Irritability

• If you’re a parent with kids at home, it often leaves you and your children on edge.
• Children with neurodiverse conditions, such as autism and attention-deficit/hyperactivity disorder, or ADHD, are even more susceptible to the effects of poor sleep, given their emotional reactivity and impulsivity..
• Struggles with sleep have been linked to increased aggression, irritability, inattention and hyperactivity in children with autism spectrum disorder.

The science behind sleep difficulties

• There are multiple reasons why neurodiverse children don’t sleep well, including medical conditions, biological causes and behavioral and environmental factors.
• Medical conditions, such as obstructive sleep apnea or epilepsy, can affect a child’s sleep.
• Medications that are used to treat medical conditions, such as antidepressants for mood disorders or stimulants for ADHD, can further disrupt sleep.

Treating sleep problems

All of these factors can be addressed and treated. A thorough evaluation by the child’s health care provider may reveal a medical cause, or medication, that is interfering with sleep. Behavioral approaches can make a big difference in improving sleep. These might include:
Changes to daytime habits, including getting lots of morning light and physical activity.
Shifts in evening habits, such as removing all screens (TV, computers, phones, etc.) and establishing calming bedtime routines.
Modifications to how a parent interacts with their child for those families who would like a child to fall asleep and stay asleep independently.

• It’s important to note that not all families want their children to sleep on their own.
• Because there are so many factors that can cause disrupted sleep, addressing sleep problems cannot be a one-size-fits-all approach and should be done in partnership with parents.
• Our team has developed a family-centered approach to address sleep problems in neurodiverse children.

The ups and downs of melatonin

• While behavioral approaches are recommended as a first-line treatment, melatonin can be helpful in jump-starting a behavioral routine.
• Overdoses can result from children eating a bunch of gummies, or parents not understanding how much melatonin is safe to give.
• To help parents sift through all the resources and articles on melatonin on the internet and social media, one of us created a video and wrote several blogs on melatonin safety.
• These include topics like whether children can become dependent on melatonin supplements over time, whether taking melatonin will delay puberty, whether children might experience side effects from taking melatonin and more.

Promoting healthier sleep

Here are some general tips for helping your child sleep better, regardless of whether they are neurodiverse:
Choose a consistent bedtime and wake time. This consistency will help children’s own natural melatonin kick in.
Make sure bedtime isn’t too early. For example, an 8 p.m. bedtime is too early for most 10-year-olds. Neurodiverse children may struggle to sleep and will become more anxious, which makes going to sleep even harder.
Help your child get natural sunlight in the morning. Morning sunlight sets our brain’s internal clock so that we can fall asleep more easily at bedtime.
Ensure your child is getting physical activity during the day.
Minimize naps longer than one hour, or after 4 p.m. for school-age children. Naps can interfere with going to sleep at night.
Avoid caffeine, including many types of soda, tea and chocolate.
Turn off all screens and smartphones at least 30 minutes before bedtime.
In the evening leading up to bedtime, turn down all lights in the house. Consider using red night lights, if possible. Set any devices to night mode in the evening to limit exposure to blue light.
Create wind-down time in place of screens. Have your child identify an activity they enjoy that is calming and soothing, such as reading a book, coloring or listening to music. If a bath is stimulating, move it to earlier in the evening, such as after dinner.
Help your child learn to fall asleep without needing you or their devices to be there with them. That way, they will settle down on their own at bedtime. And when they wake up throughout the night, since we all wake up in the night, they will be able to go right back to sleep without becoming fully awake.
For more tips, see Autism Speaks for free downloads of brochures and visual aids.

• She also receives funding from the American Academy of Sleep Medicine.
• She has received funding from the American Academy of Sleep Medicine and Autism Speaks for research on sleep in children with ASD.