Behavioral Parent Training as a Sleep Health Intervention? Unexpected Sleep Gains of Parent–Child Interaction Therapy
Background: Sleep problems in young children are a significant public health concern, disproportionately affecting racial, ethnic, and socioeconomically disadvantaged groups. Poor sleep health is linked to cognitive, behavioral, and emotional difficulties. Parenting practices play a key role in shaping children’s sleep behaviors. Addressing behavior and sleep problems concurrently may enhance intervention outcomes. Objective: This study examined the impact of Parent–Child Interaction Therapy (PCIT), a widely used behavioral parent training (BPT) program, on children’s sleep health. It also explored factors contributing to changes in sleep, including parenting practices, treatment dosage, and parenting stress and family conflict levels. Method: Participants included 403 children (ages 2–9 at enrollment) and their caregivers enrolled in an 18-week PCIT program at a University-affiliated clinic. Sleep health was evaluated using the Children’s Sleep Habits Questionnaire at pre-, mid-, and post-treatment. Parenting practices, family stress, and child compliance were measured through observational and caregiver-report assessments. Linear mixed-effects models examined sleep problem changes over the course of treatment. Results: Significant improvements in children’s sleep were observed at post-treatment, particularly in the areas of caregiver-reported bedtime resistance, sleep onset delay, sleep duration, sleep anxiety, night awakenings, and parasomnias. These improvements were most notable during the parent-directed discipline phase of PCIT. Parenting skill acquisition, treatment dosage, and family stress factors did not significantly predict sleep improvements. Greater pre-treatment sleep problems were associated with higher externalizing behavior scores but did not moderate behavioral improvements over time. Conclusions: PCIT may improve both behavior and sleep health even without sleep-specific interventions. Findings suggest BPTs could streamline treatment efforts, particularly for families with limited access to care. Future research should explore which BPT components contribute most to sleep improvements and the potential for integrating targeted sleep interventions.
