Brain Rules for Baby (John Medina) / quote 85 of 91
Cry-It-Out and graduated extinction
It is not often a scientist becomes so engrained in popular culture that his name becomes a verb. But that is exactly what happened to pediatric sleep researcher Dr. Richard Ferber, a prominent advocate of the Cry-It-Out method. Dr. Ferber, founder of Boston’s Center for Pediatric Sleep Disorders, didn’t make up CIO. Core CIO ideas can be found as far back as the 19th century. But his name is so closely associated with the practice that parents who embraced his protocol were accused—yes, accused—of “Ferberizing” their children. How does CIO work? Researchers call CIO methods “extinction styles.” In psychology, “extinction” is a general term for weakening a behavior by restricting its reward structure. The reward structure is attacked because it is the reinforcing agent keeping a behavior alive, a behavior whose extinction is desired. With infant sleep, a reinforcing agent looks like this: (a) baby is crying at 3:00 a.m. for attention; (b) parent comes into the room, picks him up, and comforts him, providing the attention; (c) baby stops crying, thus reinforcing the behavior. The baby learns that crying is a good way to get attention, day or night. He cries in anticipation of parental response, creating an internal attitude called a “reinforcement expectation.” The parent learns that the most successful method to calm the infant at night is to go in and hold him, which rewards the crying. The way to “break” this cycle is to not provide attention every time baby wants it. He must instead be taught to fall back asleep independently, CIO advocates say. Baby then learns to sleep on his own, and the nighttime crying is extinguished. This process is not usually greeted with enthusiasm on the part of the child. That’s why it’s called “crying it out.” CIO can properly be described as a continuum between “unmodified extinction,” in which the parent refuses to respond regardless of how long the crying continues (researchers don’t recommend this), and “camping out” or “fading,” in which the parent is close but spends less and less time by the child’s crib providing assurance. In the middle of the continuum, we find “graduated extinction.” The parent does respond to the child’s nighttime cries, but on a strict schedule. The amount of time a child is allowed to cry gradually lengthens. The delays are deliberately timed and incremental, hence the term “graduated.”