Mini-KiSS – ein multimodales Gruppentherapieprogramm für Eltern von Kleinkindern mit Schlafstörungen
Eine Pilotstudie
Abstract
Fragestellung: Schlafstörungen im Kindesalter neigen zur Chronifizierung und gehen häufig mit elterlicher Belastung einher. Daher war das Ziel dieser Pilotstudie die Entwicklung und Evaluation eines multimodalen Trainingsprogramms für Eltern von Kindern zwischen 0.5 und 4 Jahren mit Schlafstörungen (Mini-KiSS). Die Annahme war, dass sich die Schlafproblematik und die elterliche Befindlichkeit durch ein solches strukturiertes Gruppentraining signifikant verbessern lassen. Methodik: In der Pilotstudie wurde ein prä-post-Testdesign ohne Kontrollgruppe durchgeführt. Es nahmen n = 17 Eltern von Kindern zwischen 0.5 und 4 Jahren mit Schlafstörungen nach ICSD-II an der Untersuchung teil. Jede der sechs Sitzungen wurde evaluiert, das Schlafverhalten der Kinder wurde mittels Schlaftagebuch sowie CBCL erhoben. Emotionale und verhaltensbezogene Beeinträchtigungen des Kindes wurden anhand der CBCL gemessen. Die elterliche Befindlichkeit anhand der SCL-90-R. Ergebnisse: Es zeigte sich eine hohe Akzeptanz des Mini-KiSS-Trainings und eine sehr positiv eingeschätzte Durchführbarkeit. Die Schlafprobleme der Kinder, wie beispielsweise die Anzahl des nächtlichen Erwachens, die Dauer der nächtlichen Wachzeit sowie das Schlafen im Elternbett, nahmen signifikant ab. Die psychische Befindlichkeit der Kinder sowie der Eltern verbesserte sich signifikant. Darüber hinaus zeigten die Mütter eine Verbesserung hinsichtlich der Depressivität. Schlussfolgerungen: Mit dieser Pilotstudie konnte gezeigt werden, dass das multimodale Kurzzeitinterventionsprogramm Mini-KiSS sehr gut durchführbar ist und akzeptiert wird. Das Programm erwies sich als effektiv zur Reduktion der kindlichen Schlafproblematik.
Objective: Sleep disorders in early childhood tend to be chronic and almost always a burden for the parents. This study developed and evaluated a multimodal parent training program for children 0.5 to 4 years of age suffering from sleep disorders (Mini-KiSS). We hypothesized that there would be specific improvements following the structured group training (reduction of sleep problems, improvement of parental well-being). Method: The pilot study consisted of a pre-post test design without control group. Participants were n = 17 parents of children 0.5 to 4 years of age with sleep disorders determined according to the ICSD-II. Each of the six sessions was evaluated, and changes were assessed by sleep diary and CBCL. Behavioral and emotional problems of the child were assessed by CBCL, parental well-being, and SCL-90-R. Results: The results showed high acceptance of Mini-KiSS and satisfactory feasibility. Children showed significant improvements of the sleep disturbances such as nightly awakenings as well as sleeping in parents’ bed. Furthermore, improvements were found for children’s emotional and behavioral problems and for parental well-being, in particular for the depression scale of the mother. Conclusions: This pilot study shows a high acceptance and good feasibility of the multimodal short-time parent-training program Mini-KiSS. Sleep problems were significantly reduced.
Literatur
2000). Manual for the ASEBA preschool forms and profiles. Burlington, VT: University of Vermont.
(1989). Reducing bedtime tantrums – Comparison between positive routines and graduated extinction. Pediatrics, 84, 756–761.
(2005). International classification of sleep disorders: Diagnostic and coding manual (2nd ed.). Westchester, IL: American Academy of Sleep Medicine.
(2006). Differences in infant and parent behaviors during routine bed sharing compared with co sleeping in the home setting. Pediatrics, 117, 1599–1607.
(1980). The development of sleep behavior within the first 5 years of life. Helvetica Paediatrica Acta, 35, 211–223.
(2002). Sleep and adjustment in preschool children: Sleep diary reports by mothers relate to behavior reports by teachers. Child Development, 73, 62–75.
(2007). Child sleep disorders: Association with parental sleep duration and daytime sleepiness. Journal of Family Psychology, 21, 88–94.
(1977). SCL-90-R: Administration, scoring and procedures manual-I for the R(evised) version. Baltimore: John Hopkins University School of Medicine.
(2007). Leitlinien zur Diagnostik und Therapie von psychischen Störungen im Säuglings-, Kindes- und Jugendalter (3. überarbeitete Aufl.). Köln: Deutscher Ärzte Verlag.
(2004). Treatment of sleep problems in families with young children: Effects of treatment on family well-being. Acta Paediatrica, 93, 126–134.
(2009). A review of the effects of sleep during the first year of life on cognitive, psychomotor, and temperament development. Sleep, 32, 1449–1458.
(2006). Marital conflict and disruption of children’s sleep. Child Development, 77, 31–43.
(2003). Überprüfung der psychometrischen Parameter von CBCL 1½–5 und C-TRF an einer deutschen Stichprobe. Dissertation, Frankfurt am Main.
(1995). SCL-90-R. Die Symptom-Checkliste von Derogatis – Deutsche Version. Göttingen: Beltz Test.
(2002). Randomised controlled trial of behavioral infant sleep intervention to improve infant sleep and maternal mood. Pediatrics, 107, 1317–1322.
(2005). A longitudinal study of bed sharing and sleep problems among Swiss children in the first 10 years of life. Pediatrics, 115, 233–240.
(1991). Infant and toddler sleep: a telephone survey of parents in one community. Journal of Developmental and Behavioral Pediatrics, 12, 108–114.
(1999). Handbook of research methods in clinical psychology (2. Auflage). New York: Wiley.
(1984). A developmental approach to the management of children with sleep disturbances in the first three years of life. European Journal of Pediatrics, 142, 170–173.
(1991). Treatment of infant sleep disturbance by graduated extinction. Child and Family Behavior Therapy, 13, 39–56.
(1999). Psychosocial treatments for adolescent depression. Clinical Psychology Review, 19, 329–342.
(1985). Sleep problems seen in pediatric practice. Pediatrics, 75, 477–483.
(1997). Bedsharing promotes breastfeeding. Pediatrics, 100, 214–219.
(2007). Relationship between child sleep disturbances and maternal sleep, mood and parenting stress: A pilot study. Journal of Family Psychology, 21, 67–73.
(2006). Behavioral treatment of bedtime problems and night wakings in infants and young children. Sleep, 29, 1263–1282.
(1993). Treatment of childhood sleep disorders: Generalization across disorders and effects on family members. Journal of Pediatric Psychology, 18, 731–750.
(2009). A nightly bedtime routine: Impact of sleep in young children and maternal mood. Sleep, 32, 599–606.
(2010). Bedtime problems and night wakings: Treatment of behavioral insomnia of children. Journal of Clinical Psychology, 66, 1195–1204.
(2002). Clinical sleep services for children: Clinical and administrative considerations. Sleep Medicine, 3, 291–294.
(1988). Management of sleep Problems in preschool children: Effects of a behavioural program on sleep routines, maternal depression, and perceived control. Early Child Development and Care, 34, 227–240.
(2005). Assessment of young children using the Achenbach System of Empirically Based Assessment (ASEBA). Mental Retardation and Developmental Disabilities Research Reviews, 11, 226–238.
(1981a). Sleep problems in young children. Archives of Diseases in Childhood, 56, 491–493.
(1988). Reducing nocturnal awakening and crying episodes in infants and young children: A comparison between scheduled awakenings and systematic ignoring. Pediatrics, 81, 203–212.
(1994). Activity-based sleep-wake identification: an empirical test of methodological issues. Sleep, 17, 201–207.
(2011a). Mini-KiSS – Das Therapeutenmanual zum Elterntraining für Kinder mit Schlafproblemen. München: Kohlhammer.
(2011b). Mini-KiSS – das Elterntraining für Kinder mit Schlafproblemen. München: Kohlhammer.
(2010). Insomnien in der pädiatrischen Praxis – Häufigkeiten, familiäre Belastung und Behandlungsempfehlungen. Somnologie, 14, 129–134.
(2009). Schlafstörungen in der Kindheit als Risikofaktor für psychische Störungen im Erwachsenenalter. Neuro-aktuell, 32, 21–23.
(1990). Night waking in 1-year-old children in England. Child: Care, Health and Development, 16, 283–302.
(1989). Reducing sleep disruptions in young children: evaluation of therapist-guided and written information approaches: a brief report. Journal of Child Psychology and Psychiatry, 30, 913–918.
(2001). Sleep and behaviour problems in school-aged children. Pediatrics, 107, 1–9.
(1987). Persistence of sleep disturbances in preschool children. The Journal of Pediatrics, 110, 642–646.
(2010). The role of cognitive-behavioral therapy in behavioural childhood insomnia. Sleep Medicine, 11, 686–691.
(1985). The relative influence of child and environmental characteristics on sleep disturbances in the first and second years of life. Journal of Developmental & Behavioral Pediatrics, 6, 81–86.
(2010). Association between sleep patterns and daytime functioning in children with insomnia: The contribution of parent-reported frequency of night waking and wake time after sleep onset. Sleep Medicine, 1, 281–288.
(2007). Diagnostik von Schlafstörungen. Monatsschrift Kinderheilkunde, 155, 600–607.
(1994). Incidence and persistence of problems at sleep onset and sleep continuation in the preschool period: Results of a prospective study of a representative sample in Bavaria. Praxis Kinderpsychologie und Kinderpsychiatrie, 43, 331–339.
(2005). The theory and practice of group psychotherapy (5th ed.). New York: Basic Books.
(