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PARENT SKILL BUILDING SERIES
by Kim Ward, Psychologist
TREATMENT SUGGESTIONS
- Research indicates that approximately 56% of all developmentally delayed individuals present with sleep-related issues (e.g., difficulty falling asleep at night, early waking). It has also been demonstrated that children with autism do not tend to "grow out" of their sleeping difficulties.
- Attempt to determine what is "causing" or maintaining your child's sleep difficulties (e.g., attention seeking, anxiety, medical issues). This will help you to decide which strategies to utilize.
- Attempt to establish a consistent bedtime routine. The child's activity level should be gradually reduced over the course of the evening. It is also helpful to include "calming" activities such as warm baths, towel rub downs, and lotion applications in the routine. Deep pressure and gentle rocking can also have a calming effect on children with autism. The routine can be outlined using words and/or picture symbols in a script or book.
- Provide transition warnings before putting your child to bed.
- Consider the role that diet may play in your child's sleep difficulties.
- Increase the amount of physical activity that the child engages in during the day (e.g., community walks, swimming).
- Avoid "sleeping in" and naps if your child has tendency to get up during the night or has difficulty falling asleep. This may help your child to establish a more regular sleep pattern.
- Allow your child to stay up until they are very sleepy/tired and then put them to bed. This may give them experience falling asleep in their room without fussing. Over time the bed time can be gradually adjusted to a more age appropriate time.
- For children who have difficulty laying still when they are put to bed it is often helpful to remain in their room and provide praise and concrete reinforcement for remaining still. For example, one could play music when the child is laying quietly and stop the music when they become restless.
- Teach the child to imitate relaxation strategies (e.g., deep breathing, tensing/relaxing muscle groups, deep pressure) and engage in a relaxation session prior to bedtime.
- If your child insists on sleeping in your room introduce a cot or air mattress on the floor. Inform the child that they must sleep on the cot if they want to remain in the room. Over time the cot can be gradually moved door, to hallway etc. Some children choose to sleep in their bed when the cot is introduced as they realize their bed is more comfortable.
- Make your child's bedroom as safe as possible (e.g., remove cord from blinds, cover electrical outlets, remove breakable items). This may make it easier for parents to withdraw their attention when their child gets up in the night.
- Some parents have found it effective to put a lock on their child's bedroom door. This makes it easy to withdraw attention after the child is put to bed.
- Make an effort to reduce how much attention/reinforcement the child receives when he/she gets up. Try to limit physical contact, discussions, and eye contact. It is also important to remain as neutral and business-like as possible.
- Gradually reduce or phase out parental attention after your child has been put to bed. For example, gradually increase the length of time before you respond to crying or screaming.
- Some children find it difficult to fall asleep in a dark environment. Night lights can be comforting in this situation. Also, some parents have found that a fish aquarium provides a low intensity light source as well as a calming stimuli.
- Some children have difficulty falling asleep when it is light outside (or they wake up with the sun). In such situations black blinds can be very effective.
- Some parents find it effective to provide their child with quiet toys to play with when/if they wake up. That is, the child is directed to remain in their room until it is time to get up.
- Provide the child with a concrete cue about when it is time to get up (e.g., when daddy gets up, when the alarm goes off). Direct to the child to return to bed until they hear/see the cue.
- Plan ahead - do not attempt to address bedtime issues the night before a big presentation at work. Plan to start on a weekend or during a holiday period. You may miss a few nights sleep, but most parents report the sacrifice is well worth it in the end.
- Utilize respite or school hours to catch up on your sleep to ensure that you have the resources to effectively cope with sleep difficulties the next night.
- Have a family meeting prior to implementing any bedtime strategies. It is critical that all care givers are in agreement to ensure that issues are dealt with in a consistent manner.
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