Sleep Challenges and Autism
As a Behavior Analyst and Special Educator, I have worked with thousands of families of kids with autism during my career both in the classroom and in the clinic. Many of the clients I have worked with reported sleep challenges: falling asleep independently, staying asleep, or broken sleep throughout the night. Over time, these issues tend to worsen behavioral challenges and decrease overall quality of life. Not know what else to do, some of these families resorted to putting their children on medication or using natural supplements like Melatonin to address the problem.
Using behavioral strategies to address sleep issues is one approach I have found to be successful in my work. As with many Evidence Based Practices (EBPs) found to be successful with individuals with autism, setting up the environment, establishing clear expectations, developing a consistent routine, and utilizing reinforcement are the hallmarks of these interventions. Several tips I share with the families I work with include:
1. Set up the Sleep environment: the bedroom should be dark, quiet and cool (i.e., 68-70 degrees). If the room is not fully dark, consider using blackout shades or taping a dark sheet to the window.
2. Bedtime routine: Establishing a clear and consistent routine is essential. You can include a visual schedule to communicate the steps of that routine. Make sure it is not too long and does not include anything that will activate the system (e.g., TV, playing active games). Try to include something that is calming for your child like readings, yoga, or playing with a quiet toy like puzzles.
3. No TV or electronics at least 45 minutes to one hour before bedtime: These activities will alert the brain and will keep the body from calming down.
4. Teach your child to fall asleep alone: Make sure your child learns to fall asleep alone without a parent present. All children and adults wake briefly during the night but quickly put themselves back to sleep by reestablishing associations used at bedtime. If your child needs a parent present to fall asleep at bedtime, they might need a parent to help him fall back asleep during the normal awakenings. A fading procedure is one option for working towards independence IF your child is used to you being present to fall asleep.
5. Exercise: Make sure your child is getting enough activity during the day, but not too close to bedtime (i.e., within one hour). Don’t try to “ware them out” right before bedtime as it will backfire!
6. Napping. Solid day sleep leads to solid night sleep. Napping is a good thing and cutting out naps before the age of three is not recommended. Many children continue napping until they are 4 or 5. Monitor the length of the nap and if the child is waking up happy that is a good sign.
7. Avoid sugar and caffeine: Both sugar and caffeine can interfere with sleep. Avoid consuming either of these after the evening meal.
Remember, each child is different and the strategies I have outlined all need to be individualized to meet the needs of the child and family. Please make sure you first rule out all potential medical conditions that could be contributing to sleep issues.
Dr. Hampshire