As the parent of an autistic child, I’m sure you’re aware of the unique challenges that come with nurturing and supporting your child’s development. You work hard to give them the best care, guidance, and opportunities to thrive. But have you thought about sleep? Sleep issues can have a significant impact on your child’s overall well-being, their ability to learn, and the quality of life for your whole family. As a Board Certified Behavior Analyst (BCBA) with a decade of experience treating sleep problems in autistic individuals, I want to help you understand why children on the autism spectrum frequently struggle with sleep and what you can do to help.
Autism and Sleep Problems
Sleep is a vital part of overall health and well-being for people of all ages. However, for children with autism, good sleep can be hard to come by. Research suggests that as many as 80% of children with autism experience sleep problems at some point. So, if your child is struggling with sleep you certainly aren’t alone! These sleep problems can include difficulty falling asleep and staying asleep, irregular sleep patterns, unhealthy sleep dependencies, bed wetting, and getting too much or too little sleep.
Children with autism often have a harder time sleeping than their neurotypical peers (although sleep problems are pretty common in all children!). Sensory sensitivities, which are common in people with autism, are one factor. These sensitivities can make it difficult for children to slow down, relax, and find comfort and stillness when falling asleep. In addition, many autistic children suffer from circadian rhythm dysregulation, which means that their body’s internal clock is a bit off from where we want it to be. This can disrupt the natural sleep-wake cycle, making it difficult to fall or stay asleep, or causing them to sleep at odd hours.
While comorbid medical problems (such as seizure disorders or GI issues) can also sometimes be to blame, sleep problems are most often behavioral in nature. Some of the core sympoms of autism like communication and social difficulties can have a significant impact on sleep. Many autistic children struggle with verbal and nonverbal communication, making it difficult for them to express their sleep needs and even more difficult for them to understand why they even need to sleep in the first place. In addition, difficulty understanding and following instructions can make it hard to establish consistent bedtime routines and navigate social aspects of bedtime, exacerbating sleep problems.
These sleep issues can have far-reaching consequences for your child. Poor sleep can exacerbate challenging behaviors and symptoms such as hyperactivity, inattention, and irritability. Inadequate sleep can also impair your child’s ability to learn, communicate, and develop social skills, posing additional challenges to their progress and growth. Children with autism already have to face so many challenges every day- and they don’t need sleep to be contributing!
Does Autism Cause Sleep Problems?
Many people believe that sleep problems are just “part of having autism” and one of the many challenges that children with autism face. Poor sleep, however, is not part of the autism diagnostic profile, and there has been no research showing a definitive link between autism and poor sleep to date. In other words, just because your child has autism does not mean they will always have trouble sleeping. What we do know is that sleep habits are behavior, and behavior (whether a person has autism or not), can be changed! Everyone is capable of learning healthy sleeping habits and becoming a good sleeper. Your child, no matter what their diagnosis, or how bad their sleep is currently, not only CAN learn to be a better sleep, but DESERVES to!
The Role of a BCBA in Sleep Coaching
When their child has sleep issues, parents frequently consult their pediatrician. Most people consider sleep to be a medical issue, and in some cases, it is (note: if your child has or is at risk of seizures, snores or is at risk of sleep apnea, or has any other medical problems, you should see a medical doctor). But for most children, sleep problems are behavioral in nature. Unfortunately, many pediatricians are not trained to treat behavioral sleep problems. At best, you may be referred for a sleep study (which, as you can imagine, can be a very difficult process for a child with autism), and at worst, you may be prescribed medication. Medicating a sleep problem is like putting some icy hot on a sore back, then continuing to do whatever made it sore in the first place. You might temporarily alleviate the symptoms, but until you fix the cause of the problem it will still be there and it will get worse as time goes on.
One of your best allies in treating sleep problems if you have a child with autism can be a Board Certified Behavior Analyst (also known as a BCBA) with experience in sleep (like me!). Behavior analysts have in-depth knowledge and training in behavior principles and assessment and treatment techniques. We use evidence-based approaches (aka science!) to understand and change behavior, ensuring that interventions are effective and individualized. Many people don’t realize that sleep problems are, in fact, usually behavior problems rather than medical problems. Just like we can teach someone how to read or write or ride a bike, we can teach someone how to engage in healthy sleep habits. And what’s even better is that when we treat sleep problems as behavior problems, the treatments often have life-long impact!
Typically, BCBAs will examine the sleep problems in depth, analyzing behavior around bedtime and during the night and investigating why the behavior occurs. This may entail taking a detailed history, conducting an interview such as the Sleep Assessment and Treatment Tool (SATT), and observing and collecting data during the bedtime routine. We assess each child and family’s unique needs and circumstances, allowing for a thorough assessment of potential triggers or maintaining factors that contribute to their sleep problems. The assessment helps us understanding your child’s sleep challenges so that we can develop a personalized treatment plan that specifically targets the underlying causes of their sleep problems. This tailored approach ensures that our interventions are effective.
BCBA’s provide individualized treatment plans that include evidence-based strategies that have shown promise in improving sleep quality and quantity in autistic children. Creating a sleep-friendly environment, optimizing sensory aspects of the bedroom, establishing consistent bedtime routines, addressing circadian rhythm dysregulation through exposure to natural light and consistent sleep schedules, enhancing communication through visual supports, creating healthy sleep dependencies, and managing co-occurring medical conditions and medications through collaboration with healthcare professionals are among these strategies. Sleep treatments should also take into account your family’s preferences and schedules to make sure everyone enjoys their night.
Help Your Child Take Back the Night!
Getting a good night’s sleep is crucial for your child’s mental, physical, and emotional well-being, and yours as well! Just because your child has an autism diagnosis doesn’t mean that he/she is destined for bad sleep. Sleep problems are often behavioral in nature and are easily treatable with some simple changes to the bedtime routine, sleep environment, and sleep schedules. As a BCBA with a deep understanding of behavior analysis and extensive experience in treating sleep problems in individuals with autism, I am here to help you and your child achieve a restful night’s sleep. By addressing sleep challenges through evidence-based interventions, we can enhance your child’s overall well-being, facilitate their learning and development, and improve the quality of life for your entire family. I encourage all families to seek professional help and support in addressing your child’s sleep problems. By partnering with a BCBA specialized in sleep coaching, you can have confidence in the expertise and knowledge applied to improve your child’s sleep. Contact me and together, we can take back the night!