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 of developmental pediatrics at University of Colorado School of Medicine, found that children between the ages of 2 and 5 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 on the spectrum often exhibit behaviors such as aggression, hyperactivity and other behavioral problems — and lack of sleep can be a setting event for these behaviors to be more likely to occur,” said Julie Cenzi, licensed behavior analyst, mental health counselor, and owner of Spectrum Behavioral Counseling Service in Rochester. “Having adequate amounts and quality of sleep are important so that children may function better in school and will help improve academic ability.”

Children also need sleep for their own mental health benefits. Cenzi said that otherwise, issues such as depression or anxiety may occur.

Sleep issues can also affect the rest of the family.

“This leads to decreased patience, increased irritability and depression in other family members as well,” she said.

So why do kids on the spectrum experience sleep disturbances?

Heidi Connolly, chief of pediatric sleep medicine services at University of Rochester Medical Center, said that it’s not entirely clear, but it’s a common complaint.

She said that hormones offer a few clues. Melatonin, a natural hormone produced by the body, helps set the circadian rhythm of waking and sleeping. It’s usually released close to bedtime.

“It looks like children with autism aren’t as good at making that nighttime surge of melatonin,” Connolly said. “Giving two to three mg. before bed can be helpful.”

What doesn’t help is giving the child attention when awakening at night.

“It perpetuates the behavior of getting up in the night,” Connolly explained.

She recommends a night time routine illustrated by a picture board or other display, as does Cenzi, since children on the autism spectrum generally do well on routines because they know what to expect next.

“Creating a set routine with calming activities — such as reading books, taking a bath and going to bed at the same time every night — are important,” she said. “Avoiding electronics at least an hour before bed and avoiding food or drinks with sugar or caffeine will help children fall asleep faster and sleep more soundly.”

Just before bedtime isn’t a good time for vigorous activity; however, sufficient activity earlier in the day may improve sleep.

Cenzi added that environmental factors conducive to good sleep could include white noise in the bedroom, darkened rooms, and a quieter home around bedtime. But these factors are highly individual. Some children find a bath as stimulating, for example.

“For some kids, a weighted blanket may be helpful,” Cenzi said. “Sensory concerns may make some bedding uncomfortable so ensuring that the sheets and blankets feel okay to the child is also important.”