Sleep Advice for Neurodivergent Children and Young People
By Dr Freya Spicer-White, Head of Neurodiversity Practice and Standards and Pankhuri Pilania, Assistant Psychologist
Many children and young people have sleep issues. But for those children who are Autistic, have ADHD or another form of Neurodivergence, sleeping well might be particularly difficult. In this issue we offer advice and guidance for parents and carers on how their children and young people can get a better nights’ sleep.
Why is sleep important?
Difficulties around bedtime and not getting enough sleep can result in children and young people being sleepy in the daytime, struggling to pay attention or experiencing emotional dysregulation. Those who get a good night’s sleep are generally happier, alert and able to pay more attention during the daytime.
How much sleep do children need?
Amount of sleep for a child or young person needs varies and it needs to be monitored over a period as they grow and develop. As the child grows, its required to identify their effective pattern, amount, and timings of sleep.
When does sleep become a problem?
Sleep becomes a problem when it has a negative impact on the child or young person’s quality of life.
Research suggests that around 80% of neurodivergent young people will experience some difficulties with sleep.
Types of sleep difficulties…
There are different types of sleep difficulties, these can be:
- Being unable to fall asleep
- Struggling to stay asleep and waking during the night
- Unusual or behaviours of concern at nighttime
What can impact a good night’s sleep?
- Diagnosed conditions – especially those that may feature hyperactivity; lots of young people with ADHD might be physically active before bedtime but they also may be mentally active. They might struggle to sleep because they can’t switch their brains off.
- Day time activity – children who sleep during the day or those who don’t get enough day-time activity maybe not feel tired or need to sleep as many nighttime hours.
- Environment –their bedroom might have too many distractions, bright lights, too much noise, or an overly warm temperature.
- Food and drink – Caffeinated drinks such as tea, coffee or fizzy/energy drinks may disturb sleep. Some neurodivergent children also have gastrointestinal problems so they may experience discomfort after eating, which might also disturb their sleep.
- High anxiety and arousal – If a child or a young person is anxious, which could be related to their neurodivergence, their arousal system may stay active longer and therefore it might take them longer to get to the ‘rest and digest’ state.
- Lack of routine – All children and young people find reassuring routines to help them settle to sleep useful but an Autistic child might find a lack of a bedtime routine very upsetting and stressful.
- Physical illness – Illness or discomfort including reflux, toothache or eczema can make settling for bedtime difficult. Neurodivergent children and young people have experience the physical sensations of illness more intensely causing more disruptions or they may have reduced sensation, for example not realising they have a fever but are still wrapped up tightly.
- Sensory issues – Many neurodivergent children and young can be hypersensitive to sensory experiences e.g. sound, touch, smell, taste or vision. This can be both distracting and distressing and make the process of falling asleep very difficult. For example the feel of a blanket or the sound of people nearby could be distressing.
- Transition – Some neurodivergent children and young people may struggle with transitions between a ‘doing activity’ and ‘calming bedtime activity’ and therefore need plenty of time and reassurance around bedtime to support the transition.
What helps?
Here are some ideas and techniques to help your child get a better night’s sleep.
Use a sleep diary
Try a sleep diary to record their sleep and wake cycle over a 2-week period, use this to try and spot any obvious problems or patterns. If any new routines are started a sleep diary will also help you to see if what you’re doing is working.
Have a sleep routine
A bedtime routine should be no more than thirty minutes and be consistent so that the child or young person can easily predict what is going to happen. The routine can include things that relax such as a story or music. It is important to avoid any stimulating activities before bedtime like watching TV, computer games or play. It may be helpful to have an identifiable ‘end point’ that the child or young person can become familiar with that marks bedtime e.g. a familiar phrase like ‘Sleep time (name)’. If the child or young person then struggles to go to sleep, this phrase can be repeated.
Visual routines
Neurodivergent children and young people respond well to structure and routines that are visually presented. Consider creating a visual routine so that the child or young person is aware that it is bedtime. You can use photos, drawings or words, whichever the young person prefers.
Sleeping alone
It is important that children and young people learn to sleep on their own. Parents and carers can consider using a graded approach where they will gradually build on their distance away from the child or young person. For example moving from lying on the bed to sitting on the bed, and then perhaps to standing in the doorway and then standing outside of the room.
Sleeping in bed
It is important that children and young people are encouraged to go to bed when they are drowsy and before they go to sleep. Try not to let them fall asleep on the sofa and then carry them upstairs to bed. Their bed needs to be understood as a safe place, where we go to sleep.
Avoid naps
Naps are good for preschool children but they could be interfering with sleep for older children, try to reduce or avoid these during the day.
Exercise
Having some exercise during the day, especially outdoor activities, can make it easier for children and young people to fall asleep and children who exercise tend to have deeper sleep. However, try to avoid exercise too close to bedtime as it could make sleep more difficult.
Relaxation
This of activities of that you can do together that will be relaxing and that will encourage self-soothing and relaxation. Relaxation activities could be:
- A warm bath
- A gentle foot, hand or scalp massage
- Quiet calm music
*As a parent or carer of a neurodivergent child or young person who is not sleeping, it is highly likely that you are also not sleeping.
When you make any plans, try to realistic with what you know you can achieve, even when you are exhausted, as consistency will be the key to success.
Lack of sleep can have a negative impact on your mental and physical health so also think about ways you can look after yourself and be kind to yourself. *