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Sleep

Disclaimer: This summary is based off of research conducted by Autism Treatment Network members. It is not a summary of the entire body of research literature available on this subject.

Many kids and teenagers with autism have problems sleeping which can be hard on the child and caregivers [1][2]. Some have trouble falling and staying asleep, or wake up too early and have a hard time getting back to sleep [3][4]. Problems sleeping happen more often if the child has restricted and repetitive behaviors (lining up toys, rocking, hand-flapping) [5], anxiety [6], or sensory problems [4] and can lead to having trouble paying attention, feeling restless, getting angry, and throwing tantrums [7][8]. Watching TV, videos, or playing on the computer, especially if the shows or games are scary or violent, can lead to kids with autism having more trouble sleeping [9]. All kids and teenagers with autism should be checked for trouble sleeping [10][11], by asking specific questions about bedtime, waketime, daytime and nighttime habits and bedtime routines [1][12][13]. Then the parents can learn ways to help their child sleep better, for instance by cutting back on computer or video game time [9]. Teaching parents about sleep habits [14], and sometimes using the right medicine can help kids with autism sleep better [10].

Frequently Asked Questions

  1. WHAT HAPPENS TO THE CHILD/TEENAGER?

    • Some have trouble falling and staying asleep [3][4]
    • Some wake up too early and have a hard time getting back to sleep [3][4]
  2. WHEN DO WE SEE THIS HAPPENING?
    Problems sleeping happen more often:

    • If the child/teen has restricted and repetitive behaviors (lining up toys, rocking, hand-flapping) [7]
    • If the child/teen has anxiety [6]
    • If the child/teen has sensory problems [4]
  3. WHAT ARE SOME ACTIVITIES THAT CAUSE PROBLEM SLEEPING?

    • Watching too much TV, especially programs that are scary or violent [9]
    • Watching too many Videos, especially ones that are scary or violent [9]
    • Playing too much on the computer, especially games that are scary or violent [9]
    • Being exposed to light from screens (phones, tablets, TVs, computers) [9]
  4. WHAT IS THE RESULT OF PROBLEM SLEEPING?
    Lack of sleep can lead to Children or Teenagers [7][8]:

    • Having trouble paying attention
    • Feeling restless
    • Getting angry
    • Throwing tantrums
    • Having low energy
  5. WHAT SHOULD PARENTS DO?

    • Parents can learn ways to help their child sleep better, for instance by cutting back on computer or video game time [9].
    • Talk with your health care provider or therapist to learn about sleep habits.
    • If you are not sure, ask them what to look for. What information do they need from you to help your child/teen with their problem sleeping?
    • Keep track of your child’s sleep habits by asking questions about bedtime, waketime, daytime and nighttime habits and bedtime routines [1][12][13].
    • A sleep specialist can also keep track of sleeping habits with a special activity monitor (actigraph) which is much more accurate than a FitBit.

Additional Tips

Take your findings to your next appointment. All children and teens with ASD should be checked for trouble sleeping [10][11]. Health care providers can help you and your child/teen to learn good sleep strategies and may prescribe medications to help children and teens with autism sleep better [10]. For more information on the individual research article referenced, please click on the title of the article (in dark blue) the reference section below.


References

  1. Delahaye J, Kovacs EA, Sikora DM, Hall TA, Orlich F, Clemons TE, et al.. The relationship between Health-Related Quality of Life and sleep problems in children with Autism Spectrum Disorders. Research in Autism Spectrum Disorders. 2014 ;8:292-303.
  2. J. Tilford M, Payakachat N, Kuhlthau KA, Pyne JM, Kovacs EA, Bellando J, et al.. Treatment for Sleep Problems in Children with Autism and Caregiver Spillover Effects. Journal of Autism and Developmental Disorders. 2015 ;45(11):3613-23.
  3. Goldman SE, Richdale AL, Clemons TE, Malow BA. Parental sleep concerns in autism spectrum disorders: Variations from childhood to adolescence. Journal of Autism and Developmental Disorders. 2012 ;42:531-538.
  4. Mazurek MO, Petroski G. Sleep problems in children with autism spectrum disorder: examining the contributions of sensory over-responsivity and anxiety. Sleep Medicine. 2015 ;16(2):270-9.
  5. Hundley RJ, Shui AM, Malow BA. Relationship between subtypes of restricted and repetitive behaviors and sleep disturbance in autism spectrum disorder. Journal of Autism and Developmental Disorders. 2016 ;46:3448–3457.
  6. Johnson CR, DeMand A, Shui AM. Relationships Between Anxiety and Sleep and Feeding in Young Children with ASD. Journal of Developmental and Physical Disabilities. 2015 ;27:359–373.
  7. Mazurek MO, Sohl KA. Sleep and behavioral problems in children with autism spectrum disorder. Journal of Autism and Developmental Disorders. 2016 ;46:1906–1915.
  8. Sikora DM, Johnson KP, Clemons TE, Katz TF. The relationship between sleep problems and daytime behavior in children of different ages with autism spectrum disorders. Pediatrics. 2012 ;130:S83-90. NLM Journal Code: oxv, 0376422
  9. Mazurek MO, Engelhardt CR, Hilgard J, Sohl KA. Bedtime Electronic Media Use and Sleep in Children with Autism Spectrum Disorder. Journal of Developmental & Behavioral Pediatrics. 2016 ;37:525–531.
  10. Malow BA, Byars K, Johnson KP, Weiss SK, Bernal MPilar, Goldman SE, et al.. A practice pathway for the identification, evaluation, and management of insomnia in children and adolescents with autism spectrum disorders. Pediatrics. 2012 ;130:S106-24. [Review]; NLM Journal Code: oxv, 0376422
  11. Malow BA, Katz TF, Reynolds AM, Shui AM, Carno M, Connolly HV, et al.. Sleep Difficulties and Medications in Children With Autism Spectrum Disorders: A Registry Study. Pediatrics. 2016 ;137:S98–S104.
  12. Veatch OJ, Reynolds AM, Katz TF, Weiss SK, Loh A, Wang L, et al.. Sleep in Children With Autism Spectrum Disorders: How Are Measures of Parent Report and Actigraphy Related and Affected by Sleep Education?. Behavioral Sleep Medicine. 2015 ;:1-12.
  13. Malow BA, Connolly HV, Weiss SK, Halbower A, Goldman SE, Hyman SL, et al.. The Pediatric Sleep Clinical Global Impressions Scale—A new tool to measure pediatric insomnia in autism spectrum disorders. Journal of Developmental & Behavioral Pediatrics. 2016 ;37:370–376.
  14. Malow BA, Adkins KW, Reynolds AM, Weiss SK, Loh A, Fawkes DB, et al.. Parent-Based Sleep Education for Children with Autism Spectrum Disorders. Journal of Autism and Developmental Disorders. 2013 ;:1-13.