Sleep Difficult for Children on Autism Spectrum

By Deborah Jeanne Sergeant

Recent research published in the journal Pediatrics indicates that children with autism spectrum disorders (ASDs) are at double the risk for experiencing difficulties with sleep than children not on the spectrum.

Researcher Ann Reynolds, a physician and associate professor, developmental pediatrics, University of Colorado School of Medicine, found that children between the ages of 2 and 5 years are more likely to delay bedtime, struggle getting to sleep, feel anxious about sleep, awaken during the night and have night terrors, all of which can mean fragmented sleep.

Children also need sleep for their own mental health benefits.

Soda Kuczkowski, owner of Start With Sleep in Buffalo, is certified in maternity, child and adult sleep and is a diagnostic sleep consultant and clinical sleep health educator.

“When children don’t have good sleep habits or aren’t sleeping well, you’ll see a lot more behavioral issues,” Kuczkowski said. “They can’t concentrate and don’t listen well. Behavior in school and in their development is better when you have good sleep.”

So why do kids on the spectrum experience sleep disturbances? It’s not entirely clear.

Kuczkowski said that it may be because they lack sufficient levels of melatonin, a natural  hormone produced by the body that helps set the circadian rhythm of waking and sleeping. It’s usually released close to bedtime. If that doesn’t happen, sleep can prove elusive.

Sensitivity issues prevalent with people on the autism spectrum may also affect sleep quality and quantity.

Tracy Panzarella, director of clinical services at Autism Services, Inc. in Amherst, said that parents should work with their child’s pediatrician to rule out medical issues that can affect any person, such as sleep apnea or acid reflux, when addressing sleep issues.

“It’s a partnership with them to help children get better sleep,” she said.

Providing those issues are not present or effectively managed, parents can work on making bedtime adjustments to improve sleep. Just before bedtime isn’t a good time for vigorous activity; however, sufficient activity earlier in the day may improve sleep. Quieting the household before bedtime can assist in easing into the transition to sleep.

Panzarella recommends a regular nighttime routine, illustrated by a picture board or other display with times listed for older children.

“When you’re working with individuals on the spectrum, routine is key,” she said. “It should be consistent and predictable. That way, they know the order they’ll happen in. Do it at the same time every night.”

For example, a picture of a toothbrush, toilet, sink, storybook and bed in a row could symbolize the order of use of these objects.

“With anything, transition them onto a predictable routine,” Panzarella said.

For some children, the same pajamas, teddy bear, blanket or other objects associated with sleeping help them settle because they’ve added them to the routine.

Panzarella added that environmental factors conducive to good sleep are highly individual.

“Our kids on the spectrum have so many sensory sensitivity issues,” Panzarella said. “If your child could be distracted at night, heavy curtains can block the light.”

Those who are noise sensitive may find white noise or a fan unbearable, as well as ambient sounds from outside the room. Thick carpeting, soft wall hangings and sound-absorbing ceiling material can help absorb sounds from the rest of the household with a later bedtime.

“It may make sense to move their bedroom to a quieter area of the house,” Panzarella suggested.

Consider the room’s temperature, as well as the bedclothes and pajamas. It’s difficult to sleep in an overly warm bedroom.

Many of the steps towards better sleep are simple and inexpensive; however, maintaining them consistently is key to achieving better sleep.