the hallmark of pediatric sleep disturbance among infants and toddlers involves bedtime resistance and frequent night waking [10]. Like the outdated term ‘‘dyslexia,’’ use of the term ‘‘pediatric insomnia’’ has fallen into recent dis- favor. The preferred term, ‘‘pediatric sleep disturbance,’’ avoids potential overlap and confusion with the adult insomnia literature. Pediatric sleep medicine is a distinctive field with unique causal and maintaining variables and different interventions. For example, adults with insomnia complain of difficulty falling asleep despite their best 0022-3999/03/$ – see front matter D 2003 Elsevier Inc. All rights reserved. doi:10.1016/S0022-3999(03)00061-8 * Corresponding author. E-mail address: brkuhn@unmc.edu (B.R. Kuhn). Journal of Psychosomatic Research 54 (2003) 587 – 597