Every parent has experienced their child not wanting to go to bed or having trouble falling asleep at least once, and for some kids, this can be an almost daily occurrence. These sleep problems are disproportionately present in kids with autism compared to their typically developing peers. Sleep challenges can take a variety of forms, such as trouble falling asleep, waking throughout the night, restlessness, or waking too early. Thankfully there are some behavioral techniques to help with these issues and build good sleep hygiene habits.
What is Sleep Hygiene?
Good quality sleep is essential for proper cognitive development and behavioral functioning. According to the Sleep Foundation, a medically reviewed news organization focused on delivering information on sleep science and medicine, poor quality sleep is associated with a variety of physiological symptoms like stomach aches, headaches, high blood pressure, and low immunity (Pacheco, 2022). Lack of sleep can negatively affect concentration and memory at school. Not getting enough sleep can make someone feel depressed, withdrawn, irritable and it even is associated with aggression in some children (Pacheco, 2022).
The good news is that parents can systematically promote good sleep habits in children. These good habits are often referred to as sleep hygiene and should be thought of as a daily practice and taught to children just like other physical hygiene tasks are taught. Consistency with repeated practice and behavioral shaping is the key to success.
Building Good Habits
Start with a good environment for sleep. The room should be dark even when the sun is still out. All electronics, like phones, tablets, TVs, etc., should be turned off. Some neurotypical children and especially those with autism, can have a lot of sensory sensitivities, so use a white noise machine to block out sounds, make sure PJs and sheets are soft, make sure the room is not too hot or too cold and consider infusing a calm-inducing smell such as lavender into the room.
Develop a bedtime routine and stick to it. Follow this same routine on the weekends, during holidays, on vacation and when family is visiting. The bedtime routine should start about an hour before bedtime. Start turning the lights low an hour before a consistent bedtime to help the brain start naturally producing melatonin. Turn off all the screens at least an hour before bedtime. Do a soothing event like bath time at a consistent time every night. Use consistent cues like soft music or a bedtime story after the bath to ease into sleep. A bedtime story can be a special bonding time between parent and child but do not be tempted to lay in bed right next to your child while they fall asleep; you want them to develop a self-soothing sleep strategy that does not involve your touch.
Have reasonable expectations about how much your child will sleep. Talk to your pediatrician about a reasonable number of hours per night. Determine when your child needs to wake up in the morning for the family to function appropriately and then work backwards. Also, ensure that your child is getting adequate exercise during the day to be able to sleep through the night. Neurodiverse children often require more physical activity than their typically developing peers, but every child is unique, so it is important that you do not compare children but rather just meet each one’s individual needs.
Start a Reward System
Once you have developed a solid bedtime routine, you can start to use behavioral reward strategies to encourage your child to stay in bed. Dr. Patrick Friman is the former Editor of the Journal of Applied Behavior Analysis and former President of the Association for Behavior Analysis International. He developed the “bedtime pass strategy,” and this system is brilliantly simple.
Friman et al., 1999, suggests giving your child two bedtime passes to start every night. Explain the rules to your child about how these bedtime passes work. Any time your child leaves their room, they must give you a pass. A pass gets them one trip out of the room for a parent visit. These visits should be short (e.g. less than three minutes) and have a specific purpose, like getting a drink or giving a hug. Once the passes are gone, ignore all attempts to get your attention. If your child leaves their room after all the passes are gone, guide them back to the room without talking or looking at them.
Allow your child to select a prize in the morning if he has one or more unused passes from the previous night, such as picking a small prize out of a prize box, getting a special breakfast treat or getting 10 minutes of screen time in the morning. Once your child has been successful with only using one bedtime pass per night for two straight weeks, then fade to your child only having one bedtime pass at the beginning of the night (Friman et al., 1999). Then follow the above procedures.
All Together Now
Reading about good sleep habits is one thing. Putting it into practice is another. Sleep experts say it can take three weeks to get the hang of something new, so give yourself a lot of time and even more grace to practice sleep hygiene. Most importantly, even if your efforts result in just an hour more of sleep a night, it’s important to celebrate the wins when you’re a parent and to share the excitement that comes from these wins with the whole family.
Pacheco, D. (2022, September 19). Children and sleep. Sleep Foundation. Retrieved January 4, 2023, from https://www.sleepfoundation.org/children-and-sleep
Friman PC, Hoff KE, Schnoes C, Freeman KA, Woods DW, Blum N. The Bedtime Pass: An Approach to Bedtime Crying and Leaving the Room. Arch Pediatr Adolesc Med. 1999;153(10):1027–1029. doi:10.1001/archpedi.153.10.1027
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