Healthy sleep is essential to a well-functioning person, it is even more important for children and adolescents to consistently get healthy sleep because it’s instrumental to their growth and development. What is alarming is that twenty-five to forty percent (25-40%) of studies indicate that children and teenagers have sleep problems (Mindell and Meltzer 2008). Children and adolescents with ADHD, autism, and anxiety disorders are most likely to have sleep problems in addition to their diagnosis.
Sleep difficulties in children can be especially troublesome for parents as they can affect the entire family. When a child with autism isn’t sleeping, other family members typically aren’t either. To help your child who is having sleep difficulties, it’s important to know the root cause. Once a cause or sleep disorder is identified, the appropriate treatment option can be determined.
Sleep Tips for Children with ASD and Sleep Problems
Whether your child has been diagnosed with a sleep disorder or just has problems sleeping, these tips are for you! Any child or adult can benefit from good sleep hygiene and consistent routines. When making changes to your family’s sleep schedule, make small changes first. Start with one change at a time and slowly add in others. It takes a while to form a habit – stick with whatever you decide to change for at least two weeks to see if it makes a notable difference for your family.
Setting the Sleep Mood
Bedrooms should be comfortable, quiet, and dark for successful sleep. Avoid screens and noise when the child is falling asleep. Consistent background noise, like a noise machine or fan, could be soothing for some people.
Determine if your child likes a certain type of pajamas, noise, or no noise, and a little or no light in their bedroom. Use what they prefer for their bedtime routine.
Bedtime habits can make all the difference in getting anyone to fall asleep at or shortly after their bedtime. Starting a short and predictable routine 15-30 minutes before bedtime is recommended. This routine should be calming and done in a relaxing environment. It can be helpful to complete the routine in the child’s bedroom. However, completing part of the routine in the living room or another area of the house is okay, if there aren’t any distractions, noises, or other hindrances in those settings.
Each step should be done in the same order every night. This process can be assisted with the use of a bedtime checklist or visual schedule depending on the person’s needs. This process should include changing into pajamas, going to the bathroom, and brushing teeth. Reading a book to or with a child can help calm them and give them individualized attention before bed, as well. You can personalize the bedtime routine for your child in any way you think is appropriate for them.
Consistency Counts (Sheep)
When it comes to optimal sleep, keeping your children on a consistent schedule including bedtime, naptimes, and mealtimes is beneficial.
Bedtime – Choose a bedtime for your child and keep it. Having a set bedtime and wake time seven days a week is recommended. The bedtime should work well with your life, activities, and for your child’s age. When you set a consistent bedtime, the bedtime routine can also occur at a consistent time. If life changes happen or the bedtime needs to change, see how it affects your child’s sleep. Adjust the bedtime if you see the change is negatively impacting your child.
Although consistency is ideal, as life and/or schedules change, you should have some flexibility. For instance, as young children age, they may need less sleep, or their nap time may be better later in the day. Also, if a child is sick or simply overly tired from daily life activities, they may benefit from being able to sleep in or going to bed early. It takes a careful balancing act to know when to be flexible with your child’s sleep schedule and when to maintain careful consistency.
Keep an eye on your child’s energy levels in the evening. If your child has difficulty falling asleep at their scheduled bedtime, you might consider changing their bedtime to 15, 30, or even 60 minutes later and monitoring how that change affects their ability to fall asleep.
Naps - The nap should occur in the child’s bedroom and be awakened from an afternoon nap by a certain time, such as 3:00 pm, if needed, to avoid difficulty at bedtimes.
Meals – Breakfast should happen at the same time on weekdays and weekend days. Heavy meals and large snacks should not happen late at night. A light snack though can facilitate sleep.
Many children and adults struggle to calm down physically and mentally to get into the right headspace for sleeping. There are many strategies, like progressive muscle relaxation mentioned above, deep breathing for older kids and adults, and blowing bubbles for young kids. These can facilitate relaxation, before bed. Additional strategies include four-count breathing, visualization, and a worry box.
Four-count breathing - This involves breathing in for four counts, holding their breath for four counts, and then breathing out for four counts. This will get easier as it is practiced.
Visualization - Adults and teenagers can practice thinking of preferred, enjoyable, and calming locations to calm their mind. This could be thinking of a beach, a fireplace, or any area that brings calm feelings. Children may benefit from looking at pictures instead of places they enjoy or find calming.
Worry box - Adults, teenagers, or children write down or draw a picture of any worries they had from the day so they can let them go.
Communicating with your child about what they would want to do and what they find helpful for calming can help them buy into the strategies that you put in place.
Teaching Sleep Independence
A major problem for many children is learning to sleep independently. Waking up throughout the night is common and independent sleepers are able to fall back asleep easily. However, if a child is not an independent sleeper, they will need a parent’s assistance to fall back asleep throughout the night when they wake up. This disrupts the child’s and the parent’s sleep. Using some of the methods below will be helpful in teaching your child sleep independence.
Fading your support at bedtime is a great place to start. For example, instead of laying down with your child while they fall asleep, sit at the end of their bed for a few nights. Then move to a chair and slowly move the chair from beside their bed, to the doorway, to the hallway. Reducing attention as you do this is also recommended. Less talking, eye contact, and facial expressions should be used each time you adjust your sitting position.
If your child is upset, you can do a check-in on them after a few minutes. Have a brief visit with limited contact. Use a firm voice that it is time for bed and that your child is safe. Wait longer and longer between each check-in until your child is asleep. These same techniques can be used when your child wakes in the night.
Bedtime passes can be a tool parents use for their child to exchange one time per night for either one parent visit, a drink of water, a hug, or a kiss. The stress on this is one time only. The child will have to turn in the pass to use it that evening. The pass will be returned to the child each night at bedtime.
If your child does not use the bedtime pass during the night, it can be traded in for a prize or reward in the morning.
If you use the bedtime pass as a teaching tool, a written explanation and visual representation of the rules may be helpful for your child to understand the uses and rules of the bedtime pass, as well as how to earn rewards.
If your child is okay with waiting for a reward, a sticker chart reward system might be the best approach. They can earn a sticker for different aspects of healthy sleep, such as not getting out of bed, going to sleep by a certain time, or not calling out for more than one “bedtime pass.”
Once your child has a set number of stickers, they can exchange them for an outing or to pick out a new toy, another item, or activity that your child likes. The rules of these systems are up to you as the parent and can motivate your child to sleep independently.
Set a Good Sleep Hygiene Plan
Many children and especially children with autism struggle with falling asleep, staying asleep, and getting enough sleep. Understanding your child’s sleep habits and sleep needs will help a pediatrician determine if your child has a sleep disorder. Medications may help your child, but behavioral interventions are highly recommended as they can be successful for most children.
Set a plan that seems best for your family. There isn’t one right way to help children have healthier sleep. It is important to stick to your plan at least for a reasonable amount of time. It’s okay to change your strategy but give it time to see if the approach you have chosen will be helpful. It often takes time for kids to adjust to new sleep habits.
Modeling good sleep hygiene by having your own healthy sleep habits can also be helpful. Making changes to routines, habits, and what children are used to may be difficult, but with a good plan, consistency, and compassion toward figuring out what your child needs, your child and your family will sleep more soundly in time.
Mindell, J. A., & Meltzer, L. J. (2008). Behavioural sleep disorders in children and adolescents. Ann Acad Med Singapore, 37(8), 722-728.
Content Credit: Lisa Freed