Sleep, Bedtime Routines, Anxiety, and Autism

Sleep, Bedtime Routines, Anxiety, and Autism

The association between sleep, bedtime routines, anxiety, and Autism Spectrum Disorder in children is an important quality of life issue although there is a limited amount of research regarding this topic.  Bedtime routines are a component of sleep hygiene defined as ‘a set of observable, repetitive behaviors which directly involve the child and at least one adult acting in an interactive or supervisory role … in the hour preceding bed each night’.

Some research indicates that parent-reported sleep quality in children with ASD is associated with a consistent bedtime routine such as a consistent bedtime and the same sleep location.  In addition, what occurs prior to bedtime can affect the quality of sleep.  Certain pre-bedtime activities have been shown to disrupt sleep quality.  Pre-bedtime activities that can increase physiological arousal and delay sleep onset include playing video games, active play, watching television and snacks/drinks.  Avoiding these activities prior to bedtime may help improve sleep onset.

As children get older they become more independent at bedtime and parental interaction begins to decrease.  Although, the increase in age in typically developing children is also associated with a higher frequency of maladaptive pre-bedtime activities (i.e. video games, tv, etc) during the hour before bedtime.

For children with ASD there is an association between sleep problems and anxiety symptoms.  Research indicates that parent-reported sleep problems predicted later anxiety in school-aged children with ASD.  In a small study of 21 children with ASD, there was a reduction in sleep quality characterized by an increase in anxiety symptoms and an increased frequency of maladaptive activities in the hour before bedtime.

Children with ASD should have a consistent bedtime routine and reduce maladaptive pre-bedtime activities to possibly increase sleep quality and decreased anxiety symptoms.

Reference:  Fletcher, F. E., Foster-Owens, M. D., Conduit, R., Rinehart, N. J., Riby, D. M., & Cornish, K. M. (2017). The developmental trajectory of parent-report and objective sleep profiles in autism spectrum disorder: Associations with anxiety and bedtime routines. Autism, 21(4), 493-503.

Autism Sleeps™ is an easy-to-read manual to help people with sensory processing difficulties, Autism Spectrum Disorders or a restless mind, achieve an overall healthy sleep experience.  It serves as a thorough resource for sleep sensory strategies and suggestions for preparing the “sleep environment”. Sample bedtime and wake-up routines are provided as templates, especially to guide parents of children with sleep difficulties.  Find out more information.

Read more about autism and sleep:

Aquatic Exercise and Sleep in Children with Autism

Works, ADLs, Sleep and Autism

Sensory Over-Responsivity, Autism, and Sleep

Weighted Blankets and Sleep Problems in Children with ASD

Media Use, Boys with Autism and Sleep

The post Sleep, Bedtime Routines, Anxiety, and Autism appeared first on Your Therapy Source.

Aquatic Exercise and Sleep in Children with Autism

The Focus on Autism and Other Developmental Disabilities published research on whether participation in an aquatic exercise program improved the sleep in 8 children with Autism Spectrum Disorder (ASD).  Using an A-B-A withdrawal design for 4 weeks of each phase, the children participated in 60 min of aquatic exercise 2X/week. Data was collected via phone interviews with parents who were asked questions related to sleep latency, nighttime wakenings, and sleep duration.

The results indicated the following:

• there was a statistically significant difference for sleep latency and sleep duration in the children with ASD following aquatic exercise.

The researchers concluded that participation in aquatic exercise may improve the sleep habits of children with ASD.

Reference:  Kathryn N. Oriel, Jennifer Wood Kanupka, Kylee S. DeLong, and Kelsie Noel.  The Impact of Aquatic Exercise on Sleep Behaviors in Children With Autism Spectrum Disorder: A Pilot Study.  Focus on Autism and Other Developmental Disabilities December 2016 31: 254-261, first published on November 25, 2014 doi:10.1177/1088357614559212

 

 

Autism Sleeps™ is an easy-to-read manual to help people with sensory processing difficulties, Autism Spectrum Disorders or a restless mind, achieve an overall healthy sleep experience.  It serves as a thorough resource of sleep sensory strategies and suggestions for preparing the “sleep environment”. Sample bedtime and wake-up routines are provided as templates, especially to guide parents of children with sleep difficulties.  Find out more information.

 

The post Aquatic Exercise and Sleep in Children with Autism appeared first on Your Therapy Source.

Exercise and Sleep Tips for Children

Combining exercise and sleep can be a tricky balance.  Getting proper sleep for yourself or your children can be very challenging in this fast paced world.  We want ourselves and our children to exercise but all parents want their children to sleep too!

For children some of the best suggestions are:

1. Limit vigorous physical activity before bed creating a calming atmosphere.  Try  yoga, tai chi or a stroll which may be more beneficial in order to help children transition to sleep time.
2. Turn off the television/computer/tablet/phone at least 30 minutes before bed.
3. Establish a routine at bedtime – brush teeth, read for 20 minutes and go to bed.
4. Try to stick with the routine especially with regular bedtimes and morning wake up times.

For children with sensory processing deficits or autism spectrum disorders, establishing healthy sleep patterns can be even more challenging.

Autism Sleeps™ serves as a thorough resource of sleep sensory strategies and suggestions for preparing the “sleep environment”. Sample bedtime and wake-up routines are provided as templates, especially to guide parents of children with sleep difficulties.  Also included are checklists to identify which of the six sensory area(s) are impacted by poor sleep. A menu of sensory strategies in each of those affected areas is available for use in preparing a person to sleep, stay asleep and transition to wake up. Additionally, a diary and graph are available for logging the impact of the strategies implemented to determine those that are most effective in helping restless minds sleep.  Find out more information here.

Source: Fix.com Blog

The post Exercise and Sleep Tips for Children appeared first on Your Therapy Source.

Sensory Over-Responsivity, Autism and Sleep

Sleep Medicine published research on a large well-characterized sample of 1347 children with autism spectrum disorder (ASD) examining the relationship between sleep problems, sensory over-responsivity, and anxiety.  Statistical analysis was completed using the  Children's Sleep Habits Questionnaire, Child Behavior Checklist, and Short Sensory Profile.

The following results were recorded:

1. anxiety was associated with all types of sleep problems (i.e., bedtime resistance, sleep onset delay, sleep duration, sleep anxiety, and night wakings).


2. sensory over-responsivity (SOR) was correlated with all sleep problems in bivariate analyses.


3. further statistical analysis revealed that SOR remained significantly associated with all sleep problems except night awakenings for older children, while for younger children SOR was no longer significantly associated with bedtime resistance or sleep anxiety.

The researchers concluded that children with ASD who have anxiety and SOR may be particularly predisposed to sleep problems including possible difficulties with hyperarousal. Future research using physiological measures of arousal and objective measures of sleep are recommended.

Reference:  Mazurek , M. and Petroski, G. Sleep problems in children with autism spectrum disorder: examining the contributions of sensory over-responsivity and anxiety. Sleep Medicine Publication stage: In Press Accepted Manuscript.  DOI: http://dx.doi.org/10.1016/j.sleep.2014.11.006

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Autism Sleeps™ serves as a thorough resource of sleep sensory strategies and suggestions for preparing the “sleep environment”. Sample bedtime and wake-up routines are provided as templates, especially to guide parents of children with sleep difficulties.  Find out more at http://yourtherapysource.com/autismsleeps.html

Comparing Media use and Sleep in Boys with Autism, ADHD or Typical Development

Pediatrics published research comparing questionnaire results on media use (television, computer, and video games) and sleep among 49 boys with autism spectrum disorder (ASD) compared with 38 boys with attention-deficit/hyperactivity disorder (ADHD) or 41 boys with typical development (TD).

The results indicated the following:
1. bedroom media access was associated with less time spent sleeping at night in all three groups.
2. bedroom access to a television or a computer was more strongly associated with reduced sleep among boys with ASD compared with boys with ADHD or TD.
3. the amount of time spent playing video games was uniquely associated with less sleep among boys with ASD.

The researchers concluded that screen-based media time and bedroom media access should be routinely assessed and may be important intervention targets when addressing sleep problems in children with ASD.

Read the full text article here http://m.pediatrics.aappublications.org/content/132/6/1081.full

Reference: Engelheart, M MD et al. Media Use and Sleep Among Boys With Autism Spectrum Disorder, ADHD, or Typical Development.
Published online November 18, 2013 Pediatrics Vol. 132 No. 6 December 1, 2013 pp. 1081 -1089 (doi: 10.1542/peds.2013-2066)



Autism Sleeps™ serves as a thorough resource of sleep sensory strategies and suggestions for preparing the “sleep environment”. Sample bedtime and wake-up routines are provided as templates, especially to guide parents of children with sleep difficulties.  Find out more at http://yourtherapysource.com/autismsleeps.html.

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Early Predictors of Autism - Self Regulation and Sleep Patterns

The Journal of Early Intervention published research on identifying early predictors prior to a diagnosis of Autism Spectrum Disorders (ASD) at 4 years of age. Data was analyzed on 100 children comparing children with ASD to children with other disabilities and children who were typically developing.

The results indicated the following:

1. limited unique characteristics (e.g., self-regulation and sleep patterns) at the 9-month time point were identified.
2. a majority of the differences in communication and language, mental/cognitive function, motor function, social interaction, and self-regulation were identified at the 2-year time point.

Reference: Jeans LM et al. Early Predictors of ASD in Young Children Using a Nationally Representative Data Set. Published online before print February 19, 2014, doi: 10.1177/1053815114523319 Journal of Early Intervention December 2013 vol. 35 no. 4 303-331



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Want to Improve Motor Learning? Go to Sleep.

 



Researchers from the University of Montreal taught a group of subjects a new sequence of piano-type finger movements on a box.  Using functional MRIs, the subject's brains were analyzed during their performance of the task before and after a period of sleep. In addition, the same test was performed by a control group at the beginning and end of the day, without a period of sleep.

Previously, the researchers had shown that the putamen, a central part of the brain, was more active in subjects who had slept and they had observed improved performance of a task after a night of sleep and not just the passage of daytime.

Using brain connectivity analysis the results of this study indicated that one brain network emerged from the others—the cortico-striatal network—composed of cortical and subcortical areas, including the putaman and associated cortical regions.  In other words, after a night of sleep, the cortico-striatal network was more integration among these regions when consolidation had occurred. A night of sleep appeared to provide active protection of the cortico-striatal network, but the passage of daytime did not provide.  Only a night of sleep resulted in better performance of the task.

Reference:  Medical Express. Learning to play the piano? Sleep on it! Retrieved from the web on 8/22/14 at http://medicalxpress.com/news/2014-08-piano.html#nwlt



This book is an easy-to-read manual to help people with sensory
processing difficulties, Autism Spectrum Disorders or a restless mind, achieve
an overall healthy sleep experience.  Find out more at http://yourtherapysource.com/autismsleeps.html

 

 

Effects of Weighted Blanked on Sleep Problems in Children with Autism

Pediatrics published research on a randomized phase III trial determining the effectiveness of a weighted-blanket intervention in treating severe sleep problems in children with autism spectrum disorder (ASD). Sixty seven children were randomized into a weighted blanket group or a control group (regular blanket). The blankets were introduced at bedtime and used for a two week period. The researchers measured total sleep time recorded by actigraphy, sleep-onset latency, sleep efficiency, assessments of child behavior, family functioning, and adverse events. Sleep was also measured by using parent-report.

The results indicated the following:
1. the weighted blanket, compared with the control blanket, did not increase total sleep time.
2. no group differences were recorded in any other objective or subjective measure of sleep, including behavioral outcomes.
3. Subjectively, parents and children reported favoring the weighted blanket.

The researchers concluded that the use of a weighted blanket did not help children with ASD sleep for a longer period of time, fall asleep significantly faster, or wake less often.

Reference:Weighted Blankets and Sleep in Autistic Children—A Randomized Controlled Trial
Paul Gringras, Dido Green, Barry Wright, Carla Rush, Masako Sparrowhawk, Karen Pratt, Victoria Allgar, Naomi Hooke, Danielle Moore, Zenobia Zaiwalla, and Luci Wiggs. Pediatrics peds.2013-4285; published ahead of print July 14, 2014, doi:10.1542/peds.2013-4285

Autism Sleeps™ serves as a thorough resource of sleep sensory strategies and suggestions for preparing the “sleep environment”. Sample bedtime and wake-up routines are provided as templates, especially to guide parents of children with sleep difficulties.

Find out more at http://yourtherapysource.com/autismsleeps.html

Lack of Sleep Increases Obesity and Body Fat in Children

Pediatrics has published a large study linking reduced sleep and childhood obesity.  The children who consistently received less than the recommended hours of sleep during infancy and early childhood had increases in both obesity and in adiposity or overall body fat at age 7.

Insufficient sleep was defined as less than 12 hours per day from ages 6 months to 2 years, less than 10 hours per day for ages 3 and 4, and less than 9 hours per day from age 5 to 7.

The results of the study indicated the following:

1. children with the lowest sleep scores had the highest levels of all body measurements for obesity and adiposity, including abdominal fat which is considered to be particularly hazardous.


2. association was consistent at all ages, indicting there was no critical period for the interaction between sleep and weight.

The researchers recommend that parents and children should be educated on good sleep habits.

Reference:  Medical Express.  Chronic insufficient sleep increases obesity, overall body fat in children. Retrieved from the web on 5/21/14 at http://medicalxpress.com/news/2014-05-chronic-insufficient-obesity-body-fat.html#nwlt.

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Autism Sleeps™ serves as a thorough resource of sleep sensory strategies and suggestions for preparing the “sleep environment”. Sample bedtime and wake-up routines are provided as templates, especially to guide parents of children with sleep difficulties.

Find out more at http://yourtherapysource.com/autismsleeps.html

Sleep Patterns in Children with Autism

The Archives of Disease in Childhood published research on longitudinal sleep patterns in 73 children with autism.  Parental reports of sleep duration were collected 8 times from 6 months to 11 years old.  The results indicated the following:

• from 30 months to 11 years old children with autism sleep 17-43 minutes less than their peers
• no significant difference was found in sleep patterns from 6-30 months of age
• the reduction in sleep was due to changes at night not changes during daytime sleep patterns
• night time sleep duration was shorter due to later bedtimes and earlier wake times
• frequent waking > 3x/night was seen in children with autism older than 30 months of age
• age-specific decreases of > 1SD within individuals in sleep duration across adjacent time points was a predictor of ASD between 18 months and 30 months of age and from 30 months to 42 months. 

The researchers concluded that sleep duration is decreased in children with autism from 30 months through 11 years old.  You can read the open access full text article at http://adc.bmj.com/content/early/2013/08/22/archdischild-2013-304083.short?rss=1

Reference:   Sleep patterns in children with autistic spectrum disorders: a prospective cohort study Joanna S Humphreys, Paul Gringras, Peter S Blair, Nicola Scott, John Henderson, Peter J Fleming, Alan M Emond Arch Dis Child archdischild-2013-304083Published Online First: 23 September 2013 doi:10.1136/archdischild-2013-304083

Autism Sleeps™ 

By: Ileana S. McCaigue OTR/L, IMC

Pages: 150 pages Wire-O bound with a full cover


Summary: This printed book is an easy-to-read manual to help people with sensory processing difficulties, such as Autism Spectrum Disorders, achieve an overall healthy sleep experience.
FIND OUT MORE INFORMATION

Sleep and Children with Autism

Focus on Autism and Other Developmental Disabilities published research on the sleep problems and symptom severity in children with autism.  Using mother's reports, 109 children with autism (without any co-morbid diagnoses) were studied.  The following results were reported:

• positive correlation between the severity of sleep problems and the severity of autism symptoms 
• sleep onset delay and sleep duration were positively correlated with autism symptoms and autism severity 
• sleep onset delay was the strongest predictor of communication deficit, stereotyped behavior, and autism severity

The researchers concluded that children with autism have specific sleep problems and suggest that behavioral interventions include the treatment of sleep problems.

Reference: Megan E. Tudor, Charles D. Hoffman, and Dwight P. Sweeney. Children With Autism: Sleep Problems and Symptom Severity. Focus on Autism and Other Developmental Disabilities December 2012 27: 254-262, first published on September 27, 2012 doi:10.1177/1088357612457989

Autism Sleeps

This printed book is an easy-to-read manual to help people with sensory processing difficulties, such as Autism Spectrum Disorders, achieve an overall healthy sleep experience.

Get more information on Autism Sleeps.

New Book - Autism Sleeps™

If you are like me, you have frequently had questions from parents regarding how to help their children with sensory processing difficulties fall asleep and to stay asleep.  Now there is Autism Sleeps, written by Ileana McCaigue, who has over 36 years of experience as an occupational therapist and she has sensory integration certification.  

Autism Sleeps™ serves as a thorough resource of sleep sensory strategies and suggestions for preparing the “sleep environment”. Sample bedtime and wake-up routines are provided as templates, especially to guide parents of children with sleep difficulties.

This book is easy to read with concise and thorough information on sleep and autism related sleep problems.  There are step by step directions to: create a conducive sleep environment, encourage healthy sleep and establish a wake up routine.  The book provides several case studies.  The appendix includes sensory sleep strategies, checklists, sleep record form and graph.

In my opinion, this book is a must have for any parents, pediatric therapists and pediatricians who have children with autism, sensory processing difficulties or any child with disruptive sleep patterns.

You can order the book at Your Therapy Source - http://yourtherapysource.com/autismsleeps.html

24 Hour Positioning

School based therapists are frequently involved in monitoring sitting and standing postures in order for students to access the educational curriculum without compromising range of motion.  It is the pediatric therapists job to ensure that deformities are avoided through proper positioning.  Obviously, this can be monitored and followed during the school day.  But what happens when the student goes home.  If a student is positioned properly at school whether in a wheelchair or adaptive seating and then goes home to sit slumped on a couch not much will be accomplished.  Or perhaps a student goes home and remains seated or standing with appropriate posture but then goes to sleep for 10 hours in a misaligned position.  

Although school based therapists only work in the school, educational goals may not be met if a program is not also followed through at home.  Consider the following when creating a positioning program and offer suggestions to help supplement proper positioning at home:

1. Is the child positioned properly before school and during transport?
2. Is the child positioned properly in each classroom setting ie homeroom, library, music, art, etc?
3. Does the child have appropriate posture during meal times?
4. Is the child positioned properly after school?
5. Is the child positioned properly during sleep time? (here is an informative article on sleep positioning - http://www.atgrehab.com/clinician/articles/LOJSampleSleepPositioningEquipment.pdf )

 

Presleep Activities and Time of Sleep Onset

Pediatrics published research on a survey completed by 2017 children ages 5-18 regarding activities reported during the 90 minutes before sleep time.  The results indicated that television watching was the most commonly reported activity before sleep time.  The participants who had a greater engagement in screen time  had a later sleep onset.  Participants who reported significantly greater time spent in nonscreen sedentary activities and self care had an earlier sleep onset.

Reference:   Louise S. Foley, Ralph Maddison, Yannan Jiang, Samantha Marsh, Timothy Olds, and Kate Ridley Presleep Activities and Time of Sleep Onset in Children. Pediatrics 2013; 131:2 276-282; published ahead of print January 14, 2013, doi:10.1542/peds.2012-1651

Sleep Duration and ADHD Symptoms

Pediatrics published research on sleep duration and behavioral and ADHD symptoms in healthy 7-8 year old children. The results indicated that children who had short sleep duration (less than 7.7 hours) had higher hyperactivity/impulsivity scores, higher attention-deficit/hyperactivity disorder total scores but similar inattention scores compared with children sleeping 7.7 to 9.4 hours or >9.4 hours. Many therapists serve children with behavioral problems and ADHD.

Do you inquire about sleeping habits when you evaluate or re-evaluate?  Speaking from experience, sleep duration can turn children into different people. I have seen children meltdown, exhibit erratic behavior, be inattentive and basically lose it from lack of sleep. Why do you think parents dislike sleepovers? It is not the night of the sleepover it is the day after!

So therefore just a suggestion - next time you are evaluating a child who is inattentive, hyperactive or exhibiting behavioral problems don't forget to ask how many hours of sleep per night the child has had over the past week.

Reference: E. Juulia Paavonen et al. Short Sleep Duration and Behavioral Symptoms of Attention-Deficit/Hyperactivity Disorder in Healthy 7- to 8-Year-Old Children. Pediatrics May 2009; 123:5 e857-e864; doi:10.1542/peds.2008-2164

Preschool Tip - Have Consistent Bedtime

A new study has indicated that consistent bedtime routines for 4 year olds, result in higher scores in receptive and expressive language, phonological awareness, literacy and early math abilities. The American Academy of Sleep Medicine recommends that 4 year olds get at least 11 hours of sleep per night. This study had a sample size of approximately 8000 children!

Motor skill development was not assessed but that would be another interesting research study. I would hypothesize that a lack of sleep results in a lack of coordination, precision, grading of movements and decreased safety awareness in children.

Reference: Medical News Daily. Consistent Bedtimes, Intentional Parenting Practices, Linked To Better Language, Reading And Math Skills In Preschool Children. Retrieved from the web on 6/7/2010 from http://www.medicalnewstoday.com/articles/191038.php

How To Get Your Child to Fall Asleep Faster...

Wanted to grab your attention with the title - hope it worked. So I am sure you are wondering what you can do to get a child to fall asleep faster...

How about a guess -

A. Warm milk and cookies
B. TV before bed
C. Sleeping in Mom's bed
D. Increase activity.

If you answered D you are correct. A recent study in Archives of Disease in Childhood found that the more activity 7 year olds got during the day the faster they fell asleep. Five hundred ninety one seven year olds wore actigraphs to determine activity levels. In addition, the amount of time it took the child to fall asleep was measured (sleep onset latency). Children who were more active (vigorous activity for one hour throughout the day) fell asleep 6 minutes faster. Another bonus was that the children who fell asleep faster slept for longer periods.

One more reason to encourage your children to be active for your own sake! I would love to see research on the amount of time spent outdoors during wake time and its effects on sleep onset latency. My humble hypothesis, fresh air wears you out and you fall asleep faster.

Reference: Nixon GM, Thompson JM, Han DY, Becroft DM, Clark PM, Robinson E, Waldie KE, Wild CJ, Black PN, Mitchell EA Falling asleep: the determinants of sleep latency. Arch Dis Child. 2009 Sep;94(9):686-9.