Autism & Sleep: An Interview With An Expert!

 
Autism And Sleep


 

Happy April, readers! Spring is finally here – and so is National Autism Awareness Month. This is such an important month, and it’s one that’s close to our hearts. That’s because we’ve learned over the years, through our work with families, that autism affects a child’s sleep in a big way. We’ve written about how and why autism affects sleep in the past. But today, we have something a little different for you.

SarahWToday, we are talking to special needs expert (and Baby Sleep Site® consultant!) Sarah Wisecamp. Before she joined us as a consultant, Sarah was a special education teacher for elementary-aged children with autism. And prior to teaching, Sarah worked as an early-intervention specialist, focusing on diagnosing early autism signs in children under 3. She is also trained in Applied Behavior Analysis and Verbal Behavior. So it’s clear that Sarah knows a thing or two about autism! And you can benefit from her wisdom and years of experience by reading today’s interview.

So, without further ado – let’s hear from Sarah, on the topic of autism and sleep!

The Baby Sleep Site: Sarah, to start, let’s talk about why parents of babies and toddlers should be worried about autism and sleep at all. After all, children aren’t typical diagnosed with autism until they’re school-aged, right? So how does this affect our readers?

Sarah: Good question! It’s true that, generally, a child isn’t officially diagnosed with autism, or Autism Spectrum Disorder (ASD) until age 5. However, in the past 5 years or so, the medical community has become much more intentional watching for early signs of autism in young toddlers and babies. Today, it’s not uncommon for a toddler as young as 18 months to be diagnosed as having early signs of autism. This kind of early diagnosis and intervention is key – the earlier we can work with autistic children and their families, the more progress we can make. So, when you think about this, it’s very possible that some of the families in our own Baby Sleep Site community may be directly affected by an autism diagnosis.

It’s also important to remember that autism rates continue to rise. It used to be that the statistic was 1 in 110 children had ASD; today, it’s closer to 1 in 88. So even a family who isn’t directly affected is likely affected in a secondary way – maybe you have a friend whose child has ASD, or a nephew or niece with the disorder.

The Baby Sleep Site: Wow – amazing that it’s possible to spot and diagnose early signs of ASD as early as 18 months! That’s encouraging, actually, to know that parents can get help even earlier now, and that early help can translate into better intervention. So, now that we’ve established why this matters, let’s talk about how autism and ASD affects sleep.

Sarah: Well, it’s important to remember that ALL children with special needs are more prone to sleep issues, especially children with Autism Spectrum Disorder. It is said that over 50% will experience sleep difficulties. Research has shown that early intervention is so important for all children with any delays, and addressing sleep needs is no different!

The Baby Sleep Site: Oh, good distinction, Sarah! So it’s not just ASD that impacts sleep – really, any special need diagnosis likely comes with sleep challenges.

Sarah: Yes, absolutely. It’s key that parents and practitioners watch out for sleep issues, and address them accordingly. Lack of enough sleep can impact daytime behavior in any child but especially in children with Autism. All parents want their children to be well rested to tackle the day and learn new skills whether it be learning letters at preschool or learning a new sign for drink in therapy. Parents should not just assume that sleep problems are part of your child’s delays or disorder, many doctors can rule out any underlying medical issues and sleep consultants can help develop a plan with a cognitive and behavioral approach.

The Baby Sleep Site: So what kinds of sleep challenges do children with ASD face, Sarah? Knowing that will help our Baby Sleep Site parents know what to be on the lookout for.

Sarah: Well, for starters, children with ASD tend to have trouble falling asleep and staying asleep. This is usually due to irregular circadian rhythms and sleep/wake cycles – and those are sometimes due to abnormal melatonin regulation. Insomnia is the most common sleep challenge for children with ASD. Often the child requires the parent to be present while they fall asleep.

Children with ASD are also more prone to seizures, reflux problems, night terrors, and sleep apnea – all of which can make sleep challenging.

The Baby Seep Site: Oh, that makes sense. Anything else?

Sarah: It’s also important to remember that children who have ASD also tend to have sensory issues – specifically, Sensory Processing Disorder (SPD). It’s not unusual for children to have both. Children with SPD tend to be hypersensitive to visual and audio stimuli. So any loud sounds at bedtime, or scratchy blankets or sheets, etc. can become big barriers to sleep for these children.

The Baby Sleep Site: So, we’ve covered the sleep challenges – but what can parents do to make sleep progress, Sarah? Specifically, what can parents be doing at home, on their own, to help their little ones with ASD and SPD sleep well?

Sarah: Good news – there are lots of techniques parents can use at home to encourage better sleep! For starters, establish a very strong bedtime routine. Sometimes, children with ASD and sensory issues have trouble reading bedtime cues, so having a strong and consistent bedtime routine is a great way to communicate that bedtime is drawing near. Just be sure that the routine is calming – this will help ease gently into sleep.

If your child has trouble winding down at the end of the night, it might be helpful to set a time about 15 minutes before the bedtime routine is set to begin, and then to start issuing bedtime reminders ever so often, to help your child begin to wind down.

Children with sensory issues are extra-sensitive to outside stimuli, so be sure to create a soothing sleep environment. Carpet or large rugs in the bedroom can help muffle outside noise, and room-darkening shades or curtains can help block out light that might be distracting. Check your child’s PJs, too, for any tags that might be scratchy. Same goes for bedding. Children with sensory issues may also benefit from weighted blankets – these can help them feel more anchored and secure.

One more note – children with ASD sometimes need their parents to remain present in the room while they fall asleep. This works for some families; for others, though, it becomes a difficult part of the routine to maintain. So it’s important that each family honor their unique situation in determining if this is a good step or not.

The Baby Sleep Site: Sarah, this is such great advice! Thanks for sharing your expert wisdom with us. :)

Autism Awareness Month Giveaway: Basic E-Mail Sleep Consultation Package

Readers, we are excited to announce that, in honor of Autism Awareness Month, we are giving away one Basic E-Mail Consultation Package to a family that is directly affected by autism, and needs sleep help for a child with ASD and/or sensory issues. Sarah herself will be working with the winner of the consultation package – so parents, you are really getting expert insights!

To enter the giveaway, simply leave a comment below, in the comments section. In your comment, be sure to explain how ASD and/or sensory issues affect your family, and how you believe you would benefit from getting sleep help from Sarah. The winner will be chosen at random. This giveaway is open to U.S. and international entrants. Be sure to include a valid email address when entering your comment.

Leave your comment below, and enter to win a Basic E-Mail Consultation!

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How Autism Spectrum Disorders (ASD) Affect Sleep


Here in the U.S., April marks more than the return of spring flowers and showers — it’s also National Autism Awareness Month. Autism is a growing concern not just in the U.S., but around the world: it’s estimated that 1 in 110 children has ASD (Autism Spectrum Disorder). That means that even if you haven’t been personally impacted by autism, you likely know someone who has.

A diagnosis of ASD presents numerous challenges to families — challenges related to learning, to physical and social development, and (the number one thing we tend to concern ourselves with around this site) sleep. It’s estimated that anywhere from 40% – 80% of ASD children have significant sleeping issues related to their diagnosis.

Why do Autism Spectrum Disorders Affect Sleep?

Unfortunately, there’s no specific, easily-identified reason why children with ASD are more likely to have difficulty sleeping than those without. This is probably because ASD is a variable disorder itself. The way it manifests, and the problems it causes, vary from child to child.

There are, however, some general theories as to why ASD may causes sleep disorders:

  • Social Cues: Children with ASD typically have a harder time reading social cues than other children do. This can make socializing hard for ASD children; it can also make bedtime hard! ASD children are less likely to register the social cues that it’s time to go to sleep (seeing their siblings putting on pajamas, listening to mom reading a bedtime story, etc.) They have difficulty seeing these as pre-bedtime rituals the way other children likely would.
  • Increased sensitivity to light, sound, and/or touch: Some children with ASD under-respond to stimuli like light and noise; others over-respond. This is commonly referred to as Sensory Processing Disorder, or SPD. It should be noted that while a large percentage (70% – 80%) of autistic children also have SPD, autism and SPD are separate diagnoses. So it’s possible for a child to have one without having the other. Children who are hypersensitive to stimuli may have difficulty sleeping For example, a child who’s extremely sensitive to light may find even a dim nightlight distracting. Or a child who’s hypersensitive to sound may be awoken by even the faintest noises. And a child who is extremely sensitive to touch may find the feel of sheets next to his skin unbearable.
  • Low levels of melatonin: The hormone melatonin helps regulate the human body’s circadian rhythms (or daytime/nighttime cycles.) For most of us, our melatonin levels rise when it gets dark outside, making us sleepy; then, they drop off when the sun comes up, helping us feel awake and alert. Children with ASD, however, have lower-than-normal levels of melatonin, which may explain why they sometimes have difficulty falling asleep and staying asleep at night.
  • Anxiety: Feeling anxious can make any child sleepless. Children with ASD, however, are especially prone to feelings of anxiety; a large percentage of children with ASD even suffer from anxiety disorders.

Effects of Sleep Disorders on Autistic Children and Their Families

Poor and interrupted sleep obviously affects an ASD child’s nights, but this kind of chronic sleep deprivation may also affect his daytime behaviors. Sleep deprivation has been shown to have the same negative affects on children with ASD as on non-autistic children: increased irritability and aggression, depression, increased hyperactivity and emotional problems, and behavior problems.

And of course, the ASD child isn’t the only one affected — parents and siblings feel the effects, too. Siblings, as well as parents, may suffer sleepness right alongside the ASD child, and that kind of endless sleep deprivation can take a serious toll (maybe even put your marriage or relationship at risk.)

Helping Children with Autism Spectrum Disorder Get a Good Night’s Sleep

The first step in helping your child with ASD get the rest she needs is to make sure that her sleep disorder isn’t related to something else. Make sure that her sleeplessness doesn’t stem from sleep apnea, teeth grinding, Restless Leg Syndrome (RLS), or another physical cause. Once you’ve ruled these out, you can begin implementing meaningful solutions.

Consider the following ways to help your child with autism get the sleep he needs:

  • Keep a sleep diary: Keeping a sleep diary can help you identify any patterns in your child’s sleep disturbances and then work on solutions that match the problem patterns. And if your child is older, it can be a way for him to take ownership of his sleep disorder and become a partner (instead of merely a by-stander) in the problem-solving process.
  • Develop a bedtime routine: Children with autism spectrum disorder must have predictable daily routines to help them feel safe and make sense of the world around them. Therefore, a bedtime routine (which is helpful for all kids) is especially crucial for ASD children. As you build a bedtime routine, try to build it with intention: don’t include any patterns or routines that you know you’ll have to break later (even if they’ll make your life easier in the short term!) Also keep in mind that children with autism don’t respond well to abrupt and unexpected changes. So it’s probably best to ease into the new routine.
  • Evaluate the sleeping environment: If hypersensitivity is an issue for your child, evaluate their bedroom to see if anything there may be causing problems. Then, work to create a sleep environment that’ll be restful and soothing for your child. That could mean installing thick carpet to muffle noise (if your child is sensitive to sound) or hanging room-darkening curtains (if your child is sensitive to light). For children who are sensitive to touch, these weighted blankets have been shown to help. And you may even need to consider a custom-made bed designed specifically for autistic children (like this one) if your child is getting out of the bed and wandering the house at night, and you have concerns about her safety.
  • Consider medication (but only as a last resort!) Vitamins and other supplements, like melatonin or iron, may help improve an ASD child’s sleep and are considered good options, as long as they’re administered under a healthcare provider’s supervision. We advise that you always speak to your doctor before giving your child any supplement. Sleep medications should be a last-resort option, and they should only be used once a family has considered any sleep associations or schedule problems and even then, we recommend they only be used in conjunction with some of the strategies listed above. Otherwise, once the child stops taking the medication, the sleeping issues will likely return full-force.

If you feel that your baby or toddler may be showing signs of ASD behavior, we recommend you consult your child’s healthcare provider for further information and testing.

Today, we live in a day and age in which families affected by ASD have abundant resource for help and education available to them (although there’s certainly room for more research into causes and treatments). And we here at the Baby Sleep Site count ourselves among those resources! We’re dedicated to helping every child, including those with special needs like Autism Spectrum Disorder. Autism Spectrum Disorder can present many challenges for families, to be sure, but it doesn’t have to mean years of sleep deprivation.

Have you been personally impacted by an Autism Spectrum Disorder diagnosis? Share your story!

Please be sure to pick up your FREE copy of 5 (tear-free) Ways to Help Your Child Sleep Through the Night, our e-Book with tear-free tips to help your baby sleep better. For those persistent nighttime struggles, check out The 3-Step System to Help Your Baby Sleep (babies) or The 5-Step System to Better Toddler Sleep (toddlers). Using a unique approach and practical tools for success, our e-books help you and your baby sleep through the night and nap better. For those looking for a more customized solution for your unique situation with support along the way, please consider one-on-one baby and toddler sleep consultations, where you will receive a Personalized Sleep Plan™ you can feel good about! Sometimes it’s not that you can’t make a plan. Sometimes you’re just too tired to.

Article Sources:

Autism Society
http://www.autism-society.org/about-us/national-autism-awareness-month/

National Institutes of Health
http://www.nichd.nih.gov/health/topics/asd.cfm

Web MD
http://www.webmd.com/brain/autism/helping-your-child-with-autism-get-a-good-nights-sleep

Sensory Processing Disorder Foundation
http://www.sinetwork.org/about-sensory-processing-disorder.html

Autism Speaks
http://www.autismspeaks.org/science/science-news/melatonin-shows-promise-improving-sleep-problems-children-autism

SensoryProcessingDisorder.com
http://www.sensory-processing-disorder.com/autism-anxiety-overload.html

Science Daily
http://www.sciencedaily.com/releases/2010/05/100502080232.htm

Autism Day-by-Day Blog
http://autismdaybyday.blogspot.com/2012/03/sleep-deprivation-and-our-mental-health.html

The National Autistic Society (based in the UK)
http://www.autism.org.uk/living-with-autism/understanding-behaviour/sleep-and-autism-helping-your-child.aspx

Autism Support Network
http://www.autismsupportnetwork.com/news/establishing-positive-sleep-patterns-young-children-autism-spectrum-disorder-2271623

National Autism Resources Blog
http://www.nationalautismresourcesblog.com/2012/03/05/creating-a-good-sleep-environment-for-the-child-with-autism-asperger’s-or-special-needs/

SensaCalm
http://www.sensacalm.com/

Noah’s World LLC
http://noahsworldllc.com/