Sleep can be a very difficult problem for many kids with Autism Spectrum Disorders (ASDs). Something like 60% have sleep problems. Fixing sleep fixes a lot, especial challenging behaviors
Before treating sleep, treat any medical problems that could be interfering with sleep. If they snore, they may have enlarged adenoids and they have obstruction. Removing the adenoids (and the tonsils at times) can lead to decreased awakenings, deeper sleep, and more time in REM sleep. In turn, this helps brain development. If they had GE reflux as an infant, they may still have it. Treating reflux can lead to better sleep. In general, the better your health, the better you sleep.
Many kids with ASD have difficulty with sleep onset, but once asleep, they sleep through the night. Melatonin can help with this. Most kids respond to 1 to 3 mg 30 to 60 minutes before bedtime. Some need as much as 10 mg. you want a vegetarian formulation, because if it comes from an animal, it can carry brain viruses. We don’t want Mad Cow Disease to add to their problems.
Melatonin is good for sleep onset, but many kids have frequent night waking and wake early. guafacine (Tenex) and clonidine are blood pressure medicines that also decrease hyperactivity and impulsivity in kids with ADHD. Their use is limited because they can be sedating. However they can be helpful for sleep as well, especially clonidine. Trazodone is an old antidepressant that can also help with falling and staying asleep.
Another big problem with sleep is when a child will not sleep alone in their own bed. Research shows kids sleep better when they sleep alone. Going to sleep is a habit. You can have good habits or bad habits. Our surroundings when we go to sleep are out “sleep onset associations”. When everything is “just right”, we go to sleep. When we come up to light sleep, we expect our sleep onset associations to be there. If they are, we go back to sleep and never know we were awake. If not, we wake all the way up to get them back. If a parent is one of the associations, a child will wake all the way up to get them back.
This is a situation where the child needs “retraining” for sleep. First, use melatonin to get the child going to sleep in their own bed. The parent can sit in a chair next to the bed, but not lie down with the child. Once the child has started falling asleep this way, then as they are just about asleep, say “I have to go to the bathroom, I’ll be right back”. You then leave, and return in about 30 seconds. The next night it is a minute, then 1 1/2 minutes, then 2 minutes, 3, 4 etc. At some point you will return, and they will be asleep. You are 90% the way there! Usually night waking resolves because they have new sleep onset associations, and they don’t need the parent present anymore. If night waking persists, then start rewarding everyone in the house who stayed in their own bed with something the child wants – like 3 M&Ms. Jealousy can be a powerful motivator, especially if a sibling is getting the reward.
This approach may not work with all children, but it works often.
When sleep is good, everyones life is better. It is important for everyone in the family to get good sleep. It is well worth working for it.