The Exhausting Journey of Autism and Sleep

Autism Spectrum Disorder (ASD) is on the rise. Once thought to affect 1 in every 100 children, it is now 1 in every 68 children [1, 2]. If you don’t already have a child with autism it is likely that someone close to you does. Nearly 70% of children with autism suffer from sleep problems [3]. Sleep, bedtimes, naptimes, middle of the night wakings and early morning wakeup times can all be a struggle for parents to manage. Plus, add in that each autistic child needs a different formula for help, which will likely be a trial and error process for the parents as they navigate their specific sleep issue.

As a marriage and family therapist and baby sleep consultant, I have a unique understanding of the challenges associated with ASD and sleep. In this article, I hope to outline some of the best practices for toddlers and young children who struggle with ASD and sleep. These are general recommendations because ASD varies wildly from child to child. Though I have made this list as thorough as possible, you may need to consider some individual help if more personalized intervention is needed. I offer a free 15-minute consultation to help answer any questions and to help you decide if my services are right for you.

What does autism look like in a baby or toddler?

While this list should not be used to self-diagnose your child with autism, these warning signs warrant further investigation with your child’s pediatrician.

If by 6 months your baby is not offering big smiles or other warm and joyful expression;

If by 9 months your baby is not sharing sounds, smiles or other facial expressions back and forth with you and or others;

If by 12 months your baby does not respond to his name, there is no babbling or baby talk, no back-and-forth gestures, such as pointing, showing, or waving;

If by 16 months there are no spoken words;

If by 24 months there is no meaningful two-word phrases from your baby that don’t involve imitating or repeating [4].

What would sleep problems look like in an autistic child?

Your autistic child might have a sleep problem if he or she has trouble falling asleep and/or wakes up repeatedly throughout the night, has early morning wakings, or restless or poor-quality sleep [5]. To know for sure, you can schedule an appointment with me or your child’s pediatrician to assess sleep behaviors.

How can I help my child sleep better?

These suggestions are geared towards children up to about age 6. If your child is past the age of 6, these suggestions may be helpful, but you may want to begin looking at resources for older children and eventually teens as they approach 12 and up.

Feeling Safe

Feeling safe and secure is vital for good quality sleep for a child with autism. There are a few different ways to help your child feel safe in their sleeping environment depending on their age and preferences.

Use a Crib. While a crib might feel like a cage for us, a toddler and young child actually feel safest in a crib. The crib walls provide physically boundaries that tell the child they are in a safe and in secure place. Having these physical boundaries is a strong reminder to your child to stay in his bed. I recommend all toddlers stay in cribs until at least 3 years of age. With an autistic child, I recommend staying in the crib as long as you can. As your child develops, he will begin to display improved impulse control and moving out of the crib is an option. At this point many children still need strong physical boundaries to feel safe in bed. I recommend either a bed net or a bed railing. Both of these barriers allow the child to get up and leave if they need to while providing clear, touchable boundaries for the child.

  1. Stay in the Room. This is a suggestion I only make to help an autistic child feel safe going to bed. The least amount you have to do to help your child fall asleep, the better, but having a parent near may help a child relax enough to fall asleep. You may be able to just sit near the door, or perhaps you will lie on the floor near your child. Feeling safe is a prerequisite to falling asleep; therefore, your goal is to help your child feel safe and not necessarily soothe him to sleep.

  2. Pets Could Increase Safety. More and more research is confirming there is an association between dogs and social improvements in an autistic child [6, 7, 8, 9, 10]. More research is needed to completely understand this relationship, but many autistic families are moving forward and noticing huge improvements in their child. There may even be a possibility that the benefits of a pet would transfer over to sleep. This pet could provide some sense of safety and security for your child while falling asleep and even during nighttime wakeups. While this theory is not researched based, I have had families report that when the pet do