Damian is a 7-year-old boy with PDDNOS who has experienced a sleep regression over the past 12 months where he will only sleep in his parents' bed after being awakened by a nightmare. His parents have tried reward strategies to encourage Damian to sleep in his own bed but they have not been effective long-term. The parents are looking for a new strategy to help Damian sleep in his own bed throughout the night.

1. Damian
Module 10
Case Scenario
By Melissa and Eugene

2. Case Scenario
Damian is a 7-year-old boy with PDDNOS. At home, he presents with a
significant amount of life skills deficits.
One such deficit is that he is not able to
sleep in his bed at night. For the last 12
months Damian experienced a sleep
regression where he will only sleep when
he is in bed between his mother and
father. This regression started after
Damian was awoken in the middle of the
night by a nightmare.

3. Case Scenario cont…
Damian’s parents have tried several
reward strategies where Damian was
rewarded for spending specified amounts
of time in his bed, but these strategies
have proven ineffective at bringing about
sustained changes in his sleeping habits.
Damian’s parents are looking for a new
strategy to have their son stay in bed
throughout the night.

4. Extinction Intervention Plan
The parents should start out with one of them
sleeping in Damian’s bed for three days with him. Then
after that proves to be working, one of them should try
sleeping in his bed with him for half the night and then
going to their own bed. This step should be used for three
days. If Damian wakes up in the middle of the night, one of
the parents should lead Damian back to his own room and
lay with him until he falls asleep. After this step is
completed, Damian’s parents should lie in bed with him
until he falls asleep and then leave him. If Damian does
wake, his parents should bring him back to his bed and
once he falls asleep, they leave him. After these three
steps are followed and completed, Damian should only be
placed in his own bed to sleep. If any of the steps are not
being successful during the three-day period time frames,
the parents should return to the step before and continue
using that step for 2 more days.

5. DR Intervention Plan
Damian’s parents can try to set up a
differential reinforcement plan. They can talk
with Damian and try to find something that he
may want or really enjoys doing (such a seeing
new movie, going bowling or buying a new
game) and can use this as the reinforcement.
They can make a token board to use with
Damian. After a night’s sleep, Damian can place
a token on his board and track how many more
nights he needs before he receives his
reinforcement. They can start out with just a
two-night period and if Damian sleeps in his own
bed for two nights, he can receive his
reinforcement. As Damian’s behavior decreases,
his parents can increase the number nights
needed to receive his reinforcement.

6. Damian’s Token Board
Night 1
Night 2
If Damian sleeps in his bed for __2___ nights, he will
get to ______________________________.