Behavioral Therapy for Sleep Issues in Autism

As many bleary-eyed, exhausted parents will tell you, children with autism often have sleep issues. These can include difficulty falling asleep, night waking, short sleep duration, and early morning waking. Sleep difficulties affect the entire family, as parents and siblings are often awakened by the child’s nocturnal activities. Chronic lack of sleep affects many aspects of daily life, including mood, attention span, cognitive functions, and motor planning.

Children with autism who suffer from sleep disturbances show increased autistic-like symptoms, such as stimming, withdrawl, and meltdowns. Lack of sleep also affects the parent’s ability to care for their child, making it even more difficult for them to offer their child the stimulation and interventions that could make a difference.

Research using polysomnography (PSG), which measures sleep using physiological factors such as brain waves and eye movements, and actigraphy, a device resembling a wristwatch that record activity patterns and can estimate sleep parameters, confirms that children with autism have increased sleep latency, decreased sleep efficiency, and increased number of night wakings, and disrupted eye movement as compared to typically developing children.

Many parents have used the supplement Melatonin to ease their child’s sleep issues, but others prefer to stay away from supplements or drugs. Research shows that behavioral and sensory modifications can be helpful in treating sleep issues for children with autism.

Sleep hygiene is the first line of treatment. It includes things like sticking to a regular bedtime routine, making sure the child’s room is dark and comfortable, avoiding stimulating activities close to bedtime, and keeping a consistent schedule. Many parents are surprised to learn that their child’s sleep issues may be a simple as removing an itchy tag from their pajamas and following a consistent routine.

Extinction involves parents ignoring bedtime interruptions. With standard extinction, parents ignore all bedtime interruptions, with no interaction until morning. This can result in a temporary increase in problem behaviors, and can be problematic for children who have self-injurious behaviors.

Graduated extinction is the process of ignoring problem behaviors for a given period of time, then settling the child back in bed with a minimum of interaction. The waiting period is gradually lengthened until the child is able to fall asleep independently.

Faded bedtime can be useful for children who fall asleep very late at night. Parents start by determining a bedtime in which the child will be likely to fall asleep independently within 15 minutes of laying down. Once the child is falling asleep regularly, the bedtime is moved up by 15 minutes and the process begins again. Parents continue moving the bedtime up until it reaches a reasonable time.

Behavioral strategies require more work and patience than pharmaceutical interventions, but in the long run they help the child to develop effective sleep habits, and have fewer side effects. Getting a child on a regular sleep schedule takes pressure off the entire family, and often makes a difference in the child’s autistic behaviors.

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Laurel Joss About Laurel Joss

Laurel Joss is a freelance writer with a Master’s Degree in Early Childhood Education. She worked as an RDI® Program Certified Consultant and has published articles in Autism Spectrum Quarterly and on her blog www.remediatingautism.blogspot.com. She is a mother to two children, one of whom is on the autism spectrum. You can also follow her on https://twitter.com/speaking_autism and https://www.facebook.com/speaking.autism.ca