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The Use of Technology and Telehealth to Improve Behavioral Sleep Assessment and Intervention

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Children diagnosed with autism spectrum disorder (ASD) are likely to experience sleep disturbance. Evidence supports the effectiveness of functional analysis and behavioral sleep interventions to address sleep problems. However, these approaches are resource intensive in terms of assessment and measurement of target sleep behaviors, intervention implementation, and progress monitoring. Recent advances in the use of technology and telehealth in behavioral services may improve the efficiency and effectiveness of behavioral intervention. We evaluated the effectiveness of a hybrid (face-to-face and telehealth) model of behavioral sleep assessment and intervention as implemented by community-based behavior analysts. We used motion/sound detection cameras and various “apps,” for remote viewing, caregiver coaching, data collection, and treatment decision making. We explored the agreement between various data sources. Three autistic children, who engaged in caregiver reported unwanted co-sleeping or behavioral sleep challenges, participated in the study along with their caregivers. A nonconcurrent multiple baseline design across participants was used to evaluate the effects of the intervention on sleep onset delay, sleep interfering behavior, and total sleep duration. For two participants, caregiver co-sleeping was eliminated, target bedtimes were achieved, and child participants regularly achieved an age-appropriate amount of sleep. Caregivers rated the intervention and child outcomes positively. The results provide preliminary evidence for the use of telehealth technology to provide caregiver coaching, monitor child progress, and make timely data-based treatment decisions. Results of this study may be used to increase the efficiency of––and access to––behavioral sleep assessment and intervention.

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Data Availability

All data generated and analyzed during the current study are available from the corresponding author on reasonable request.


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Financial support for this research was provided through the Council for Research in the Social Sciences (CRISS), Faculty of Social Sciences, Brock University.

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Authors and Affiliations



Julie Koudys, Catherine McConnell, Angeline Savard, and Krysten Spottiswood were involved in study conception and design. These authors, along with Alyssa Treszl, Paige O'Neill, Kaitlyn Harrison, and Michelle Guzman Ratko were responsible for material preparation, data collection and analysis, and manuscript preparation. Aman-preet Randhawa supported the literature review and manuscript preparation. The first draft of the manuscript was written by Julie Koudys and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

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Correspondence to Julie Koudys.

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Informed consent for participation was provided by all caregivers for their own, and their child’s, participation.

Ethics Approval

Ethical approval for this research was granted by a university Research Ethics Board and the research was conducted in a manner consistent with the standards for research involving human participants.

Updated Author Affiliations

Michelle Guzman-Ratko is employed by St. Joseph's Healthcare Hamilton. Paige O’Neill is completing her doctoral studies at the University of Nebraska Medical Center, Munroe-Meyer Institute. Krysten Spottiswood, is now employed by Pyramid Educational Consultants of Canada. Alyssa Treszl is now employed by Thames Valley Children’s Centre.

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The authors have no competing interests to declare that are relevant to the content of this article. The authors have no conflicts of interest to disclose.

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Koudys, J., McConnell, C., Savard, A. et al. The Use of Technology and Telehealth to Improve Behavioral Sleep Assessment and Intervention. Behav Analysis Practice (2024).

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