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A Good Night's Sleep: What's It to a Kid with ASD?
FEB. 7, 2021
Sensory challenges are typical of children with autism, in so far as disrupting their ability to sleep at night.
CHAPEL HILL, N.C. — In a classic children’s book, a little rabbit is tucked into his equally small bed, preparing for a night’s rest. Before he’s able to comfortably close his eyes, he must say goodnight to every object in sight – his light, a red balloon, two kittens, a pair of mittens, and most notably, the moon. It is not until every object has been told goodnight, that the rabbit is able to close his eyes and fall asleep – a coping mechanism for pent-up anxiety, it seems.
Despite being a fictional tale, the story of “Goodnight Moon” is not all that different from a nighttime routine for those on the spectrum. For the rabbit in “Goodnight Moon,” a pressing need is felt to say goodnight to all objects in his room. For a child with autism, they too have various needs that must be met before they can fall asleep – perhaps their blanket is too scratchy or they miss a parent’s close proximity.
Danielle Howell Abbott, a mother of two living in Statesville, N.C. faced many sleepless nights while raising her son Eli who is on the spectrum.
“It was awful,” said Abbott. “I was working full-time, my husband was working full-time, and we were exhausted. I really feel that looking back on it, [his insomnia] started the moment he was born.”
In infancy, Eli, who is now 17, would never nap at daycare. When he returned home, however, it would only take a moment for him to fall asleep on Abbott’s chest. Then into childhood, he would sleepwalk. This led Abbott and her husband to put a gate at the top of their staircase.
More pressing than Eli’s insomnia stood a larger problem. Abbott knew something “wasn’t right” in her son and his behavior, outside of sleep alone. Teachers described him as disruptive and pediatricians overlooked his spectrum-like tendencies. It wasn’t until Eli was seven that he was officially diagnosed with autism. In addition to addressing his behavioral problems at school, the diagnosis explained why he couldn’t sleep at night. It was the answer Abbott and her husband were desperately searching for.
Up to 80% of children with autism will have sleep problems at some point in their life, according to Micah Mazurek, director of the University of Virginia’s Supporting Transformative Autism Research program. Traits typical of children with autism, such as sensory hyperactivity and social cognitive challenges, can lead to sleepless nights, said Dr. Zheng Fan, medical director of the Sleep Laboratory at the University of North Carolina at Chapel Hill. Perhaps a blanket is uncomfortable or the child’s social challenges limit their ability to recognize that it’s time for bed, according to Fan. In hindsight, Abbott attributes Eli’s insomnia primarily to his sensory challenges. Most prominently, Eli required comfort from a parental body lying beside him.
“There was a period of time I remember I just went and slept in his bed so [I] could get up and leave,” said Abbott as a solution to getting Eli out of her own bed. “He had no preference as to if it was mom or dad, it just needed to be somebody.”
Alongside Eli’s autism diagnosis came solutions to his insomnia. Eli’s pediatrician recommended he try a weighted blanket to help ease his tactile needs. The blanket that Abbott referred to as “16 pounds of love,” is brought everywhere with Eli to this day. However, it only temporarily helped his sleep. It wasn’t until years later that a doctor prescribed him clonazepam, commonly referred to as its brand name Klonopin, that he slept with less disruptions. The drug is a tranquilizer, typically used to treat seizures and panic disorders. Since starting the medication, Eli’s sleep has improved, and by association, so has the rest of the household’s.
Fan at UNC Chapel Hill describes the relationship between sleep and behavior as a trade-off. When children sleep better, their behavior is better the following day. In typically-developing children, it’s common for them to act irritable or hyperactive out of exhaustion, said Fan. These problems are amplified in children with autism, as their challenges already lend themselves to behavioral difficulties, like engaging in social situations. A common treatment for typically-developing children is cognitive behavioral therapy – childhood insomnia (CBT-CI), where several techniques are used such as a routine bedtime and relaxation techniques, to help improve the child’s sleep.
Through pilot trials at the University of Missouri, researchers are hoping to learn if such therapy can help treat insomnia in children on the spectrum. Melanie Stearns, a post-doctoral fellow at the school’s Sleep Research Lab, serves as the study’s project coordinator. A breadth of factors, such as monitoring activity and rest cycles through actigraphy, will help determine whether CBT-CI treatment will play an effective role, said Stearns.
“[We are] trying to better understand the process,” said Stearns. “So we do have subjective measures, which is the daily diaries that [the participants] fill out, but we also have actigraphy to try and get at some objective measures as well.”
The study, dependent on funding, is expected to run for the next four to five years, said Stearns. Until it is determined whether or not behavioral therapies can prove to be a key intervention tool, many parents are in search of alternatives. In some households, this means weighted blankets. In others, it means saying goodnight to the moon.
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