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Parent-Child Interaction and Autism Spectrum Disorder ASD
Autism continuing education MFT CEUs

Section 2
Parents Teaching Children with Autism Spectrum Disorder
How to Sleep Better

CEU Question 2 | CEU Test | Table of Contents | Autism
Counselor CEUs, Psychologist CEs, Social Worker CEUs, MFT CEUs

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On the last track, we discussed Teaching Good Manners.  This included Getting an Autistic Child to Sit Down and Eat, Eating Pace, Insisting on Proper Utensil Use, Cutting Down the Mess and Restaurants.

As you are aware, many children whether autistic or not get up in the middle of the night and want to sleep in their parents’ bed. However, children with disabilities are likely to have sleep issues, and often don’t grow out of them.Do you have any clients who complain of sleep issues with their children? How do you respond? 

Techniques presented on this track will include Keeping an Autistic Child Awake During the Day, Bedtime Routines, Not Giving In and Dark versus Light.

Ernesto, age 38 and Angelica, age 34, had an autistic son, Rafael, age 7.  Ernesto stated, "I know it’s typical for all children sometimes to want to climb into bed at night with their parents, but Rafael does it every night! What happens first is that we put him to bed at 8 o’clock. I don’t know if he ever actually falls asleep or just waits, but when he gets up in the middle of the night, we can hear him jumping on his bed and humming loudly. Then he comes into our bedroom and wants to sleep with us! I haven’t gotten a full night’s sleep since he was born!" 

Angelica stated, "In the morning, though, it’s precious, because he wants to cuddle. It’s hard to say no to that.  Still…I would like to get some sleep the night before!"  How might you have responded to Ernesto and Angelica concern regardin Rafael sleeping with them nightly?

Four Effective Tools for Sleep Issues

Tool #1 - Keeping Rafael Awake During the Day

I stated, "First, let’s discuss keeping Rafael awake during the day. If Rafael is having trouble sleeping at night, it may be because he’s getting some sleep during the daytime hours. Keeping a sleep diary will probably clue you in to this."  Angelica asked, "What’s a sleep diary?"

Technique:  Sleep Diary
I stated, "A sleep diary would be a log of Rafael’s sleep patterns. You note when he’s sleeping at times he shouldn’t be. The sleep diary includes the date; what time Rafael was put to bed at night; what time he fell asleep, if at all; whether Rafael woke up during the night and for how long; and every single nap during the day. You might also include information such as what Rafael did and eat right after he was put to bed and what he did when he got up in the middle of the night." 

Ernesto stated, "But Angelica and I don’t go to school with Rafael. How would we know if he was sleeping on the bus or in class?"  I stated, "You may want to make sleep diary sheets and send them to school with Rafael. Give one to all his teachers and even his bus driver. That way, you can know all the details."

"If Rafael is falling asleep during the day, you might want to keep Rafael awake during the day until the sleep cycle is normalized.  If Rafael seems extremely sleepy at any point during the day, you may have to do something active, like taking a walk or playing.  You might also try giving him a favorite snack. Remember, you’re trying to help Rafael establish good sleep patterns at this point.  If he is sleeping during the day, he probably needs that sleep, but you will want to channel it toward the nighttime." 

Ernesto asked, "What if Rafael falls asleep in the car while I’m driving and I can’t keep him awake?"  I stated, "If Rafael is falling asleep in the car or even on the bus, it may be necessary to have someone ride with him to keep her occupied so he doesn’t sleep. Particularly on the bus, this may necessitate having a one-on-one aide or behavior specialist accompany Rafael until he no longer sleeps on the way to school or home."
Tool #2 - Bedtime Routines
I stated, "Second, let’s discuss bedtime routines. If Rafael’s sleep problems seem to be mostly about settling down for the night, you may have to look closely at how you put him to bed. In my experience, most children with autism, like typical children, have difficulties falling asleep, but over time, that generally becomes less of a problem, if there’s a bedtime routine and if parents stick to the routine.

"You may find it helpful to reward good behavior, and since bedtime, in and of itself, may not be that rewarding, you might try to provide Rafael with an opportunity to engage in favorite activities after getting in bed. A favorite storybook, an opportunity to listen to a favorite CD, a chance to have Mom or Dad sing his favorite nursery rhyme, or an opportunity to cuddle with a favorite toy can go a long way toward making Rafael more enthusiastic about bedtime.

"If bedtime continues to be a struggle despite these rewards, and Rafael wants you to lie down with him or demands you rock him, you can do this for a short time, but you may want to set a timer or give him some other clear and consistent message that the routine is finished. Then make sure you’re firm when the timer ends; you can leave the room, but don’t come back. Only by being firm and consistent will you convince Rafael to stop calling for you and let himself fall asleep." 

Have you found, as I have, that getting into a firm, consistent bedtime routine can be effective in helping an autistic child sleep at night?

Tool #3 - Not Giving In
Ernesto and Angelic felt the bedtime routine might work so I stated, "Third, in addition to keeping Rafael awake during the day and bedtime routines, let’s discuss not giving in. You can help Rafael out by teaching him that if he gets up, you will matter-of-factly put him back in bed.You will want to do this every time, or he will keep trying to get into bed with you. You’re not punishing him. Try not to yell or get mad, no matter how tired you are. 

"But also remember that you don’t want to reward him for getting out of bed, either. If you play with him, give him a snack, get back in bed with him, let him come into your bed for even a brief period of time, or interact in any way that’s desirable, you will have rewarded him for getting out of bed and waking you up. You will want to teach Rafael that when it’s nighttime, he needs to stay in his room."

Angelica stated, "Do you know how hard that is at 2 in the morning? I am usually so tired that it’s just easier to let Rafael climb into bed with us than to force myself out of bed to walk him back to his room!"  I stated, "Remember that if you give in, you’re actually increasing the likelihood that he’ll continue to wake you up in the future. Try to look at the long-term goal, that Rafael stay in bed all night long, and sacrifice a few minutes of comfort for a lifetime of improved sleep for both of you."

Tool #4 - Dark versus Light
I then stated, "Fourth, let’s discuss dark versus light. Sometimes it’s hard for autistic children to differentiate between the times when they need to stay in bed and when they can get up.They may get confused about why Mommy or Daddy is sometimes annoyed when they appear and at other times happy to give them a good-morning cuddle.

"One way to help Rafael make that distinction is by teaching him that when it’s dark outside, he needs to stay out of his parents’ room. Teach him to look at the window to see if it’s light out or dark, and tell him he has to stay in his room  if it’s still dark but can go into your room if it’s light. That way, if you enjoy cuddling in bed in the mornings, you can have then when it’s light, but if Rafael does awaken in the middle of the night, he will learn not to go into your room and wake you up.

"Remember, most kids with autism are good visually.  Even if Rafael can’t communicate that well, chances are that he can learn the difference between light and dark if he gets enough practice."

Do you have an Ernesto or an Angelica who has an autistic child with sleep issues?  Would playing this track be beneficial for him or her? 

On this track, we discussed Sleep Issues.  These included Keeping an Autistic Child Awake During the Day, Bedtime Routines, Not Giving In and Dark versus Light.

On the next track, we will discuss Toilet Training.  This will include Seven Steps to Toilet Training in a Week. 

Peer-Reviewed Journal Article References:
Malow, B. A., MacDonald, L. L., Fawkes, D. B., Alder, M. L., & Katz, T. (2016). Teaching children with autism spectrum disorder how to sleep better: A pilot educational program for parents. Clinical Practice in Pediatric Psychology, 4(2), 125–136. 

Paasch, V., Leibowitz, L., Accardo, J., & Slifer, K. (2016). Preparing children with autism spectrum disorders for overnight sleep studies: A case series. Clinical Practice in Pediatric Psychology, 4(2), 153–163.

Schwichtenberg, A. J., Hensle, T., Honaker, S., Miller, M., Ozonoff, S., & Anders, T. (2016). Sibling sleep—What can it tell us about parental sleep reports in the context of autism? Clinical Practice in Pediatric Psychology, 4(2), 137–152.

Online Continuing Education QUESTION 2
What are 4 sleep issues? To select and enter your answer go to CEU Test.

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