Most parents have had some experience with a child who has difficulty falling asleep, wakes up frequently during the night, and/or only sleeps a few hours each night. Temporary sleep difficulties are an “expected” phase of child development. Ongoing and persistent sleep disturbances can have an adverse effect on the child, parents and other household members. Children with autism spectrum disorders (ASD) appear to experience these sleep disturbances more frequently and intensely than typically developing children. A child’s sleeping problems can quickly become a daily parenting challenge.

There are a number of factors to address when establishing a plan to reinforce a positive sleep pattern. First, any underlying medical problems that may be affecting sleep should be assessed. Consider checking for food and/or environmental allergies or intolerances, gastrointestinal disturbances, and seizures. All of these are more common in persons with ASD. Also sleep disturbances can be a side effect of other medications an individual takes and so this should be considered, too.

Typical Sleep Patterns: Babies and toddlers

Sleep disorders that affect the general population should also be ruled out for your child with ASD. Sleep apnea is a disorder that can affect anyone at any age. It is a disorder in which a person experiences pauses in breathing when the airway becomes obstructed during sleep. The most common cause for blockage is enlarged tonsils or adenoids. Upper respiratory illnesses and/or allergies can also contribute to the development of sleep apnea. Beside pauses in breathing, symptoms of sleep apnea in children include: snoring, mouth breathing, restless sleep, sweating, night wakings, and/or frequent coughing or choking while asleep. Other sleep disorders to assess in a child, if appropriate, include sleep terrors and confusional arousals. These both are frequently referred to as parasomnias. Parasomnias are disorders of “partial arousal” that lead to unusual behaviors during sleep. Children with sensory processing difficulties have more problems falling asleep and night waking. An assessment and consultation with an occupational therapist trained in sensory integration may be important to assess relaxation and arousal difficulties, and to help design strategies that address these issues.

After possible medical problems have been addressed, other factors contributing to sleep problems should be considered and strategies for addressing these implemented. Other issues to consider are: environmental variables, bedtime routines and the use of a sleep training method. Each of these three topics is discussed in further detail below.