5 Sleep Factors That Are Especially Important for Neurodiverse Children
When it comes to children and their sleep, parents the world over often have similar struggles. From difficulty getting their children to sleep to them waking frequently during the night, ensuring a good night’s sleep for our little ones is never easy.
But for parents of neurodivergent children, the difficulties are often compounded. The evidence is becoming increasingly clear that neurodiverse children – particularly children with autism and ADHD – are especially susceptible to poor sleep health.
In fact, in 2019, the most extensive study into children with autism and their sleep concluded that 80% of participants experienced disruptive sleep. The study also revealed that children with autism are twice as likely to have trouble sleeping compared with neurotypical children or those with other developmental conditions.
While there are a number of general tips that parents may be given with regard to sleep, there are some key factors that parents of neurodiverse children should pay particular attention to. Here we outline the 5 most important factors that you should consider while trying to improve the sleep health of your neurodiverse child.
1. Sensory Sensitivities
In the aforementioned study, it was posed that sensory sensitivities may be a factor in disruptive sleep in autistic children. It suggests that understanding and adapting for your child’s sensitivities may be an essential step in getting your child to sleep quicker and for longer.
It is important to note that these sensitivities may not be specifically related to sleep itself. While there may be more obvious sleep-affecting sensory factors (such as not liking the feeling of the sheets or pajamas or needing the sleep environment to be just right), there are a number of things that you should consider when assessing the sensory sensitivities that may be affecting sleep in your household.
A great place to start in your assessment is to think about the elements of your evening routine. Does your child hate the taste of their toothpaste? Or get upset during shower/bath time? Or even have a difficult time eating dinner? Think about anything that dysregulates your child in the hours leading up to bedtime because it could reveal a factor in your child’s sleep difficulties.
This article explains more about the relationship between sensory processing and sleep. Plus it gives you a number of suggestions on how to adapt for the most common sensory processing issues.
It likely comes as no surprise to you that diet would play a role in the sleep health of your child – and it’s likely that you’ve already explored (or you’re continuing to explore) foods that work for your child.
So, while food may be a big point of contention for your household, it’s important to empower yourself with the facts so you can introduce certain foods or more regularly include them in your child’s diet.
There have been a number of sleep and diet studies and some of the findings will help you develop a plan for increasing or decreasing your child’s intake of certain foods. And while you may already include or eliminate these foods to mitigate certain behaviours, it is important to understand their importance in terms of sleep too.
Here are some of the findings:
- Sugar and high-fructose drinks are huge contributing factors to poor sleep health.
- Complex carbohydrates (like wholemeal toast or oatmeal) are a great supper snack as they release serotonin.
- High-fat foods should be avoided before bed as they decrease sensitivity to orexin, which helps regulate the body’s sleep clock.
- High-protein foods should be avoided before bed as they can take a while to digest which can disrupt sleep.
- Processed foods such as cheese and salami should be avoided before bed as they contain properties that stimulate the brain.
As an interesting side note, it has been proven that sleep-deprived children tend to snack more, meaning the cycle of unhealthy eating and poor sleep is self-perpetuating.
Related: Try our Cooking OT at Home Program to empower your children with food
Routines are vital for all children but even more so for those who have trouble handling transitions. With the transition from day to night and going to bed being one of the day’s biggest transitions, it is clear to see why a solid bedtime routine is essential.
Many neurodiverse children have the need for routines and rituals, and with each child’s individual requirements being different, helping them create and maintain a bedtime routine that works for them is a key part of the puzzle.
Many bedtime routines will include bath, brushing teeth, putting on pajamas, story time and sleep, but your child might need additional steps to help regulate their body for sleep.
Additional steps may include things like:
- Turning on the nightlight
- Listening to ABC Kids Listen Bedtime stories
- Bedtime yoga or stretches
Additionally, in the Monash study, in addition to the implementation of routines, each child met with a specialist who provided individual strategies for improving sleep.
The strategies included things like:
- Bedtime fading – temporarily adjusting ‘bedtime’ to the time when the child usually falls asleep and bringing the time forward in 15-minute increments.
- Graduated extinction – weaning the child off the need to have a parent in the room while they fall asleep by instead performing check-ins at regular, decreasing intervals.
- Bedtime pass – granting the child one ‘free’ pass to get out of their room each night
Professor Rinehart, director of research at Monash’s Krongold Clinic, said the study showed behavioural sleep interventions could have a significant impact on children and their families.
“The research showed an improvement in not only sleep problems but also the potential to reduce childhood anxiety. This was an important finding given the enormous impact that anxiety has on a child’s ability to function in everyday life,” Professor Rinehart said.
The science behind routines
As adults, we make 30,000 choices a day, and many of these are subconscious and automatic, based on habits that we have formed over the years. For our children though, they only make around 300 decisions.
The key difference is that children often consciously have to think about many of these decisions which can lead to decision fatigue. It is this decision fatigue that can lead to dysregulation and meltdowns, especially when it comes to bedtime.
With routines and repetition, actions are more able to become automatic and subconscious, meaning children don’t have to access the decision-making portion of the brain, allowing for a smoother transition. Plus, if we can free up as much space as possible in our children’s brains by implementing a number of routines, not just bedtime routines, we free up space for new learning.
4. Underlying Issues
Studies show that children with autism are more likely to have genetic mutations that are linked to insomnia or control the sleep-wake cycle. Some children with autism also have lower levels of melatonin, the hormone which controls sleep.
And while those specific issues might be improved by following the guidance within this article, it is important to consider any other underlying issues that may be affecting your child’s sleep health.
Gastrointestinal disorders are more than 8 times more common in children with autism than in neurotypical children. Epilepsy is prevalent in up to one-third of children with autism (compared to only affecting 1-2% of the general population). Both of these issues are known to cause sleep disruptions.
But there are also some more general underlying factors that may affect many neurodiverse children (not just those with autism), including:
- Obstructive sleep apnoea – can be caused by enlarged tonsils, dental issues, or birth defects
- Snoring – children who snore loudly and regularly should be assessed by their doctor
- Sleepwalking and bedwetting – usually resolve on their own but should be discussed with a doctor if persistent.
- Night terrors – up to 30% of children experience night terrors and they can be brought on by stress. They usually resolve on their own but this highlights the importance of a calming bedtime routine.
- Restless Leg Syndrome – can be caused by an iron deficiency and is often underdiagnosed in children. If your child has an overwhelming urge to move their legs that increases at night, consult your doctor.
- Teeth grinding – again, this can be caused by stress. Your dentist may identify this before you do and provide a mouthguard as a solution.
5. The Right Kind of Stimulation
All children need stimulation. At The Play Project, a significant factor in our occupational therapy strategies is assessing the type of stimulation a child needs in order to feel good in their bodies.
We often speak of making sure our bodies feel ‘just right’ and doing what we can to bring children back to equilibrium if their energy is too high or too low. For each child, what feels ‘just right’ to them may be different from the next, which is why it is so important to explore the types of stimulation (and how much) your child needs.
In getting the balance of stimulation during the day right, the transition to bed can become smoother.
That said, there are certain types of stimulation that should be included and some that should be avoided for all children, no matter what their ‘just right’ feels like.
One of the most important forms of stimulation is movement. In addition to the health benefits that come from exercise, movement has a number of other benefits when it comes to child development, including promoting better sleep health.
Australian guidelines recommend that:
- Preschool-aged children should have 3 hours of daily physical activity, including 1 hour of energetic play (running, jumping, etc).
- School-aged children should have several hours of daily physical activity, including 1 hour of moderate to vigorous activity.
Screen time is a prime example of the type of stimulation that needs to be closely monitored. Although there are recommended guidelines (see below) with regard to how much screen time children should be exposed to, we recommend that screen time should end well in advance of the evening routine beginning.
Screens can really stimulate children’s brains to become more heightened, which is the opposite of what we want to be doing as we transition to bed.
Australian screen time guidelines recommend that:
- Children under 2: no screen time unless video chatting.
- Children ages 2-5: 1-2 hours of high-quality programming per day.
- School-aged children: up to 2 hours per day.
In order to allow our children to bring their bodies to their ‘just right’ state, it is important that we teach them strategies that allow them to regulate their bodies. This is especially important if they have been in a high-energy state during the day as many children need help moving from this energy to becoming calm enough to go to bed.
Some ideas include:
- Guided meditations and breathwork
- Journaling about the day
- A quiet activity like drawing or colouring
A number of our OT at Home Programs can assist you with calming activities and you can explore them here.
Your Next Steps
To sum up, the key thing to understand about your child’s sleep health is that there is no one-size-fits-all solution. Use these tips as a framework to create a pathway to a better night’s sleep that works for you and your child.