Visual Schedule to Promote Compliance With Bedtime Routine in a Child With Autism Spectrum Disorder (Poster 46)

Sleep problems are frequently reported by parents of children with autism spectrum disorder (ASD), with prevalence estimates of 44–83%. While it is important to address any underlying medical or psychiatric issues that contribute to sleep challenges, establishing good sleep hygiene is considered a good first step, which often includes establishing a consistent bedtime routine. In this study, a visual schedule was used to facilitate compliance with a bedtime routine in a child with ASD. Using an ABAB reversal design, results indicated positive treatment effects, with an increase in bedtime routine compliance during intervention and maintenance of positive effects over time. Sleep problems are frequently reported by parents of children with autism spectrum disorder (ASD) with prevalence estimates of 44–83% (Williams et al., 2004). Recent research in children with ASD shows that poor sleepers exhibit more problematic behavior than good sleepers (Cohen et al., 2014). Moreover, problems sleeping occur more often if the child has restricted and repetitive behaviors, anxiety or sensory problems, and can lead to difficulty with sustained attention, feelings of restlessness, irritability, and tantrums (Goldman et al., 2009). Research has also shown that insufficient sleep exacerbates the severity of core ASD symptoms (e.g., repetitive behaviors, social and communication difficulties; Park et al., 2012) as well as other maladaptive behaviors (e.g., self–injury, tantrums, and aggression; Goldman et al., 2011; Henderson et al., 2011), and is chief among the more worrisome concerns reported by parents of children with ASD (Goldman et al., 2011). While it is important to address any underlying medical or psychiatric issues that contribute to sleep challenges, establishing good sleep hygiene is often considered a good first step (Lamm, 2021). Good sleep hygiene includes attending to elements such as adapting the environment to ensure the child is as comfortable as possible, having a predictable bedtime routine, keeping to regular sleep/wake schedule, and limiting screen time prior to bed (Lamm, 2021). Incorporating visuals and other concrete supports assists individuals with ASD (Marans et al., 2005) across a number of domains, including following routines. The use of visual supports is a common evidence-based practice that aids students in grasping concepts and comprise concrete cues that provide information about an activity, routine, or expectation and/or support skill demonstration (Wong et al., 2014). These supports are beneficial to students with ASD because they provide cues to aid students when performing tasks (Wong et al., 2014). Visual supports are also identified by the National Professional Development Center on Autism Spectrum Disorder (2016) as an effective evidenced-based strategy for individuals with ASD. In this study, we focused on using a visual schedule to improve compliance with a bedtime routine of a 5-year old boy with ASD who experienced sleep problems and exhibited noncompliance when transitioning to a typical bedtime routine. Theoretical Framework: Visual Supports and Individuals with ASD Individuals with ASD require environmental and instructional support that will help them Correspondence concerning this article should be addressed to Juliet E. Hart Barnett, Arizona State University, Mary Lou Fulton Teachers College, PO Box 871811, Tempe, AZ 85287-1811. E-mail: Juliet. Hart@asu.edu 196 / Education and Training in Autism and Developmental Disabilities Education and Training in Autism and Developmental Disabilities, 2022, 57(2), 196–203 © Division on Autism and Developmental Disabilities overcome challenges posed by difficulties in their ability to use and understand language (Rao & Gagie, 2006). Many students with ASD have difficulty understanding, recalling, and using verbal communication (Hodgdon, 1999). These students will often process visual support more easily than other modes of communication (Rao & Gagie, 2006). Therefore, visual supports are recommended for students with ASD because they provide cues to aid students when performing tasks and assist them in processing information, understanding and using language, and understanding and interacting with their physical and social environments (Wong et al., 2014). ‘Visual supports’ is a collective term referring to items perceived via the eyes and that increase understanding of a particular environment and/or expectations in that environment and which contribute to an understanding of communication by making auditory information available visually (Hume & Smith, 2009). Visual schedules are regularly used as an environmental modification to enable engagement with routines for children with ASD (Goldman et al., 2018). As mentioned, this approach builds on the visual strengths of many individuals with ASD (Ganz et al., 2014) with the goal of promoting their independence (Banda et al., 2009). When children with ASD know what’s expected of them, or what’s going to happen next, this can reduce feelings of anxiety, decrease transition time and challenging behaviors during transitions, as well as increase children’s independence (Dettmer et al., 2000). Moreover, there is strong evidence for the use of visual schedules to increase task completion among children with ASD (Banda et al., 2009) across both age and levels of intellectual functioning (Koyama &Wang, 2011). Parents are crucial participants in interventions that take place in the home contexts of children with ASD. Training parents to employ evidence-based strategies, including naturalistic interventions for increasing compliance, is also important to the field. Research has demonstrated that parents can learn to implement naturalistic interventions effectively with their children with ASD spanning ages from preschool to high school (Franzone, 2009; Roberts & Kaiser, 2011). However, despite research that confirms the importance of empowering parents with the knowledge and skills to act as intervention agents for their children with ASD, examples of parent-mediated interventions that focus on problem behaviors are limited (Kuravackel et al., 2018). Therefore, the purpose of this study was to determine the effect of a parent-mediated intervention in which a visual schedule was implemented with a child with ASD who displayed noncompliant behavior at bedtime. The research question was, “What is the effect of a visual schedule on compliance with a bedtime routine in a 5-yearold boy with ASD? ”