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Showing posts sorted by relevance for query sleep problems. Sort by date Show all posts

What are some other conditions that Aspergers children may have?

Most Aspergers (high functioning autistic) children and teens have at least one comorbid (i.e., co-existing) condition in addition to their autism diagnosis as listed below:

1. Co-occurring mental disorders— Kids with Aspergers can develop mental disorders (e.g., anxiety disorders, attention deficit hyperactivity disorder (ADHD), depression, etc.). Research shows that children and teens with Aspergers are at higher risk for some mental disorders than those without Aspergers. Managing these co-occurring conditions with medications or behavioral therapy, which teaches kids how to control their behavior, can reduce symptoms that appear to worsen a youngster's Aspergers symptoms. Controlling these conditions will allow kids with Aspergers to focus more on managing their disorder.

2. Fragile X syndrome— Fragile X syndrome is a genetic disorder and is the most common form of inherited intellectual disability, causing symptoms similar to Aspergers. The name refers to one part of the X chromosome that has a defective piece that appears pinched and fragile when viewed with a microscope. Fragile X syndrome results from a change, called a mutation, on a single gene. This mutation, in effect, turns off the gene. Some children may have only a small mutation and not show any symptoms, while others have a larger mutation and more severe symptoms. Around 1 in 3 kids who have Fragile X syndrome also meet the diagnostic criteria for Aspergers, and about 1 in 25 kids diagnosed with Aspergers have the mutation that causes Fragile X syndrome. Because this disorder is inherited, kids with Aspergers should be checked for Fragile X, especially if the moms and dads want to have more kids. Other family members who are planning to have kids may also want to be checked for Fragile X syndrome.


3. Gastrointestinal problems— Some moms and dads of Aspergers kids report that their youngster has frequent gastrointestinal (GI) or digestion problems (e.g., stomach pain, diarrhea, constipation, acid reflux, vomiting, bloating, etc.). Food allergies may also cause problems for kids with Aspergers. It's unclear whether these kids are more likely to have GI problems than neurotypical kids. If your youngster has GI problems, a doctor who specializes in GI problems, called a gastroenterologist, can help find the cause and suggest appropriate treatment. Some studies have reported that kids with Aspergers seem to have more GI symptoms, but these findings may not apply to all Aspergers kids. For example, a recent study found that kids with Aspergers in Minnesota were more likely to have physical and behavioral difficulties related to diet (e.g., lactose intolerance or insisting on certain foods), as well as constipation, than kids without Aspergers. The researchers suggested that kids with Aspergers may not have underlying GI problems, but that their behavior may create GI symptoms (e.g., a youngster who insists on eating only certain foods may not get enough fiber or fluids in his or her diet, which leads to constipation). Some moms and dads may try to put their youngster on a special diet to try to control Aspergers or GI symptoms. While some kids may benefit from limiting certain foods, there is no strong evidence that these special diets reduce Aspergers symptoms. If you want to try a special diet, first talk with a doctor or a nutrition expert to make sure your youngster's nutritional needs are being met.

4. Intellectual disability— Many kids with Aspergers have some degree of intellectual disability. When tested, some areas of ability may be normal, while others—especially cognitive (thinking) and language abilities—may be relatively weak. For example, a youngster with Aspergers may do well on tasks related to sight (e.g., putting a puzzle together) but may not do as well on language-based problem-solving tasks. Kids with Aspergers often have average or above-average language skills and do not show delays in cognitive ability or speech.

5. Seizures— One in four kids with Aspergers has seizures, often starting either in early childhood or during the teen years. Seizures, caused by abnormal electrical activity in the brain, can result in: (a) staring spells, (b) convulsions (i.e., uncontrollable shaking of the whole body) or unusual movements, and (c) a short-term loss of consciousness or a blackout. Sometimes lack of sleep or a high fever can trigger a seizure. An electroencephalogram (EEG), a nonsurgical test that records electrical activity in the brain, can help confirm whether a youngster is having seizures. However, some kids with Aspergers have abnormal EEGs even if they are not having seizures. Seizures can be treated with medicines called anticonvulsants. Some seizure medicines affect behavior; changes in behavior should be closely watched in kids with Aspergers. In most cases, a doctor will use the lowest dose of medicine that works for the youngster. Anticonvulsants usually reduce the number of seizures but may not prevent all of them.

6. Sensory problems— Many kids with an autism spectrum disorder either over-react or under-react to certain sights, sounds, smells, textures, and tastes. For example, some may: (a) have no reaction to intense cold or pain, (b) experience pain from certain sounds – and sometimes cover their ears and scream (e.g., vacuum cleaner, a ringing telephone, a sudden storm, etc.), and (c) dislike or show discomfort from a light touch or the feel of clothes on their skin. Researchers are trying to determine if these unusual reactions are related to differences in integrating multiple types of information from the senses.

7. Sleep problems— Kids with Aspergers tend to have problems falling asleep or staying asleep, or have other sleep problems. These problems make it harder for them to pay attention, reduce their ability to function, and lead to poor behavior. In addition, moms and dads of Aspergers kids with sleep problems tend to report greater family stress and poorer overall health among themselves. Fortunately, sleep problems can often be treated with changes in behavior (e.g., following a sleep schedule, creating a bedtime routine, etc.). Some kids may sleep better using medications such as melatonin, which is a hormone that helps regulate the body's sleep-wake cycle. Like any medication, melatonin can have unwanted side effects. Talk to your youngster's doctor about possible risks and benefits before giving your youngster melatonin. Treating sleep problems in kids with Aspergers may improve the youngster's overall behavior and functioning, as well as relieve family stress.

8. Tuberous sclerosis— Tuberous sclerosis is a rare genetic disorder that causes noncancerous tumors to grow in the brain and other vital organs. Tuberous sclerosis occurs in 1 to 4 percent of children with Aspergers. A genetic mutation causes the disorder, which has also been linked to mental retardation, epilepsy, and many other physical and mental health problems. There is no cure for tuberous sclerosis, but many symptoms can be treated.

More resources for parents of children and teens with High-Functioning Autism and Asperger's:

==> How To Prevent Meltdowns and Tantrums In Children With High-Functioning Autism and Asperger's

==> Parenting System that Significantly Reduces Defiant Behavior in Teens with Aspergers and High-Functioning Autism

==> Launching Adult Children with Asperger's and High-Functioning Autism: Guide for Parents Who Want to Promote Self-Reliance

==> Teaching Social Skills and Emotion Management to Children and Teens with Asperger's and High-Functioning Autism

==> Parenting Children and Teens with High-Functioning Autism: Comprehensive Handbook

==> Unraveling The Mystery Behind Asperger's and High-Functioning Autism: Audio Book

==> Highly Effective Research-Based Parenting Strategies for Children with Asperger's and High-Functioning Autism

Aspergers & Associated Conditions

“Our son is diagnosed with AS. He has stomach problems, difficulty sleeping, and can’t stand loud noises of any kind. Is this part of AS, or are these totally separate issues?”

It’s very likely that these issues are part of the Aspergers (AS) condition. There are a number of concerns that often accompany a child with Aspergers and High-Functioning Autism. Here are the primary ones:

1. Fragile X syndrome is a genetic disorder and is the most common form of inherited intellectual disability, causing symptoms similar to Aspergers. The name refers to one part of the X chromosome that has a defective piece that appears pinched and fragile when viewed with a microscope. Fragile X syndrome results from a change, called a mutation, on a single gene. This mutation, in effect, turns off the gene. Some people may have only a small mutation and not show any symptoms, while others have a larger mutation and more severe symptoms. Around 1 in 3 kids who have Fragile X syndrome also meet the diagnostic criteria for Aspergers, and about 1 in 25 kids diagnosed with Aspergers have the mutation that causes Fragile X syndrome. Because this disorder is inherited, kids with Aspergers should be checked for Fragile X, especially if the mom or dad wants to have more kids. Other family members who are planning to have kids may also want to be checked for Fragile X syndrome.



2. Some moms and dads of kids with Aspergers report that their youngster has frequent gastrointestinal (GI) or digestion problems (e.g., stomach pain, diarrhea, constipation, acid reflux, vomiting, bloating, etc.). Food allergies may also cause problems for kids with Aspergers. It's unclear whether kids with Aspergers are more likely to have GI problems than typically developing kids. If your youngster has GI problems, a doctor who specializes in GI problems, called a gastroenterologist, can help find the cause and suggest appropriate treatment. Some studies have reported that kids with Aspergers seem to have more GI symptoms, but these findings may not apply to all kids with Aspergers. For example, a recent study found that kids with Aspergers in Minnesota were more likely to have physical and behavioral difficulties related to diet (e.g., lactose intolerance or insisting on certain foods), as well as constipation, than kids without Aspergers. The researchers suggested that kids with Aspergers may not have underlying GI problems, but that their behavior may create GI symptoms (e.g., a youngster who insists on eating only certain foods may not get enough fiber or fluids in his or her diet, which leads to constipation). Some moms and dads may try to put their youngster on a special diet to control Aspergers or GI symptoms. While some kids may benefit from limiting certain foods, there is no strong evidence that these special diets reduce Aspergers symptoms. If you want to try a special diet, first talk with a doctor or a nutrition expert to make sure your youngster's nutritional needs are being met.

3. Some kids with Aspergers have some degree of intellectual disability. When tested, some areas of ability may be normal, while others—especially cognitive (thinking) and language abilities—may be relatively weak (e.g., a youngster with Aspergers may do well on tasks related to sight such as putting a puzzle together, but may not do as well on language-based problem-solving tasks). However, most kids with Aspergers often have average or above-average language skills and do not show delays in cognitive ability or speech.

4. One in four kids with Aspergers has seizures, often starting either in early childhood or during the teen years. Seizures, caused by abnormal electrical activity in the brain, can result in: (a) staring spells; (b) convulsions, which are uncontrollable shaking of the whole body, or unusual movements; (c) a short-term loss of consciousness, or a blackout. Sometimes lack of sleep or a high fever can trigger a seizure. An electroencephalogram (EEG), a nonsurgical test that records electrical activity in the brain, can help confirm whether a youngster is having seizures. However, some kids with Aspergers have abnormal EEGs even if they are not having seizures. Seizures can be treated with medicines called anticonvulsants. Some seizure medicines affect behavior; changes in behavior should be closely watched in kids with Aspergers. In most cases, a doctor will use the lowest dose of medicine that works for the youngster. Anticonvulsants usually reduce the number of seizures but may not prevent all of them.

5. Many kids with Aspergers either over-react or under-react to certain sights, sounds, smells, textures, and tastes. For example, some may: (a) have no reaction to intense cold or pain; (b) experience pain from certain sounds (e.g., a vacuum cleaner, ringing telephone, sudden storm, etc.) and cover their ears and scream; (c) dislike or show discomfort from a light touch or the feel of clothes on their skin. Researchers are trying to determine if these unusual reactions are related to differences in integrating multiple types of information from the senses.

6. Kids with Aspergers tend to have problems falling asleep or staying asleep, or have other sleep problems. These problems make it harder for them to pay attention, reduce their ability to function, and lead to poor behavior. In addition, moms and dads of kids with Aspergers and sleep problems tend to report greater family stress and poorer overall health among themselves. Fortunately, sleep problems can often be treated with changes in behavior (e.g., following a sleep schedule or creating a bedtime routine). Some kids may sleep better using medications such as melatonin, which is a hormone that helps regulate the body's sleep-wake cycle. Like any medication, melatonin can have unwanted side effects. Talk to your youngster's doctor about possible risks and benefits before giving your youngster melatonin. Treating sleep problems in kids with Aspergers may improve the youngster's overall behavior and functioning, as well as relieve family stress.

7. Tuberous sclerosis is a rare genetic disorder that causes noncancerous tumors to grow in the brain and other vital organs. Tuberous sclerosis occurs in 1 to 4 percent of people with Aspergers. A genetic mutation causes the disorder, which has also been linked to mental retardation, epilepsy, and many other physical and mental health problems. There is no cure for tuberous sclerosis, but many symptoms can be treated.

8. The particularly high comorbidity with anxiety often requires special attention. One study reported that about 84 percent of Aspergers kids also met the criteria to be diagnosed with an anxiety disorder. Because of the social differences experienced by those with Aspergers (e.g., trouble initiating or maintaining a conversation, adherence to strict rituals or schedules), additional stress to any of these activities may result in feelings of anxiety, which can negatively affect multiple areas of one’s life, including school, family, and work.

Children with Aspergers may also be diagnosed with:
  • ADHD
  • Bipolar disorder
  • Obsessive compulsive disorder
  • Tourette syndrome
  • Clinical depression
  • Visual problems

More resources for parents of children and teens with High-Functioning Autism and Asperger's:

==> How To Prevent Meltdowns and Tantrums In Children With High-Functioning Autism and Asperger's

==> Parenting System that Significantly Reduces Defiant Behavior in Teens with Aspergers and High-Functioning Autism

==> Launching Adult Children with Asperger's and High-Functioning Autism: Guide for Parents Who Want to Promote Self-Reliance

==> Teaching Social Skills and Emotion Management to Children and Teens with Asperger's and High-Functioning Autism

==> Parenting Children and Teens with High-Functioning Autism: Comprehensive Handbook

==> Unraveling The Mystery Behind Asperger's and High-Functioning Autism: Audio Book

==> Highly Effective Research-Based Parenting Strategies for Children with Asperger's and High-Functioning Autism

==> Parenting System that Reduces Problematic Behavior in Children with Asperger's and High-Functioning Autism

Frequent "Night Wakings" and Moodiness in Children on the Autism Spectrum

“My son wakes in a terrible, nasty mood. He goes to bed happy, laughing and loving. Nothing that I do can deter him from ruining his day and the day of those around him. I have tried everything to help him turn the day around - from being extra cheerful, music, ignoring, consequences, taking away privileges, talking about it, timeouts, etc... Although I do everything that I can to make sure that he gets adequate sleep (9pm-7am) he has been diagnosed with frequent night wakings. The doctors will not do anything about it. He was diagnosed with ADHD, age 5. However, I realized at age 7 that it was something much more complex than that. Finally, this past winter, he was diagnosed with mild-to-moderate ASD. We have provided countless hours of traditional and non-traditional therapy yet he still struggles a good portion of the time. His father passed away January '14 so that does not help matters -- and he has entered precocious puberty (being treated). Would you please be willing to give me suggestions to help get him off that path as quickly as possible so that everyone can go on about their day?”

__________

I think the harder you try to fix this, the worse you may be making it. Sometimes you just have to let a child be angry and upset. Kids need to vent, too.

Let's try this: Stop trying to change it. I'm sure your efforts to "cheer him up" annoy him even further. Give him permission to be moody. You can even say something like this first thing in the morning: "Good morning, this is the time you have a mood, so go ahead and get started." [reverse psychology]

But first, tell him tonight, while he is in a good mood, that you are giving him permission to have a mood in the morning. Then remind him in the morning using the line I just mentioned. In addition, while he is disgruntled in the morning, you can say things like, "I know honey – it's hard to get up and get going in the morning, isn't it?" In this way, you aren't punishing, ignoring or cajoling -- rather you are validating his feelings. Try it!

==> How to Prevent Meltdowns and Tantrums in Asperger's and High-Functioning Autistic Children


Having said that, here are some common reasons for “night wakings” and tips for dealing with them:

1. Children may be awakened during the night due to an urge to urinate, thus your son should avoid drinking fluids before bedtime. Some kids may have urinary tract problems that awaken them even when their bladders aren’t full. If your son has frequent night wakings, try to find out if bathroom trips are contributing to the problem.

2. Children who suffer from heartburn may experience frequent night wakings. Heartburn is associated with sleep-disordered breathing, and can be dangerous in some cases. If you think your son may suffer from heartburn, consult your doctor for treatment options. Meanwhile, avoid acidic and hard-to-digest foods before bedtime.

3. Children who suffer from headaches are more likely to suffer from frequent night wakings. It’s not clear if headaches cause sleep problems, or sleep problems are causing the headaches. Either way, it’s a good idea to have your youngster’s headaches checked by a doctor.




4. Night terrors are distressing, disruptive, and cause night wakings. But night terrors differ from nightmares. A youngster may move (even sleep walk) during a night terror, which puts him at risk of hurting himself. Have you ever noticed your son sleep walking?

5. Nightmares are associated with REM sleep, and they are more likely to occur after a youngster has been sleeping for several hours. When a youngster wakes up immediately after a nightmare, he is likely to remember it. Triggers for nightmares include anxiety and medications that interfere with REM sleep. Children who awaken from nightmares need to be reassured that their dreams are not real. Also, check to see if any of your son’s medications are contributing to sleep problems.

6. Worried, frightened children have more sleep problems. Research suggests that ignoring a youngster’s fears may lead to nightmares and emotional problems. Thus, it’s important to take an active role in teaching your son to overcome his fears.

7. When children are overtired, their sleep may become more restless – and they suffer more frequent night wakings. If your son is overtired, he needs more sleep. An earlier bedtime may help.

8. Children often learn to associate falling asleep with certain forms of comforting stimulation (e.g., parental soothing, a particular sleep environment, etc.). These sleep aids may be very effective, but if your child becomes dependent on them, he fails to learn how to fall asleep on his own. Thus, if your son is used to falling asleep in your presence, but wakes up alone, he may not be able to settle himself back to sleep. If you want your son to develop self-soothing skills, you may want to consider sleep training.

==> How to Prevent Meltdowns and Tantrums in Asperger's and High-Functioning Autistic Children

9. “Sleep disordered breathing” includes interrupted breathing (i.e., sleep apnea), loud breathing, snoring, and troubled breathing during sleep. Sleep disordered breathing can restrict the oxygen supply to a youngster’s brain and cause serious health problems. It is also associated with attention problems, daytime sleepiness, frequent night wakings, hyperactivity, nighttime crying, and poor sleep quality. If you suspect your son suffers from sleep-disordered breathing, consult your doctor.

10. Kids who have experienced traumatic events are likely to suffer from night wakings and other sleep disturbances (and you did say his father passed away recently --- BIG FACTOR THERE!). Even everyday stressors disturb sleep. Children experiencing family stress suffer more night wakings and get less sleep overall. These sleep problems are associated with elevated stress hormone levels. Check to see if your son is experiencing an inordinate amount of stress for some (perhaps hidden) reason. Grief counseling may be in order as well.

Morning moodiness is associated with the "sleep inertia" phase, which is a transitional period of fatigue that usually lasts between 5 and 20 minutes after a child first wakes, though it can go on for a longer time in some cases. The process of waking up is slow – it’s not like a light switch. Feeling excessively grouchy in the morning is not enjoyable, but does not necessarily indicate having had a poor night of sleep.

Why some kids are able to cheerfully connect their sleep inertia phase with the rest of their day is much more specific and individualized. Moodiness might be associated with not getting enough rest and being tired, but it might also be symptomatic of having a bad attitude about the day. For some children though, chronic morning moodiness is simply a symptom of an over-scheduled life, with too little sleep, and not enough things that bring them joy on a day-to-day basis.

==> How to Prevent Meltdowns and Tantrums in Asperger's and High-Functioning Autistic Children

Help for Sleep Problems in Children on the Autism Spectrum

"I need suggestions on how to help my child fall asleep and stay asleep! It takes him a long time to settle down, and even when he finally gets to sleep, it's not long before he wakes up and we start the whole process all over again."

Studies find that approximately 73% of young people on the autism spectrum experience sleep problems, and these problems tend to last longer in this group than they do for kids without the disorder. For example, kids on the spectrum are more likely to be sluggish and disoriented after waking.

Laboratory research has begun to describe the unique physiological presentation associated with sleep problems in these children, including disruptions in the sleep stage most associated with cognitive functioning (i.e. REM or Rapid Eye Movement sleep). In addition to physiological differences, some of the sleep difficulties in this population may be related to anxiety.

The impact of poor sleep is unequivocal. Poor sleep negatively impacts mood and exacerbates selective attention problems commonly found in kids with Aspergers and High-Functioning Autism, as well as impairing other aspects of cognitive function.

There is no one panacea to manage sleep problems for these children. However, there are many interventions that are likely to be helpful. In general, moms and dads need to understand and be prepared for resistance to change that these “special needs” kids often show. Parents should also be prepared for problems to get worse before they get better as kids often initially challenge - but then gradually become accustomed to - new routines.

A good place to start an intervention targeted at improving sleep is changing lifestyle behaviors and environmental conditions that can influence sleep/wake patterns. These include exercise, napping, diet, and aspects of the bedroom and sleep routine.

Many children with Aspergers and High-Functioning Autism (HFA) have problems sleeping through the night or getting to sleep due in large part to sensory issues. Sensory dysfunction is typically an issue for kids on the autism spectrum. Many moms and dads are forced to try medications, or natural supplements (e.g., melatonin) to try to regulate sleep patterns. These may be beneficial.

Using sensory integration therapy can also be helpful so that the youngster can learn to regulate his or her activity level. The idea behind sensory integration therapy is that it is possible to "rewire" the brain of the child with sensory processing difficulties. Practitioners of sensory integration therapy are usually occupational therapists. Their focus is on the following systems:
  • proprioceptive (i.e., helping the child work on his ability to manage his body more appropriately; for example, to run and jump when it's time to run and jump, to sit and focus when it's time to sit and focus, etc.)
  • tactile (i.e., normalizing the child’s reactions to touch)
  • vestibular (i.e., helping the child to become better aware of his body in space)

A trained sensory integration therapist evaluates the child for sensory defensiveness, hypersensitivity, and sensory cravings, using several different scoring techniques. Some of the standard tests include:
  • The PEERAMID for ages 6-14 years
  • The Bruininks Osteretsky Test of Motor Proficiency for ages 5-15 years
  • Sensory Integration and Praxis Tests (SIPT) for kids between the ages of 4 to 8 years, 11 months
  • The Test of Sensory Integration for kids between the ages 3 to 5 years (TSI)

Depending upon the needs of your youngster, the therapist may use various techniques such as:
  • brushing and joint compression
  • deep pressure therapy, which may include squeezing, rolling, etc.
  • gross motor play such as wall climbing, balance beam, etc.
  • jumping on a mini or full-sized trampoline 
  • playing with a toy that vibrates, is squeezable, etc. 
  • swinging

Sensory integration therapists also may develop a sensory "diet," which may include a variety motor activities (e.g., spinning, bouncing, swinging, squeezing balls or silly putty, etc.), as well as therapist-provided interventions such as brushing and compressing arms and legs. The idea is that this "diet" will be provided throughout the day, whether by trained therapists, by the child’s teacher, or by the child’s parent. 

* Additional information on this topic can be found here:  Settling and Waking Problems




More resources for parents of children and teens with High-Functioning Autism and Asperger's:

==> How To Prevent Meltdowns and Tantrums In Children With High-Functioning Autism and Asperger's

==> Parenting System that Significantly Reduces Defiant Behavior in Teens with Aspergers and High-Functioning Autism

==> Launching Adult Children with Asperger's and High-Functioning Autism: Guide for Parents Who Want to Promote Self-Reliance

==> Teaching Social Skills and Emotion Management to Children and Teens with Asperger's and High-Functioning Autism

==> Parenting Children and Teens with High-Functioning Autism: Comprehensive Handbook

==> Unraveling The Mystery Behind Asperger's and High-Functioning Autism: Audio Book


==> Parenting System that Reduces Problematic Behavior in Children with Asperger's and High-Functioning Autism


Here's what other parents have had to say:

•    Anonymous said... A friend of mine uses melatonin, for her son and has done for few years now. They use a low dose and only on school nights, never in holidays or fri or sat night. tThis is a godsend for them as he was only sleeping a couple of hours a night.

•    Anonymous said... A good routine, dont rush them and my best friend Melatonin. Its been shown that asd kids produce much less melatonin than their peers. Hideously expensive here in the uk and hard to get in the uk prescription only £200+ for a months supply but over the counter in the usa for $15 three months worth. Go figure.

•    Anonymous said... Chamomile tea, warm bath, aromatherapy, benadryl......any combination of the above.

•    Anonymous said... I have a routine. Often I will lie down with her for1-5 mins which we agree on beforehand and we have a music box which seems to soothe her. Took a long time to get this routine. Initially I was just glad to get her out of my bed now its much easier

•    Anonymous said... melatonin has been a life-saver for us! Talk with your dr. but there's usually no issues whatsoever. My aspie/severe SPD kiddo was the same way...up and down all night long. We started him on 3 mgs and that would help him drift off but he kept waking all night still. So we upped to dose to 6 mgs and that has worked awesome! Finally we can ALL get some rest!!

•    Anonymous said... Melatonin no side effects, safe. We noticed a huge difference in daytime behavior right away as well, a good nights rest is amazing.

•    Anonymous said... My aspie takes medications. He struggled with sleeping for awhile, but now with meds he sleeps better and is less irritable.

•    Anonymous said... My son will sit in the bathroom until he is calmed down enough to go to sleep. Sometimes it's an hour.

•    Anonymous said... Not enough light, too much light? Room to noisy, room too quiet? Hot and sweaty then gets cold when asleep? Needs something over his head Scared of spiders / monsters / shadows Lots and lots of things you can try, keep melatonin as a last resort

•    Anonymous said... our 5 yr old has same problem. In the beginning, we avoided medication. We tried aromatherapy, soothing bath + massage, classical music, etc., but nothing worked. He would sleep for 45 min., then jump to his feet in bed while screaming scared out of his mind. This would happen 2-3 times every night. After 1 yr. of minimal sleep, we had our son's Pediatric Behavioral Specialist prescribe him medication to aide in his sleep & help w/anxiety. He put him on Guanfacine 1/2 tablet at night. It also helps calm him due to severe anxiety. He's been on it for 2 yrs & it has done wonders for him. He's never had any side-effects from this medicine. Good luck in finding the best method for your child. I'll be praying for your son & your family!

•    Anonymous said... Physical activity helps, particularly yoga and gardening. As a last resort use melatonin and of course cannabidiol.

•    Anonymous said... Routine . Routine . Routine . Then he will still wake up tho about every few hours . My son is 13 . At age four we started clondine . Till he was about 7 then seroquel for a year . Off and on meletonin . It's not good for all night staying asleep . We tried trazadone also . Actually to get him to naturally stay asleep will take him getting older . My son at 13 can and will go to bed, early actually, and stay asleep with usually nothing . Ambilify in morning now and orap at night . But because he active and older its much much better . No problems with sleep at this time ! Good luck , just be patient and get help so YOU can get rest ! I'm catching up on mine during these "slow" years lol things have leveled out for now , as much as they can anyways . Never a dull moment that's for sure !

•    Anonymous said... We have used clonidine for the last 4 years. It has made a world of difference in our family. We have not noticed any negative side effects.

•    Anonymous said... We start our bedtime ritual an hour early. It includes bathroom, changing clothes, brushing teeth, etc. in the same sequence every night (the process is prompted by "ten minutes to bedtime.....5 minutes to bedtime....."). All of this is navigated/ motivated by reward. For us it is a book of his choosing and prayers from mom and dad. If he chooses to be uncooperative or takes too long playing in the bathroom sink, he is reminded he may be losing his book time. Also, we have always told him that he didn't have to go right to sleep if he is not tired, but he did have to stay in his bed and rest. He always goes to sleep within a reasonable time.

•    Anonymous said... We use a kids hypnosis cd on repeat and Relax & Sleep aid from the dollar tree. It has Melatonin in it. But I heard bad things about melatonin in larger quantities. Always research meds even the herbal ones

•    Anonymous said... Our doctor put our son on trazidone. He would fall asleep but not stay that way. I would find him up playing on his tablet or sleep walking. The meds help him stay asleep and we see such a HUGE difference in his behavior after a good sleep

•    Anonymous said... We used melatonin for almost a year but he started waking up and it became ineffective. So we brain stormed, as usual, and now we do our best to get some of his energy out. We do stretches. We put him in a long shower or bath depending on how he is feeling. I rub lavender baby oil on his legs and feet and neck. It has seemed to be more effective.

•    Anonymous said... We used to have the same issue. Still do from time to time but it's rare now. Our Dr.told.US to try melatonin . It's natural over over the counter. Found with vitamins and supplements. It helped.a lot!
 
*    The trick is finding the routine that works. We went through a lot of trial and error. After several years of melatonin, she was able to power through it and it no longer worked. We struggled for a while and then found that a sound machine, a diffuser with calming essential oil, 3mg of melatonin and rolling her tightly in her favorite blanket works. If we miss one of these components - it doesn't work.
 
Please post your comment below… 

Settling and Waking Problems in Children on the Autism Spectrum

"My son has a terrible time getting to sleep, but then in the mornings, I have a terrible time getting him up and out the door for school. Any suggestions?"

Unfortunately, it seems that virtually all kids with Aspergers and High-Functioning Autism (HFA) are likely to suffer from disturbed sleep patterns at some point or another. Sleep problems can be divided into three main categories: (1) settling problems, where the youngster has difficulty going to sleep at the appropriate time, (2) waking problems, where the youngster wakes repeatedly during the night, and (3) arousal problems, where the child has a hard time waking up in the morning due to such a restless night.



Coping with settling/waking/arousal problems will require consistent reassurance on your part -- and a creative approach to your youngster's needs. Here are some tips:

1. Allergy and food sensitivities: Kids on the autism spectrum are perhaps more likely than their peers to be sensitive to foodstuffs (e.g., sugar, caffeine, additives, etc.), which can keep them awake. If your youngster frequently has sweet or caffeine-rich drinks and foodstuffs near bed time, then it is worth checking whether this could be disturbing his sleep.

2. Medication: Medical interventions are typically seen as a last resort in treating sleep disorders in kids because they can be habit-forming and do not treat the root cause of the problem. As a general rule, it is better to minimize the medication your youngster is on, but at certain times it may be desirable to have a mild sedative on hand (e.g., going on vacation). Some moms and dads have also found that using medication in tandem with a behavioral approach can help to restore a good sleep pattern. The combination is crucial, because without the behavioral intervention when the medical treatment ends, the youngster is likely to return to his old sleep patterns.

3. Melatonin: This is a hormone secreted by the pineal gland which has been shown to regulate sleep patterns. In kids with the disorder, their patterns of melatonin secretion may be irregular, so it is not that they don't produce it, but that they don't produce it at the right times of day. Some foods are rich in melatonin (e.g., oats, rice, sweet corn, tomatoes, plums, bananas and Brazil nuts).

4. Natural remedies: Many of the natural remedies available from health food stores are supposed to treat insomnia and other sleep disorders. These may have similar effects to conventional medicines but carry less risk of side-effects than conventional sedatives. You could also try contacting a homoeopath.

5. Removing stimulants from the diet: Changing your youngster's bedtime routine can be stressful, and if they are used to having certain drinks or snacks near bedtime, suddenly switching to something different may be counter-productive. However, you could change to decaffeinated drinks, replace ordinary chocolate with sugar-free chocolate bought in health food stores, use carob powder to replace cocoa and chocolate, switch to sugar-free drinks or replace sugar in drinks with sweetener or fruit sugar, which may help some kids. Alternatively, you could try gently phasing certain foods out over a period of days or weeks so that your youngster is consuming less and less sugar and caffeine overall without having anything suddenly taken away from them.

6. Lack of social sense: Kids with Aspergers and HFA may have difficulty understanding why and when they need to sleep. Problems with social cueing (i.e., learning why and in what order things should happen) are common in these children, and this may mean your youngster doesn’t make the connection between his family going to bed and his own need to sleep.

7. Establishing a routine: Kids on the spectrum respond well to routine and structure because it allows them to feel safe and in control. Whatever routine you try to impose needs to be something you feel comfortable implementing and that your family can agree on. It may take several weeks for it to alter your youngster's sleep patterns. It can help to present this routine visually, using a timetable for example, so your youngster knows exactly what to expect, including getting up in the morning. If the routine needs to be altered, it can then be explained visually. It may be that your youngster's timetable needs to be more detailed so that he is told exactly what to do when going to bed, for example, draw the curtains, get in to bed, turn light off, lie down, pull cover up, etc. It may also be worth setting aside some time to prepare for the next day in the routine. This could include getting the school bag ready or making a list/timetable of things that need to be done the next day.

8. Using relaxation techniques: Kids with Aspergers and HFA may not be able to articulate their need to unwind and relax, and they may feel more anxious and confused around bedtime. Relaxation techniques can be introduced in low-key, non-intrusive ways. Some possible techniques are as follows:
  • Adding a few drops of lavender oil to your youngster's bath or pillow.
  • Giving your youngster a massage. 
  • Introducing an hour's quiet time before the youngster's bedtime. 
  • Providing the youngster with a set time to talk about their day or their worries as part of the evening routine. 
  • Physically exhausting your kids is a good way of ensuring that they sleep! Many kids with Aspergers and HFA enjoy rough and tumble play, and although this may seem to be the opposite of the points made above regarding quiet time, it might be more effective for some kids. 
  • Relaxation aids such as music and yoga can be very useful. 
  • Some moms and dads have reported having lighting (e.g., a lava lamp) in the bedroom can be helpful.

9. Dealing with sensory issues:
  • It’s worth considering if smells in the room, or coming from other parts of the house, may affect children with heightened senses.
  • Some kids are exceptionally sensitive to light, so sleeping when there is even a very dim light on could be very difficult for them. Putting up thick curtains will block out as much light as possible in your youngster's room. 
  • Some moms and dads have found that their kids can be woken by very slight sounds at night. Ear plugs, or music playing on headphones, could be used to block out noise for those kids who are comfortable with wearing these.
  • The layout of the room may need to be adjusted. Although it may be comforting for some kids to have lots of their belongings around them, it may serve to be quite distracting for others. Even the colors of the room or pictures on the wall may be disturbing. 
  • Touch sensitivity is extremely common in Aspergers and HFA. Some kids experience certain types of touch as physical pain. Labels on bed clothes and different materials can also be uncomfortable. Some kids respond well to a weighted blanket, which is made from thick blanket material like a quilt with the pockets filled with beans.

10. Keeping a diary: If you think your youngster may have a sleep disorder and you want to get an idea of the extent of the problem, it is a good idea to keep a sleep diary as the initial step to solving the problem. If you decide to try any routines or behavioral modifications to help your youngster to sleep, then the sleep diary will allow you to see if what you are doing is working consistently, sporadically or not at all.


More resources for parents of children and teens with High-Functioning Autism and Asperger's:

==> How To Prevent Meltdowns and Tantrums In Children With High-Functioning Autism and Asperger's

==> Parenting System that Significantly Reduces Defiant Behavior in Teens with Aspergers and High-Functioning Autism

==> Launching Adult Children with Asperger's and High-Functioning Autism: Guide for Parents Who Want to Promote Self-Reliance

==> Teaching Social Skills and Emotion Management to Children and Teens with Asperger's and High-Functioning Autism

==> Parenting Children and Teens with High-Functioning Autism: Comprehensive Handbook

==> Unraveling The Mystery Behind Asperger's and High-Functioning Autism: Audio Book


==> Parenting System that Reduces Problematic Behavior in Children with Asperger's and High-Functioning Autism

Sleep Problems in Teens on the Autism Spectrum

Question

I'm a single mother and don't know how to deal with my 13 yr old anymore. He doesn't want to go anywhere or do anything which is hard when you have to, and I am now homeschooling him due to trouble going to school. A big problem right now is sleep issues… he is so active at night and tired during the day. At the moment he is not falling asleep till about 1 or 2 am, and I've tried waking him up earlier to reset his body clock but I can't get him out of bed. I don't know how to get him back into a healthy sleep routine.

Answer

Studies find that approximately 73% of kids with ASD level 1 (high-functioning autism) experience sleep problems, and these problems tend to last longer in this group than they do for kids without ASD. For example, kids on the spectrum are more likely to be sluggish and disoriented after waking. Laboratory research has begun to describe the unique physiological presentation associated with sleep problems in kids with ASD, including disruptions in the sleep stage most associated with cognitive functioning (i.e., REM or Rapid Eye Movement sleep). In addition to physiological differences, some of the sleep difficulties in this population may be related to anxiety.

The impact of poor sleep is unequivocal. Poor sleep negatively impacts mood and exacerbates selective attention problems commonly found in kids with ASD, as well as impairing other aspects of cognitive function.
 

There is no one panacea to manage sleep problems in autistic kids. However, there are many interventions that are likely to be helpful. In general, moms and dads need to understand and be prepared for resistance to change that these kids often show. Moms and dads should also be prepared for problems to get worse before they get better as kids often initially challenge but then gradually become accustomed to new routines.

A good place to start an intervention targeted at improving sleep is changing lifestyle behaviors and environmental conditions that can influence sleep/wake patterns. These include exercise, napping, diet, and aspects of the bedroom and sleep routine.

Exercise & Activity—

The goal is decreasing arousal as bedtime approaches. To achieve this it may be useful to have a scheduled period before bedtime (approximately 30-45 minutes) in which the aim is calmness and relaxation. During that period, media such as television, computers, electronic games, and music should be limited as they can stimulate the youngster through activity, sound, and light. 
 
The availability of VCR and DVR technology makes it easier to control when kids can watch particular shows, thereby avoiding conflict over missing favorite programs that are shown in the late evening. The presence of televisions in kid’s bedrooms has been consistently associated with sleep problems and should be avoided at all costs. Likewise, computer access in a youngster’s bedroom is discouraged for sleep as well as for safety reasons.

In general, exercise during the day is associated with better sleep. However, exercise within 2-4 hours of bedtime can lead to difficulties in falling asleep, as it can disrupt the natural cooling process of the body that leads to rest at night. Having the youngster soak their body, particularly their head, in a calm bath that is as warm as can be tolerated 90 minutes before bedtime may be useful too. 
 
When the youngster gets out of the bath, core body temperature will drop rapidly; this is believed to help them to fall asleep faster. Using a waterproof pillow and avoiding the pulsation associated with showers is recommended. The use of progressive muscle relaxation, deep breathing and imagery exercises is the most widely researched treatment for insomnia in kids and may be useful for kids with autism as well.

Napping—

Controlled and limited (e.g., 20-30 minutes) napping is generally positive. However, longer daytime sleeping can be negative in that it makes it more difficult for the youngster to fall asleep at the ideal time in the evening. If the youngster’s sleep problems are associated with falling asleep, which is common for kids on the spectrum, it is advisable to avoid daytime napping.

Diet—

It is recommended that kids with sleep problems avoid all caffeine, alcohol, tobacco, high fat food, and monosodium glutamate (MSG). In contrast, food rich in protein may promote better sleep. Large meals within 2-3 hours of bedtime should also be avoided. A small carbohydrate/protein snack, such as whole wheat bread and low-fat cheese or milk before bedtime can be helpful to minimize nighttime hunger and stimulate the release of neuro-chemicals associated with falling asleep. For kids who often wake during the night to use the bathroom, and then have trouble falling back asleep, limited fluid intake in the 2 hours prior to bedtime is also recommended.

Melatonin is a natural brain hormone associated with sleep onset. There is some evidence that natural production of melatonin may be reduced in these young people on the spectrum. While melatonin supplements may be useful, a common side effect may be increased sluggishness in the morning. As discussed above, this is already a common problem for kids with autism. Use of melatonin and other alternative remedies should be discussed with a physician.
 

The Bedroom—

It is important that the bed and the bedroom are associated with sleep and are not associated with activity. When kids have sleep problems, it is highly recommended that their bed and bedroom activity be limited to sleep only. It is important to make sure that extreme changes in temperature are avoided during the night. 
 
Increasing light is associated with decreases in the release of the neuro-chemical melatonin which triggers sleep onset. Thus, it is important to get the sunlight flowing in the youngster’s room as soon as possible in the morning. Conversely, darkening the room at night is critical. When a youngster’s fear of the dark is an issue, behavioral psychotherapy may be necessary. We also recommend moving the clock so that the youngster is not watching the time while lying in bed.

Sleep Routine—

Setting and maintaining a regular time to sleep and wake may be critical. Moms and dads often make the mistake of allowing their kids to sleep much later on non-school days to “make up” for sleep. While this may be useful to a certain extent, allowing the youngster to sleep late in the day makes it difficult for them to fall asleep at an ideal time later in the evening. It is easier to wake a sleeping youngster then to force an alert youngster to go to sleep. Thus, we recommend that you keep your youngster on a regular schedule on non-school days and avoid drastic changes in the time that the youngster wakes. 
 
Likewise, having your kids go to bed when they are not tired conditions them to be awake in bed. It is recommended that you let your kids stay up until they are tired while maintaining their waking time in the morning. Then once they begin falling asleep within 10 minutes of going to bed, begin to move bed time earlier by 15 minutes at a time.

With carefully monitoring and patience, many moms and dads can make changes in a youngster’s life that promote better sleep. Improved sleep supports better mood, sustained attention and general health. However, for many families professional consultation is often necessary to design or maintain the appropriate intervention. When you need help, speak with other moms and dads of special needs kids about their experiences and ask your primary care doctor for referrals to a sleep expert.
 
More resources for parents of children and teens on the autism spectrum:
 
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COMMENTS:

•    Anonymous said…  She said she was a single mom I assume she has to work to provide... so she may not be able to adjust her schedule... I am single mom of HFA 11yr old with simular issues... and I am debating homeschooling but I am only one person !!!!
•    Anonymous said… Exactly my thought. We have a 6pm rule. No electronics after that time. Increased his exercise, and it works for us. No drugs needed. X
•    Anonymous said… Exercise, no electronics on in the house after 6 (a bored brain is a tired one), wake up same time every time with daylight, and same basic diet. We do a fruit/veg/chia smoothie to start the day. My son loves to seek electronics at night (all electronics blocked during certain hrs and collect xbox and remotes every night)
•    Anonymous said… Go to your GP and try him on Melatonin, a natural hormone that helps us to sleep. We produce it in our bodies but some have less than others hence the difficulty sleeping. It may take a little while to find the right dosage that is agreeable to his body. My son is 13 and is on it. He was like a new born with sleep patterns until he was 6 yrs old. By 11 I was going nuts. He is much better now thank goodness and gets the rest that his body and mind needs to grow and function properly. You may have to restrict the internet/pc use at night and reward him with it during the day only so as to encourage him to sleep at night. The 'blue light' projected from the pc/laptop suppresses the normal secretion of melatonin and doesn't really help ones circadian rhythms. Getting off any electronic devices atleast an hour or two before regular bedtime allows the brain to begin the whole process of slowing down and releasing that melatonin. Look, I for one know that all of this information works but unless we as the parents/carers put it into practise, our kids will never do it. I'm not perfect, some days I forget to give my son his dose at the right time and then he's struggling to wake up at the right time the next morning and so I pay the price with his bad mood and getting to school on time etc. But we all have to start somewhere right? He was doing the school refusal thing last year and not wanting to leave the house or socialise at all. We enlisted the help of a psychologist who specialised in ASD and the school and recommitted to being the driving force behind implementing new routines. Baby steps was and is what it takes at the moment for my son and I. Its so tough for him especially I know, as I'm sure it is for your son but we have to push them out of their comfort zones for them to face challenges and grow from them. How else will they grow and learn? They wont! Plain and simple. Unfortunately its up to us. We become their "Executive Secretaries" as stated in the book "The Complete Guide to Aspergers Syndrome" by Tony Attwood.
I think I have gone on too much already but I hope you will find what your son needs to help him sleep and learn and grow. Wishing nothing but joy and success for our special Aspies!!!
•    Anonymous said… i also have a 12 yrs old with similar tendancies. Our Pead told us to avoid any Blue lights (whether that be in ceiling light or of electronics) after 4pm as it over stimulates their brain. I am now also trying reading before bed. I feel your pain
•    Anonymous said… I could have written this about my (undiagnosed) 11 year old. She also is now totally not Going to school (it's always been an issue but is much worse lately), she doesn't sleep and basically stays up all night every night (sometimes until 5-6am). She gets into bed ok at around11-12 but won't/can't sleep. She is very aggressive verbally and physically towards me almost all of the time and is very anxious. She doesn't go out with her friends or actually talk to them at all anymore. (She's never had tons of friends but now doesn't talk to the ones she did have) I'm also a single mum and have w younger daughter who is really effected by all this. It's so hard! I can't really offer any advice I'm waiting on things happening from the countless referrals that have gone in to community peads, cahms, child psychologist, education physcholigist etc xx
•    Anonymous said… I guess it doesnt work for everyone. If there is a physical activity or sport that he likes to do then try to do it everyday as it will help use up that 'boy' energy during the day. A bath or warm shower at night, a warm drink, reading some stories, di...See More
•    Anonymous said… If you're homeschooling anyway flip your schedule to match his. Do schoolin the afternoon. Theres a whole raft of studies about teen boys needing to sleep later. Make wake up time 10am and shift things. If the way everyone else does things isnt working for you and him create your own path.
•    Anonymous said… I'm not a Dr but have Aspergers girls and their consultants prescribed "Melatonin" it worked a treat to get their bodies back in a sleep routine and we only use it now if required. Hope this helps xx
•    Anonymous said… I've had similar issues, and since I've started to listen to his feelings, I work around him more now allowing him to sleep in as many days as possible, he is amuck happier boy all round for it 🏻
•    Anonymous said… Melatonin did nothing for our grand son any thing else
•    Anonymous said… My 8yr old grandson exactly the same.Wont go to school awake all night and his mum and dad cant get help for him in newzealand its shocking I feel sad for you.
•    Anonymous said… My Aspie son has just turned 17 and his sleeping patterns starting changing at about 13yrs old. I know how you feel and it's really hard. I'm now told by UK Social that my son is neglected and we can't parent him because we don't enforce his sleeping pattern and he lives for the Internet (it's the only form of Social life the poor boy has!). Can you flipping believe it! I don't know what to suggest tbh, because as you know it's not like parenting our sons when they were little boys where they knew bed time was bed time. It gets so much more challenging.
Maybe go onto "The National Autistic Society" website and go onto the Members Forum (you can browse as a "Guest"). There are so many parents in the same boat trying to manage their Teens through to Adulthood.
•    Anonymous said… my daughter doesnt go to bed till 1 or 2 am every day.....Melatonin diesnt wirk for her she needed stronger stuff but ended up ODing on perscription stuff....now we just let her stay up and I wake her at 7:45 for school every day
•    Anonymous said… My daughter had similar sleep pattern issues thru the early teens (although she did lots of drama classes in the evenings so socializing wasn't an issue). All teenagers naturally will stay awake later and sleep in. The beauty of home ed is we can accomodate their changed natural bio rhythms. I treasured my mornings to myself and we did educational stuff in the afternoons/evenings. Is there anything he would like enough to entice him out of the house? Other than saying don't worry, it will pass (it did with my daughter and I miss those precious me time mornings!) I don't know what to advise. But try not to worry too much about the sleep, it is normal and entirely natural during puberty, as is needing more sleep, instead explore ways to get him outside.
•    Anonymous said… My daughter takes melatonin a half hour before bedtime I give her 4mg in apple juice and she takes it other wise she would be up all night long. She's 12 and has been taking it since she was 2. No more sleep issues ever
•    Anonymous said… My Dr put my son on Clonidine 0.1mg to help him sleep at night otherwise he would be up all night
•    Anonymous said… My son is 11 and has a similar pattern. He has been on increasing doses of melatonin for 3 yrs. The problem is it us meant to only be given for a month then nothing then for another month, in an attempt to train the body. The breaks just send my son back into vampire mode within days. He was quite sick for a few day so Dr prescribed phenegan for anti nausea. This knocked him out.... you can buy over the counter from Boots, alot if chemists won't sell it to you though. But I found that boots did when I explained my son was aspie and it calmed him down. Understand this is only used when the melatonin is wearing off and body is used to it. I use it maybe once a month just so he gets a decent nights sleep @weekend.
Maybe worth a try as I know many Dr's don't like to prescribe melatonin unless forced. We get all his meds through Camhs xx
•    Anonymous said… Should talk to you'r doctor about what you can give him to help him sleep.May be you should look into a therapist to go to for help with your son. Has help with me.
•    Anonymous said… Society imposes routines that aren't fit for all, if he's feeling ok and is willing to take responsibility for himself and things that need to be done then maybe you could be more flexible. I say this because my 13yo son is in a similar position, I worry that he doesn't have a social life but he's much calmer out of school and no longer being bullied. I'm a single parent too and have to leave him home alone while I go to work, but he's safer there than he ever was in school.
•    Anonymous said… This sounds similar to what we experienced through the middle school years. Puberty is challenging for anyone, seems even more so for young people on the spectrum for some reason. Maybe because there was no go to rule book to reference since most info out there refers to neurotypical teens. It could be depression as well. Hang in there.
•    Anonymous said… Turn electronics OFF
•    Anonymous said… Unless you were/are an Aspie teenage with sleep problems, you dont have a clue what its like, it is not their fault REMEBER that! you can feed them all the tablets and chemicals you want but at the end of the day it only masks one of the many issue that we have to deal with, they are not the instigator they are the victim of their own biology.
•    Anonymous said… we do 3 mgs of Melatonin at night. I was amazed at how much it helped my 7 year old. You can take breaks on weekends and holidays if you want but during the week we use it each night. He even said, "mom! I actually slept last night!!!"
•    Anonymous said… We use 2 mg Clonidine and 3mg Melatonin for years. It was a life saver!
•    Anonymous said… We use melatonin 20 minutes before bed with a warning that the tv,electrinics/internet,will be off soon. After 20 minutes we remove tv remotes,game paddles,etc and turn off the lights. Works for us.
•    Anonymous said… Yes!! This can be a problem. Our teenager must have a sleep aid.
•    Anonymous said… Yes, melatonin does nothing for my sleepless son also 🙁

Post your comment below…

Students with HFA, ADHD, and Anxiety: Tips for Parent and Teachers

Question

My 14 year old son has been diagnosed with high functioning autism and ADHD when he was 9 years old. He attended public elementary school and has been at a small private school for 7th grade and is currently in 8th grade. He suffered in elementary school due to a few kids, however, the private school has been such a positive experience for him, he could be himself and his self esteem grew.

Here’s the issue: He has been suffering from a “virus” since the end of August. He remains symptomatic and has been to numerous doctors and testing, all negative. His stomach pain, fevers, pains are all real; however, a few doctors have suggested that they may be psychosomatic in nature. In September, he was not able to walk, or bear weight due to acute muscle pain in his legs. Along with Migraine headaches and Flu like symptoms. His muscle pain has just recently subsided, after months of physical therapy, Gabapentin (he’s being weaned off), acupuncture, Advil and whatever we can do to help him... He has not made it through a full week of school to date. His only coping mechanism was to dive into music (grunge; Nirvana, Foo Fighters, and rock; Pink Floyd, etc.) . He has become the expert and has taught himself the guitar. He was on months of bed rest, so his room became his safe haven. He is admittedly suffering from depression and has been hearing “voices” that tell him what to do. He doesn’t sleep through the night, and the voices yell at him and put him down. He is a sweet, child who is so special...he used to be very convicted with his love for Jesus, but now can’t even say His name.

Sorry for the length of the email, but I felt that you needed some type of background on him. He currently sees a Psych MD every 2 months (15 minute visits) just for medication management and has been seeing a counselor for social skills since he was 9 years old, and outgrew the services...he hasn’t been to that therapist since the summer because the sessions had become “gab” sessions...

His PCP and Psych MD have taken him off Concerta 54mg and he’s completely off Gabapentin for a 2 week trial that’s medication free. He has NOTICEABLY improved with energy and NO stomach pain at all!! He still feels depressed inside, even though he appears to be energetic and happy... OK... what to do from this point forward?


Answer

Re: He remains symptomatic and has been to numerous doctors and testing, all negative. His stomach pain, fevers, pains are all real; however, a few doctors have suggested that they may be psychosomatic in nature…

I would agree that it is mostly psychosomatic. Sometimes a child continually complains of a discomfort or a pain for which a doctor cannot find a cause. The pain or the discomfort, however, is very real to the child. Physical complaints with no apparent medical basis may be a reflection of a stress, such as nervousness in a social situation, a demanding school setting, separation from parents, or other stressful situation. Stress, as it affects the body and the mind, has an effect on some illnesses and can influence how a child perceives the symptoms of the illness, how he deals with the illness, and the rate of recovery.

Re: He has not made it through a full week of school to date…

This is probably related to some school anxiety issues. High-Functioning Autistic (HFA) children of all ages commonly experience school anxiety (i.e., school-related stress). This is often most apparent at the end of summer when school is about to start again, but it can occur year-round. This post explains school anxiety – and what can be done to help the "special needs" child become more relaxed and confident.



Social Stressors—

Many children with HFA and Asperger's experience some level anxiety in social situations they encounter in school. While some of these issues provide important opportunities for growth, they must be handled with care:

• Bullies— Many schools now have anti-bullying programs and policies. Though bullying does still happen at many schools, even those with these policies, help is generally more easily accessible than it was years ago. The bad news is that bullying has gone high-tech. Many children use the Internet, cell phones and other media devices to bully other children, and this type of bullying often gets very aggressive. One reason is that bullies can be anonymous and enlist other bullies to make their target miserable. Another reason is that they don't have to face their targets, so it's easier to shed any empathy that they may otherwise feel.

• Peers— While most children would say that friends are one of their favorite aspects of school, they can also be a source of stress. Concerns about not having enough friends, not being in the same class as friends, not being able to keep up with friends in one particular area or another, interpersonal conflicts, and peer pressure are a few of the very common ways children can be stressed by their social lives at school. Dealing with these issues alone can cause anxiety in even the most secure children.

• Educators— A good experience with a caring teacher can cause a lasting impression on a youngster's life -- so can a bad experience. While most educators do their best to provide children with a positive educational experience, some children are better suited for certain teaching styles and classroom types than others. If there's a mismatch between student and teacher, a youngster can form lasting negative feelings about school or his own abilities.

Scheduling Stressors—

Many grown-ups find themselves overwhelmingly busy these days—work hours are getting longer, vacations are shortened or skipped, and people find themselves with little down time. Sadly, our children are facing similar issues. Here are some of the main scheduling stressors they face:

• Lack of Family Time— Due in part to the busyness of kids' lives and the hectic schedules of most moms and dads, the sit-down family dinner has become the exception rather than the rule in many households. While there are other ways to connect as a family, many families find that they’re too busy to spend time together and have both the important discussions and the casual day recaps that can be so helpful for children in dealing with the issues they face. Due to a lack of available family time, many moms and dads aren't as connected to their children, or knowledgeable about the issues they face, as they would like.

• Not Enough Sleep— According to a poll on this site, a large proportion of readers aren't getting enough sleep to function well each day. Unfortunately, this isn't just a problem that grown-ups face. As schedules get busier, even young children are finding themselves habitually sleep-deprived. This can affect health and cognitive functioning, both of which impact school performance.

• Over-scheduling— Much has been said in the media lately about the over-scheduling of our children, but the problem still continues. In an effort to give their children an edge, or to provide the best possible developmental experiences, many moms and dads are enrolling their children in too many extra-curricular activities. As children become teens, school extracurricular activities become much more demanding. College admissions standards are also becoming increasingly competitive, making it difficult for college-bound high school children to avoid over-scheduling themselves.

Academic Stressors—

Not surprisingly, much of the stress of school is related to what children learn and how they learn it. The following are some of the main sources of academic stress for children on the autism spectrum:

• Homework Problems— Children are being assigned a heavier homework load than in past years, and that extra work can add to a busy schedule and take a toll.

• Learning Styles Mismatch— You may already know that there are different styles of learning -- some learn better by listening, others retain information more efficiently if they see the information written out, and still others prefer learning by doing. If there's a mismatch in learning style and classroom, or if your youngster has a learning disability (especially an undiscovered one), this can obviously lead to a stressful academic experience.

• Test Anxiety— Many of us experience test anxiety, regardless of whether or not we're prepared for exams. Unfortunately, some studies show that greater levels of test anxiety can actually hinder performance on exams. Reducing test anxiety can actually improve scores.

• Work That's Too Easy— Just as it can be stressful to handle a heavy and challenging workload, some kids can experience stress from work that isn't difficult enough. They can respond by acting out or tuning out in class, which leads to poor performance, masks the root of the problem, and perpetuates the difficulties.

• Work That's Too Hard— There's a lot of pressure for children to learn more and more and at younger ages than in past generations. For example, while a few decades ago kindergarten was a time for learning letters, numbers, and basics, most kindergarteners today are expected to read. With test scores being heavily weighted and publicly known, schools and educators are under great pressure to produce high test scores; that pressure can be passed on to children.

Environmental Stressors—

Certain aspects of an HFA youngster's environment can also cause stress that can spill over and affect school performance. The following are some stressors that moms and dads may not realize are impacting their kids:

• Lack of Preparation— Not having necessary supplies can be a very stressful experience for a youngster, especially one who's very young. If a youngster doesn't have an adequate lunch, didn't bring his signed permission slip, or doesn't have a red shirt to wear on "Red Shirt Day," for example, he may experience significant stress. Younger children may need help with these things.

• Lack of Sleep— As schedules pack up with homework, extracurricular activities, family time and some “down time” each day, children often get less sleep than they need. Operating under a sleep deficit doesn’t just mean sleepiness, it can also lead to poor cognitive functioning, lack of coordination, moodiness, and other negative effects.

• Noise Pollution— Believe it or not, noise pollution from airports, heavy traffic, and other sources have been shown to cause stress that impacts kids' performance in school.

• Poor Diet— With the overabundance of convenience food available these days and the time constraints many experience, the average youngster's diet has more sugar and less nutritious content than is recommended. This can lead to mood swings, lack of energy, and other negative effects that impact stress levels.

Signs of school anxiety in HFA and Aspergers kids include:

• Clinging behavior
• Difficulty going to sleep
• Exaggerated, unrealistic fears of animals, monster, burglars
• Excessive worry and fear about parents or about harm to themselves
• Fear of being alone in the dark
• Feeling unsafe staying in a room by themselves
• Headaches
• Lying
• Meltdowns
• Negative attitude
• Nightmares
• Refusing to go to school
• Severe tantrums when forced to go to school
• Shadow the mother or father around the house
• Stomachaches
• Withdrawal, regressive behavior, or excessive shyness

What Can Be Done To Reduce School Anxiety In Students On The Spectrum?

Here are 12 important tips:

1. Understand the value of tears. Crying can be a great stress reliever. It flushes out bad feelings and eases tension. It's hard to see your youngster crying, and your first instinct may be to help him stop as soon as possible. But after the tears have all come out, your youngster may be in a particularly open and receptive mood for talking and sharing. Provide a soothing and sympathetic presence, but let the crying run its course.

2. Set a regular time and place for talking with your youngster, whether in the car, on a walk, during mealtimes, or just before bed. Some of these young people will feel most comfortable in a cozy private space with your undivided attention, but others might welcome some sort of distraction to cut the intensity of sharing their feelings.

3. Routines are good. They help alleviate stress. Establishing a regular bedtime, get-up time, and bath time is important at any age. It also helps children with the disorder learn to develop routines themselves. Family meetings are important. At the beginning of school, set a weekly time to regroup and to talk about what's going on and how it will work: who gets the shower first, what time to set the alarm clocks for. Give everybody a chance to talk.

4. Resist the urge to fix everything. There are some instances in which moms and dads do have to take action. If your youngster is in a class that's too challenging, or is having trouble because an IEP isn't being followed, there are steps you can take. If a teacher or a classmate is truly harassing your youngster, you will want to follow up with that. But you'll also want to teach him that some things in life just have to be dealt with, even though they stink. Fix only what's really badly broken.

5. Know when to get help. Most kids experience school anxiety to some extent, and some feel it more deeply and disruptively. When does it become a big enough problem to require professional help? Some signs to look for are major changes in friendships, style of clothing, music preferences, sleeping and eating habits, attitude and behavior. If you've established a good rapport with your youngster and he suddenly doesn't want to talk, that's a sign of trouble as well.

6. Keep the lines of communication open. Let your youngster know that he can always talk to you, no matter what. It's not always necessary even to have solutions to his problems. Sometimes just talking about things out loud with a trusted adult makes them seem less threatening. And if the situation does become overwhelming for your youngster, you want to be the first to know about it.

7. Do some role-playing. Once you have some concrete examples of anxiety-provoking events, help your youngster figure out an alternate way to deal with them. Discuss possible scenarios and play the part of your youngster in some role-playing exercises, letting him play the part of the demanding teacher or bullying classmate. Model appropriate and realistic responses and coping techniques for your youngster.

8. Be aware that all students feel anxiety about school, even the ones who seem successful and carefree. Knowing this won't lessen your youngster's anxiety, but it may lessen yours.

9. Ask, "What three things are you most worried about?" Making your request specific can help your youngster start to sort through a bewildering array of fears and feelings. If he's unable to name the things that are most worrisome, have him tell you any three things, or the most recent three things.

10. Ask, "What three things are you most excited about?" Most students can think of something good, even if it's just going home at the end of the day. But chances are your youngster does have things he really enjoys about school that just get drowned out by all the scary stuff. Bring those good things out into the light.

11. Acknowledge the problem. Does hearing, "Don't worry!" help when you're anxious about something? It probably doesn't comfort your youngster much, either. The most important thing you can do for a youngster experiencing school anxiety is to acknowledge that his fears are real to him. If nothing else, you'll ensure that he won't be afraid to talk to you about them.

12. When school anxiety persists, parents should consult with a qualified mental health professional who will work with them to develop a plan to immediately return the child to school and other activities. Refusal to go to school in the older Aspergers child or teen is generally a more serious illness, and often requires more intensive treatment.

Re: He is admittedly suffering from depression…

Depression is one comorbid condition of HFA and it is one disorder which is seen in almost every child suffering from an autism spectrum disorder. This very disorder makes its appearance when the child is as young as three years of age and the parents will find that the child is prone to crying several times a day. This number can be more than twenty or thirty times in a single day and that too for the most trivial reasons. The youngster is unable to explain as to why he is crying as one with the disorder has a difficulty in expressing their own feelings.

Re: …and has been hearing voices that tell him what to do…

Hearing voices in itself is normal – but – it is possible to become ill from hearing voices if you cannot cope with them. This means that it is coping with hearing voices that is the problem and not the voices in themselves. This little known fact is based on a lot of research. Several large scale population studies have shown that about 4% of the population hears voices. Of these 4% of the people who hear voices about 30% seek assistance from mental health services. Among children however, even more of the “normal” population hears voices (8%) and as with adults about 30% are referred to mental health services.

What this means is that there are apparently many more people who hear voices who do not require the support of mental health services than those that do. This is because they can cope with the voices and function well in their everyday lives.

Examples of the kinds of traumas that trigger voices include the death of a loved one, divorce, losing a job, failing an exam, but also longer lasting situations like being physically, emotionally or sexually abused. With children the percentage was even higher at 85%, with some traumas specifically related to childhood. These traumas might include being bullied by peers or teachers, or being unable to perform at a certain level at school, another commonly reported traumatic incident related to hearing voices is being admitted to a hospital for long periods because of a physical illness. I would say that hearing voices is mostly a reaction to a situation or a problem the child cannot cope with.

Re: He doesn’t sleep through the night…

Studies find that approximately 73% of kids with the disorder experience sleep problems, and these problems tend to last longer in this group than they do for kids without the disorder. For example, kids on the spectrum are more likely to be sluggish and disoriented after waking. Laboratory research has begun to describe the unique physiological presentation associated with sleep problems in kids on the spectrum, including disruptions in the sleep stage most associated with cognitive functioning (i.e. REM or Rapid Eye Movement sleep). In addition to physiological differences, some of the sleep difficulties in this population may be related to anxiety.

The impact of poor sleep is unequivocal. Poor sleep negatively impacts mood and exacerbates selective attention problems commonly found in kids with HFA, as well as impairing other aspects of cognitive function.

There is no one panacea to manage sleep problems in kids with HFA. However, there are many interventions that are likely to be helpful. In general, moms and dads need to understand and be prepared for resistance to change that these kids often show. Moms and dads should also be prepared for problems to get worse before they get better as kids often initially challenge but then gradually become accustomed to new routines.

A good place to start an intervention targeted at improving sleep is changing lifestyle behaviors and environmental conditions that can influence sleep/wake patterns. These include exercise, napping, diet, and aspects of the bedroom and sleep routine.

Exercise & Activity—

The goal is decreasing arousal as bedtime approaches. To achieve this it may be useful to have a scheduled period before bedtime (approximately 30-45 minutes) in which the aim is calmness and relaxation. During that period, media such as television, computers, electronic games, and music should be limited as they can stimulate the youngster through activity, sound, and light. The availability of VCR and DVR technology makes it easier to control when kids can watch particular shows, thereby avoiding conflict over missing favorite programs that are shown in the late evening. The presence of televisions in kid’s bedrooms has been consistently associated with sleep problems and should be avoided at all costs. Likewise, computer access in a youngster’s bedroom is discouraged for sleep as well as for safety reasons.

In general, exercise during the day is associated with better sleep. However, exercise within 2-4 hours of bedtime can lead to difficulties in falling asleep, as it can disrupt the natural cooling process of the body that leads to rest at night. Having the youngster soak their body, particularly their head, in a calm bath that is as warm as can be tolerated 90 minutes before bedtime may be useful too. When the youngster gets out of the bath, core body temperature will drop rapidly; this is believed to help them to fall asleep faster. Using a waterproof pillow and avoiding the pulsation associated with showers is recommended. The use of progressive muscle relaxation, deep breathing and imagery exercises is the most widely researched treatment for insomnia in kids and may be useful for kids with HFA and Aspergers as well.

Napping—

Controlled and limited (e.g. 20-30 minutes) napping is generally positive. However, longer daytime sleeping can be negative in that it makes it more difficult for the youngster to fall asleep at the ideal time in the evening. If the youngster’s sleep problems are associated with falling asleep, which is common for kids on the spectrum, it is advisable to avoid daytime napping.

Diet—

It is recommended that kids with sleep problems avoid all caffeine, alcohol, tobacco, high fat food, and monosodium glutamate (MSG). In contrast, food rich in protein may promote better sleep. Large meals within 2-3 hours of bedtime should also be avoided. A small carbohydrate/protein snack, such as whole wheat bread and low-fat cheese or milk before bedtime can be helpful to minimize nighttime hunger and stimulate the release of neuro-chemicals associated with falling asleep. For kids who often wake during the night to use the bathroom, and then have trouble falling back asleep, limited fluid intake in the 2 hours prior to bedtime is also recommended.

Melatonin is a natural brain hormone associated with sleep onset. There is some evidence that natural production of melatonin may be reduced in autistic kids. While melatonin supplements may be useful, a common side effect may be increased sluggishness in the morning. As discussed above, this is already a common problem for kids with the disorder. Use of melatonin and other alternative remedies should be discussed with a physician.

The Bedroom—

It is important that the bed and the bedroom are associated with sleep and are not associated with activity. When kids have sleep problems, it is highly recommended that their bed and bedroom activity be limited to sleep only. It is important to make sure that extreme changes in temperature are avoided during the night. Increasing light is associated with decreases in the release of the neuro-chemical melatonin which triggers sleep onset. Thus, it is important to get the sunlight flowing in the youngster’s room as soon as possible in the morning. Conversely, darkening the room at night is critical. When a youngster’s fear of the dark is an issue, behavioral psychotherapy may be necessary. We also recommend moving the clock so that the youngster is not watching the time while lying in bed.

Sleep Routine—

Setting and maintaining a regular time to sleep and wake may be critical. Moms and dads often make the mistake of allowing their kids to sleep much later on non-school days to “make up” for sleep. While this may be useful to a certain extent, allowing the youngster to sleep late in the day makes it difficult for them to fall asleep at an ideal time later in the evening. It is easier to wake a sleeping youngster then to force an alert youngster to go to sleep. Thus, we recommend that you keep your youngster on a regular schedule on non-school days and avoid drastic changes in the time that the youngster wakes. Likewise, having your kids go to bed when they are not tired conditions them to be awake in bed. It is recommended that you let your kids stay up until they are tired while maintaining their waking time in the morning. Then once they begin falling asleep within 10 minutes of going to bed, begin to move bed time earlier by 15 minutes at a time.

With carefully monitoring and patience, many moms and dads can make changes in a youngster’s life that promote better sleep. Improved sleep supports better mood, sustained attention and general health. However, for many families professional consultation is often necessary to design or maintain the appropriate intervention. When you need help, speak with other moms and dads of Aspergers kids about their experiences and ask your primary care doctor for referrals to a sleep expert.

Re: OK... what to do from this point forward?

My assessment, based on the information I have, is this is mostly an anxiety issue which is at least partially derived from past trauma (bullying in elementary school). You are on the right track with having a psychiatrist, but I would definitely have him work with a therapist who can help him deal with anxiety and past trauma.

More resources for parents of children and teens with High-Functioning Autism and Asperger's:

==> How To Prevent Meltdowns and Tantrums In Children With High-Functioning Autism and Asperger's

==> Parenting System that Significantly Reduces Defiant Behavior in Teens with Aspergers and High-Functioning Autism

==> Launching Adult Children with Asperger's and High-Functioning Autism: Guide for Parents Who Want to Promote Self-Reliance

==> Teaching Social Skills and Emotion Management to Children and Teens with Asperger's and High-Functioning Autism

==> Parenting Children and Teens with High-Functioning Autism: Comprehensive Handbook

==> Unraveling The Mystery Behind Asperger's and High-Functioning Autism: Audio Book

==> Highly Effective Research-Based Parenting Strategies for Children with Asperger's and High-Functioning Autism

My child has been rejected by his peers, ridiculed and bullied !!!

Social rejection has devastating effects in many areas of functioning. Because the ASD child tends to internalize how others treat him, rejection damages self-esteem and often causes anxiety and depression. As the child feels worse about himself and becomes more anxious and depressed – he performs worse, socially and intellectually.

Click here to read the full article…

How to Prevent Meltdowns in Children on the Spectrum

Meltdowns are not a pretty sight. They are somewhat like overblown temper tantrums, but unlike tantrums, meltdowns can last anywhere from ten minutes to over an hour. When it starts, the Asperger's or HFA child is totally out-of-control. When it ends, both you and your child are totally exhausted. But... don’t breathe a sigh of relief yet. At the least provocation, for the remainder of that day -- and sometimes into the next - the meltdown can return in full force.

Click here for the full article...

Parenting Defiant Teens on the Spectrum

Although Aspergers [high-functioning autism] is at the milder end of the autism spectrum, the challenges parents face when disciplining a teenager on the spectrum are more difficult than they would be with an average teen. Complicated by defiant behavior, the teen is at risk for even greater difficulties on multiple levels – unless the parents’ disciplinary techniques are tailored to their child's special needs.

Click here to read the full article…

Older Teens and Young Adult Children with ASD Still Living At Home

Your older teenager or young “adult child” isn’t sure what to do, and he is asking you for money every few days. How do you cut the purse strings and teach him to be independent? Parents of teens with ASD face many problems that other parents do not. Time is running out for teaching their adolescent how to become an independent adult. As one mother put it, "There's so little time, yet so much left to do."

Click here to read the full article…

Parenting Children and Teens with High-Functioning Autism

Two traits often found in kids with High-Functioning Autism are “mind-blindness” (i.e., the inability to predict the beliefs and intentions of others) and “alexithymia” (i.e., the inability to identify and interpret emotional signals in others). These two traits reduce the youngster’s ability to empathize with peers. As a result, he or she may be perceived by adults and other children as selfish, insensitive and uncaring.

Click here
to read the full article...

Highly Effective Research-Based Parenting Strategies for Children with Asperger's and HFA

Become an expert in helping your child cope with his or her “out-of-control” emotions, inability to make and keep friends, stress, anger, thinking errors, and resistance to change.

Click here for the full article...

My Aspergers Child - Syndicated Content