If you struggle with getting your child to sleep, you are far from alone. And if your child has autism, sleep troubles are even more common. Research shows at least 25% and up to 40% of neurotypical children have sleep-related problems. Among children with autism spectrum disorder (ASD), that rate doubles.
Types of sleep problems in kids with autism
“Children with ASD typically have a harder time falling asleep, which may relate to disruptive behavior at bedtime,” explains Lee Mason, applied behavior analyst with Cook Children’s Child Study Center. “They are also more likely to have decreased sleep efficiency [the amount of time they’re in bed compared to their actual time asleep], fewer total hours of sleep and shorter sleep durations.”
In some cases, a child’s issues at night are connected to the fact that their central nervous system is not fully developed. Those sleep problems can be outgrown. Some conditions, including sleep apnea, may get better with surgery. Children with ASD, on the other hand, tend to have behavioral-related sleep problems; surgery isn’t a solution, and those problems typically aren’t outgrown.
For most parents, the outcome of a bad night of sleep is a cranky child. But when your child has ASD, there can be more serious issues.
“The core characteristics of autism are deficits in communication and social skills, along with an excess of restrictive and repetitive behaviors,” says Mason. “Lack of sleep can exacerbate each of these in children with ASD. Sleep difficulties can also contribute to poor attention, and more severe challenging behaviors like aggression and self-injury.”
How much sleep does my child need?
The number of suggested hours of sleep varies based on age; children with autism generally don’t need more or less than other kids. Mason shares these recommendations:
- Ages 2–3: 12 hours of sleep per day (including night and naps)
- Ages 3–5: 11 hours of sleep, with naps gradually reduced
- Age 6: By this age, naps should be a thing of the past, and kids should be getting 10 or more hours of overnight sleep.
“Just keep in mind that these numbers are averages, and that more important than watching the clock is watching your child’s behavior throughout the day,” adds Mason.
Addressing sleep problems in children
First of all, set a standard bedtime and wakeup time. “You don’t have to be perfect,” says Mason, “but it gives you something to aim for on a daily basis. Make small, incremental changes and check to see whether they get you closer to your child’s daily sleep goal.”
And if you tend not to think about bedtime until the sun goes down, try a different approach. Eliminate caffeine at least six hours before it’s time for your child to go to sleep, and wrap up exercise before dinner. Mason also stresses the importance of a balanced diet and turning off electronics at least one hour, preferably two, before bedtime.
An important factor in healthy sleep habits is a consistent routine before lights out.
About half an hour before bedtime, start winding down: bath, pajamas, brush teeth and story. Finally, tuck your child in bed, which Mason emphasizes is for sleep only. “No playing games in the bed. No singing songs or conversations in bed. No stories in bed. Your goal is for the child to be asleep within 15 minutes of their head touching the pillow,” he says.
It might be difficult for a child with autism to really grasp the pre-bed routine. Consider using visual aids, such as drawings and pictures of bedtime routine activities—similar to social stories you might use to prepare for a vacation or camp. The website for Slumber Yard, which focuses on mattress information and reviews, has a sleep tool kit for kids with ASD (find it here, along with more tips and info) with downloadable visual schedules.
But potential issues don’t end when you tuck your child in bed. What if your child cries? What if they repeatedly leave their room or wake up frequently? Mason says those problems can often be addressed with environmental changes, such as:
- Graduated extinction—in which a parent gradually lowers their level of support and comfort-giving at night, such as allowing the child to cry for a few minutes before returning to briefly soothe the child, and gradually extending those intervals.
- Bedtime passes—a card a child can exchange to leave their bedroom for a drink, a bathroom visit, a hug, etc.; if it isn’t used, the child may redeem the card for a reward in the morning. (You can download a sample pass through the Slumber Yard site.)
- Scheduled awakenings—a method in which the parent monitors nighttime wakeups; if they happen at routine times, awaken the child a bit earlier while they are still in deeper sleep—the idea is that children will have an easier time going back to sleep while in that deeper stage.
More resources for better sleep for children with special needs
If your child has ongoing problems going to sleep and staying asleep, talk to your pediatrician about personalized solutions. Mason also points parents to Sleep Better! A Guide to Improving Sleep for Children with Special Needs by Mark Durand. “I cannot recommend [this book] enough,” he shares.
The organization Autism Speaks also provides guidebooks covering sleep strategies for children and teenagers with autism. Here’s to a good night’s rest for the whole family.
Image courtesy of iStock.