Do children with autism have more sleeping problems then typically developing children?
Yes, studies have shown children with ASD to have as many as 10 times more sleep difficulties than typically developing children. Problems include not falling asleep, sleeping for only short periods of time, being tired during the day, resisting going to bed, sleep walking, sleep anxiety, nightmares, and chronic insomnia.
What causes children with ASD to have sleep problems?
There is no clear cause. Children with ASD have several different types of sleep problems; different types of problems may have different causes. Also, it’s best not to think of ASD as one disorder but as a spectrum of disorders so different people have different things going on in their genes, gene expressions, and environments which may cause a variety of different sleep problems. Some theories are
- Some children may have biological or genetic abnormalities that cause changes to the brain which then effect sleep
- The features of ASD (such as preoccupation) can prevent sleep
- There could be factors at home that make sleep more difficult (like having a TV in a bedroom)
How do experts recommend that parents deal with sleeping problems?
Research has indicated that behavioral strategies can may be effective, however there is not enough research to say so with certainty. Right now, there is the most evidence for scheduled awakings (awaking a child at scheduled intervals to reduce night terrors) and standard extinction (ignoring all bed time disruptions- this may look like putting a child to bed and then not talking to the child until morning). Although standard extinction may be effective, it can cause distress for the child and the parents. Other interventions under investigation are
- Graduated extinction (only ignoring behavior for a specific length of time)
- Faded bedtime (setting the bedtime slightly earlier and earlier and not letting the child sleep during the day)
- Faded bedtime with Response Cost (the same as faded bedtime, but if the child does not fall asleep, you remove them from bed for a specific amount of time- eg. 30 minutes)
- Sleep restriction (the focus is on sleep duration not bedtime- you limit the amount of time the child spends in bed not sleeping)
- Stimulus fading (reducing co-sleeping)
- Chronotherapy (pushing back bed times)
Is medication recommended for sleep problems?
When behavioral interventions are unsuccessful or only partially successful, sometimes medication is prescribed, however there is no FDA approved pediatric sleep medication. Melatonin has been the most commonly studied sleep medication for children.
Where can I get more information?
We have books on sleeping and autism in our library. Also, the Lovaas Institute has a great article with several recommendations for establishing a good sleeping pattern.
Cortesi, F., Giannotti, F., Ivanenko, A., & Johnson, K. (2010). Sleep in children with autistic spectrum disorder. Sleep medicine, 11(7), 659-664.
Goldman, S. E., Richdale, A. L., Clemons, T., & Malow, B. A. (2012). Parental sleep concerns in autism spectrum disorders: Variations from childhood to adolescence. Journal of autism and developmental disorders, 42(4), 531-538.
Richdale, A. L., & Schreck, K. A. (2009). Sleep problems in autism spectrum disorders: prevalence, nature, & possible biopsychosocial aetiologies. Sleep medicine reviews, 13(6), 403-411.
Sivertsen, B., Posserud, M. B., Gillberg, C., Lundervold, A. J., & Hysing, M. (2012). Sleep problems in children with autism spectrum problems: a longitudinal population-based study. Autism, 16(2), 139-150.
Vriend, J. L., Corkum, P. V., Moon, E. C., & Smith, I. M. (2011). Behavioral interventions for sleep problems in children with autism spectrum disorders: current findings and future directions. Journal of pediatric psychology, 36(9), 1017-1029.