THE month of April is observed as “Autism Awareness Month.” In fact, the second of April is celebrated as Autism Awareness Day worldwide.
Now, a more scientific name for autism is, “autism spectrum disorder” (ASD). By spectrum I mean a range of disorders or disabilities.
Now, what is autism? Autism is a disability that significantly affects social interaction, verbal and nonverbal communication, and educational performance.
Indeed, what are the behaviours associated with persons with ADS? There is a wide range of behaviours which space does not allow me to identify or list. However, I will identify or list here a few of the disorders.
An individual with autism spectrum disorder: (a) is overly dependent or clings to individuals (parents, siblings, teacher); (b) tends to stay by himself or herself; prefers to be alone; (c) has difficulty eating (eats too fast or too slowly); (d) has difficulty sleeping (sleepwalks, frequent nightmares, over or under sleeps, given the age and stage of development); (e) refuses to attend school or complete tasks due to fear, feeling of rejection, isolation or bullying; (f) cries, laughs or cries very easily; (g) maintains limited eye contact or avoids eye contact; (h) avoids social interaction; (i) acts without thinking or impulsive; (j) intentionally
disobeys those in authority; (k) exhibits an uncontrolled outburst or anger; (l) sucks thumb or fingers; (m) sucks thumb or fingers or bites nails; (n) has difficulty paying attention.
Now caring for children with autism spectrum disorder is no easy matter. The following are four areas for investigation:
Sleep Problems. Sleep problems are common in children with and without autism spectrum disorder. However, one third to one half of children with ASD have sleep problems. This could lead to daytime problems such as paying attention, being irritable, and displaying more repetitive behaviours. The amount of nighttime sleep needed by preschool children is about 10 to13 hours. By age 13 years, that number decreases to 8 to 11 hours.
Indeed, the following are some reasons for sleep problems. (a) Children with ASD may have many reasons for having sleep problems. The causes may be medical, behavioural, or both. Medical problems may include allergies, breathing problems, and stomach discomfort. Medications can also affect sleep.
Now sleep normally has cycles with different brain wave patterns. These patterns may be different in some people with autism. Typical sleep patterns include lighter sleep and dreaming later in the night. This is when night walking often happens. The hormone melatonin is made by the brain to control sleep. Some scientific studies have shown that people with ASD may not have the same amount or action of this hormone.
Indeed, what are some sleep problems experienced by children with ASD? Some sleep problems include:
(a) Trouble falling asleep. Children may have a hard time falling asleep if there is a lot of activity in the household, if they eat foods with caffeine, or if they are hyperactive. It may be that they do not connect bedtime with falling asleep or that they want to be with the family;
(b) Night walking. Children who wake up in the middle of the night may stay awake if they do not know how to fall back to sleep alone or they don’t understand that nighttime is for sleeping. They may stay awake because they are used to getting food, attention, or other reinforcement when they wake up. By reinforcement I mean giving the children food, chocolate and watching television, to name a few. Some children wake up when they poop or pee.
(c) Early waking. Children may wake up early because of abnormal sleep cycle or melatonin production or because of problems falling back to sleep when they wake up. They may also wake up early because their sleep needs have been met.
(d) Nightmares, sleep terrors, sleepwalking. These occur in the first few hours of the sleep cycle in children with or without ASD and are related to brain activity during sleep.
Now what can we do to help our children with ASD sleep better?
Firstly, set a regular time for going to bed and getting out of bed for the day. Start a relaxing routine leading up to bedtime. Try to do this the same way each time. It should be quiet and dark, without TV or music on. The rest of the household should be quiet at bedtime. Make sure that your child knows that the bed and bedtime are for sleep only, not for play or time-out. This sleep hygiene step sometimes works all by itself to help sleep problems, but other steps may be needed.
Secondly, if sleep problems continue after setting up a good sleeping area and routine for your child, you may want to add the step of ignoring sleep protests. When leaving your child in the bedroom, say “good night” and praise your child for going to bed. Then check in at times you have decided on and ignore protests between checks. Increase the time between checks during the night and over the next several days. When checking, briefly look in the bedroom. If your child is awake, tell him or her to go to sleep, and then leave the bedroom
It is important that all care givers are consistent in this step. Protests may get worse for 2 to 3 days, but you must do this in the same way for 2 weeks. Families may need ongoing support to carry this out, especially if parents and other care givers disagree with ignoring protests.
Finally: Medication. Your child’s doctor may suggest prescription or other over-the-counter medications to be used along with behavioural training.
In closing, let me take the opportunity to call out Rashaad Taylor, whom I met at a Special Needs School, at Bon Terre, Gros Islet, almost three decades ago, and whom I continue to follow.
Let me also congratulate his parents for wonderful support given to Rashaad throughout his lifetime. Good job parents. The last time I spoke to his mom she told me he now has a job. Bravo, the Taylor parents.
To be continued.