Understanding Sleep Challenges in Children with ASD

Dr. Albert Martin Li explains solutions for sleep problems for children on the autism spectrum.

Sleep Q&A

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Dr. Albert Martin Li is a Professor of Pediatrics and the Chairman of the Department of Pediatrics at the Chinese University of Hong Kong. His clinical and research interests lie in respiratory and sleep medicine. Before assuming his academic role in Hong Kong, he completed postgraduate training at King’s College Hospital, Great Ormond Street Hospital, and the Royal Brompton Hospital in the United Kingdom.

What are common sleep issues experienced by children with ASD?

Prolonged sleep latency is often a condition experienced by children on the spectrum. This refers to taking more than 30 minutes to fall asleep, along with frequent nighttime awakenings and shorter sleep duration compared to typical peers.

How can sleep problems in children with ASD impact their daytime behavior and overall health?

Poor sleep quality and quantity can lead to poor attention and memory, as well as more behavioral issues and temper tantrums in children on the spectrum. Additionally, the sleep patterns and daytime functions of parents and siblings will also be affected.

How can I tell if my child is experiencing poor-quality sleep?

The amount of sleep a child needs varies by age. For preschool-aged children (3-5 years), it typically ranges from 10-11 hours per day. If your child is not achieving this due to poor sleep quality or insufficient sleep duration, they may experience the issues mentioned previously, such as poor attention, memory problems, and increased behavioral issues such as worsening of the core ASD symptoms.

To determine the specific amount of sleep your child needs, allow them to wake up naturally and observe if they are alert and happy in the morning. Then, calculate the total hours they slept; this will give you an estimate of their ideal sleep duration.

What are some potential causes of sleep disturbances in children with ASD?

The causes are likely multi-factorial, involving environmental factors, the child's rigidity, unclear transitions, parental behavior, and biological influences. Some studies have documented melatonin deficit or dysfunction in children on the spectrum.

Can you recommend specific bedtime routines that might help children with ASD settle down for sleep?

An effective bedtime routine needs to be individualized, but common practices include hot or warm baths and listening to soothing music or storybooks. The main goal is to engage in quiet, soothing activities for 30-45 minutes before bedtime.

Warm baths followed by story time can create a soothing bedtime routine that helps children unwind and sleep better.

What role do diet and nutrition play in sleep quality for children with ASD?

Being too full or too hungry before bedtime is not ideal. It is advisable to avoid stimulants such as caffeine and spicy foods before sleep. 

Additionally, children on the spectrum or those with ADHD should avoid artificial colorings and foods high in sugar content.

At what point should parents look into medications in managing their child’s sleep problems?

I usually recommend behavioral approaches as the first step, emphasizing the need for consistency and persistence. If behavioral interventions do not yield results after 3-4 months, then considering medication, starting with melatonin, is advisable.

What sort of doctor should I bring my child to for sleep issues? What tests will be performed to assess their condition?

A pediatrician with a clinical interest in sleep medicine may be able to help if your child snores and there is concern about possible obstructive sleep apnea. In such cases, an overnight sleep study (polysomnography) may be indicated.