Everyone experiences sleep issues at times, but children with autism have an especially higher rate of difficulty sleeping through the night and awakening too early – these issues can create an unpleasant spiral that reduces quality of life and interferes with daily functioning.
Studies indicate that children with autism spend 8-10% less time in REM sleep, the restorative period that allows the brain to consolidate learning from each day. But correlation doesn’t prove causation.
Anxiety
Anxiety is one of the most frequently co-occurring psychiatric disorders among individuals with autism, often manifesting itself through traditional anxiety symptoms and disorders or through new anxieties specific to autism. Recognizing and treating anxiety in these individuals is imperative as it can negatively impact essential aspects of their lives including social withdrawal and restricted behavior.
Adults with autism are also at greater risk for insomnia, which hinders their ability to fall and stay asleep at night. Sleeplessness may be brought about by stress, anxiety, sadness or disordered breathing patterns such as obstructive sleep apnea that lower quality of life overall.
Anxiety symptoms may include difficulty sleeping, obsessive thinking and fear of touch, as well as physical manifestations like stomachaches or heart palpitations. Co-morbid mental conditions like depression or OCD may further disrupt sleep quality.
People with autism can benefit from psychotherapy to manage anxiety and stress. They can also practice sleep hygiene such as avoiding caffeine before bed and limiting screen time; weighted blankets that provide constant pressure help them relax.
Many doctors begin treating sleep issues in children with autism without using medications, emphasizing behavioral techniques and lifestyle changes as possible solutions. Unfortunately, medications used to treat other psychiatric conditions like ADHD often cause side effects that interfere with restful slumber; additionally, individuals living with autism have an increased risk of iron deficiency anemia which may contribute to an overall feeling of unwellness that hinders their restful restful slumber.
Studies have demonstrated the effectiveness of modified cognitive behavioral therapy for anxiety and autism treatment, though research on pharmacological treatments lags behind that for typically developing children due to issues surrounding measurement and overlap, lack of specific instruments that have been validated with autism-specific testing instruments and lack of anxiety instruments that have been validated specifically for them. It’s imperative that researchers continue investigating various treatments options available in this population including investigating SSRIs and CBT as possible solutions.
Toilet training
Toilet training is an exciting yet stressful milestone that parents and children alike often anticipate, though those living with autism may find particularly daunting. To be successful at toilet training it takes patience, persistence and consistency from both parties involved.
Before beginning toilet training, it is vital that children are developmentally ready. This typically manifests itself by keeping a dry diaper for an extended period of time during the daytime hours, notifying their parent after having a bowel movement and showing an interest in using the bathroom. For children with language delays or delays such as Picture Exchange Communication System (PECS) icons that they can associate with words, step-by-step visual sequences of toileting routine can also help – these may take the form of pictures or icons which the child can associate with words for language acquisition purposes.
Current research into toilet training for those with autism primarily consists of small case studies with intensive clinical support. One example from the field of applied behavior analysis involves an intervention program to toilet train five children with autism or developmental delays at a public school setting. The curriculum included: (a) removal of diapers during school hours, (b) scheduled toilet visit times (30 min), (c) maximum three-minute sitting on the toilet and (d) immediate reinforcer delivery for any time urinated into the toilet. Each week staff reviewed data to increase bathroom visit intervals if a participant met mastery over an earlier, shorter interval.
As part of toilet training, it is crucial that children learn to put on their pants and underwear independently. When completed successfully, rewards should include stickers or gummy bears as well as verbal praise from adults, which will encourage them to try again and continue the routine. It is vital to avoid discussing accidents as this will discourage your child and slow progress.
It can also be helpful to offer adaptive supports during the toilet training process, such as providing children who may be sensitive to bathroom floors with a stool and providing them with ear defenders that protect against flushing noises. Furthermore, clothing such as Velcro pants or T-shirts which can easily be removed and put back on is key in creating an ideal learning experience for young ones.
Sensory issues
Sensory issues can leave someone feeling overwhelmed or anxious, overreacting to things others don’t notice such as bright or flickering lights, certain sounds, smells, textures and tastes which others take for granted. When this occurs it can lead to sensory overload leading to meltdown. By understanding what triggers their sensory issues you can help them avoid triggers and reduce or avoid meltdown altogether.
When someone with autism experiences sensory overload, they can quickly become upset and agitated. In extreme cases, this may escalate to self-harming behaviors like head banging or ear-clapping; hitting themselves, scratching skin or biting themselves as these activities offer temporary relief from distressing stimuli.
Sensory processing disorder sufferers frequently have trouble sleeping due to hypervigilance that prevents them from relaxing enough for an easy night’s rest. Furthermore, their sensory responses vary depending on the day or even week – all factors which make sleeping hard.
Sensory challenges associated with autism are two-fold and both can impact sleep: oversensitivity (hypersensitivity) and undersensitivity (hyposensitivity). If someone with autism experiences oversensitivity (hypersensitivity), their sleeping may suffer accordingly. Hypersensitive children may try to avoid sensory information that overwhelms them by running away from noisy or crowded places, covering their ears when overstimulated by sounds, refusing to be touched, or wearing certain clothing items that could make matters worse.
Kids who are hyposensitive to sensory input typically engage in activities that stimulate them, like seeking spicy or sour foods or engaging in trampolining activities. They may also suffer from proprioceptive and vestibular sensitivities, meaning they struggle with body awareness and spatial orientation; dislike textured clothing, be wary of certain movements and avoid wearing shoes altogether – often both seeker and avoider behaviors may co-exist simultaneously, with many having sensitivities across multiple senses that may or may not lead to autism or any mental health condition either way!
Circadian rhythms
Researchers have long recognized that people with autism display disruptions in their circadian clock – the molecular timers that keep cells aligned with the night/day cycle – which are believed to be responsible for social withdrawal, anxiety and aggression symptoms. Unfortunately, researchers had been unable to establish specific mechanisms. Recently, Ruifeng Cao from University of Minnesota Medical School’s Duluth campus and his team discovered that when Bmal1 gene disruption occurs in mice’s brains they develop autistic-like symptoms including problems with movement, light/sound sensitivity as well as impaired social and cognitive abilities.
The Bmal1 gene codes for BMAL1, which regulates the rhythmicity of our circadian clock by modulating other genes involved with activities and hormone secretion. Mutations in this gene cause it to function irregularly, leading to disruptions of sleep rhythmicity and metabolism that contributes to ASD development in an ongoing cycle.
Cao’s lab recently discovered that autism-linked genetic conditions, including tuberous sclerosis and fragile X syndrome, have been linked with mutations in the BMAL1 gene. These mutations result in misregulation of circadian clock and melatonin production which leads to symptoms similar to autism.
Another recent study explored objective sleep and circadian exposures on behavioral difficulties among children with ASD. Utilizing dominance analysis (DA), which addresses multicollinearity, they discovered that models including length of longest continuous sleep episode and chronotype measure of midpoint of nighttime wakefulness period as predictors were most predictive of behavioral difficulties; their models explained nearly 50% of variance in irritability and stereotypy on Aberrant Behavior Checklist-Community questionnaire.
DA further demonstrated that measurements of the circadian rest-activity rhythm could also serve as a strong predictor of behavioral difficulties among children with ASD, suggesting that its disruption has far-reaching ramifications that go beyond simply sleep disturbance symptoms. This was an extremely insightful discovery, suggesting that its influence is not limited to only poor sleeping individuals with autism.
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