Autism and sleep disturbances: is there a connection?
Yes, in fact up to 80% of children diagnosed with autism also experience problems related to sleep (as reported by Carin Lamm, MD and Associate Clinical Professor of Pediatrics Diplomate American Academy of Sleep Medicine).
Many children with autism experience difficulty falling asleep and staying asleep. Lack of sleep can exacerbate challenges that children on the autism spectrum experience already, such as difficulty with social interactions, inattention, and a greater intensity of repetitive behavior.
One study found that children with autism who have disrupted sleep are more hyperactive and easily distracted than those who do not experience similar sleep challenges1.
How can you help your child with autism sleep more successfully?
Tips and recommendations for improving the sleep patterns of a child with autism are similar to tips I’d give to parents of their neurotypical peers, with some exceptions…
Tip: Keep the bedroom cool, dark, and quiet. Use blackout curtains as needed. Utilize a sound machine.
Possible Exception: Some children with autism experience sensory challenges related to auditory, visual, or tactile stimuli. For most parents, I recommend using a sound machine. However, if your child with autism experiences overstimulation with auditory stimuli, you may need to continually adjust the volume to be sure it is comfortable for your child, or not use the sound machine at all. Experiment with different tones and sounds, but continue to avoid any sounds that have a pattern or clear beginning and end (as this can disrupt sleep). You may need to use similar strategies to find the right night light (amber or red tones are best for promoting sleep) for those with visual sensitivities. In addition, for children who experience tactile sensitivities, be sure pajamas are a comfortable fabric, remove tags as needed, and consider using a weighted blanket.
Tip: For the hour prior to bed, dim the lights and keep activities calm. Turn off screens at least 60-90 minutes before bedtime (this means TV, iPad, phones, computers, etc.).
Possible Exception: Many children with autism utilize electronic devices for both communication and reinforcement. If your child communicates with a speech generating device, do not stop use prior to bed (always allow access to his/her method of communication). Instead, consider a blue light blocking screen protector. If your child uses their iPad as a method of reinforcement, consider working towards developing alternative reinforcers for the evening hours to minimize exposure to blue light (a certified behavior analyst can help you with this process). If videos are necessary for reinforcement, consider dimming the screen, lowering the volume, and monitor that content is not violent or scary.
Tip: Utilize a consistent bedtime routine each night.
Possible Exception: A child with autism will benefit from the consistent routine to signal that sleep is coming, however, you can create added benefit by using a visual schedule as well. Using picture cues to signal what is coming next in the routine can create predictability and allow the child to develop independence with completion. Some children can utilize more abstract cartoon images, while other will do better with photos of the actual items/activities (i.e., a photo of your actual bathtub, his/her own bed, etc.). Additional tips to make the visual bedtime routine successful: use Velcro to allow the child to remove the images when complete, or label the activities at their location with the same picture so the child can match (for example, a picture of pajamas on the pajama drawer) while moving through the routine. Keep the routine brief, simple, and predictable.
Tip: For preschool aged children and older, consider using a “bedtime pass.”
Possible Exception: No exception here, the bedtime pass is a great tool for both children on the autism spectrum and their typically developing peers. The bedtime pass is based on the research of Dr. Patrick Friman, and utilizes a limited number of passes that allow the child to get out of bed (with some restrictions). You can find more information on how to implement a bedtime pass here, or by looking up “The bedtime pass: An approach to bedtime crying and leaving the room” (Friman, P., 1999).
I’ve been working in the field of behavior analysis, supporting families with children on the autism spectrum, for over 14 years. For many of my early years in the field, I heard parents talk about their child’s struggles with sleep, yet I didn’t always know how to guide them (as sleep disturbances with autism is not heavily researched). Now, I can pair my experience with behavior support and autism with my training in pediatric sleep to provide relevant guidance and encouragement to families. If your child on the autism spectrum is experiencing sleep challenges, don’t hesitate to reach out! I enjoy taking a collaborative approach with your child’s service providers, such as occupational therapists, SLPs, and behavior team!
1. Goldman S.E. et al. Dev. Neuropsychol. 34, 560-573 (2009) PubMed