Autism spectrum disorder and sleep: what parents need to know

Caroline DiBattisto, MD

Developmental-Behavioral Pediatrics

Trouble falling asleep and receiving the right amount of sleep are common in children with autism spectrum disorder (ASD), with up to one-half of children with ASD having sleep problems. Caroline DiBattisto, MD, explained what issues are most common when it comes to autism spectrum disorder and sleep, and what parents and caregivers can do to help children with autism sleep better.

Do children with ADHD or autism spectrum disorder “just need less sleep” than neurotypical children?

“Every individual’s sleep needs are different with or without ASD or ADHD,” said Dr. DiBattisto. “The idea that children with ASD or ADHD need less sleep is really a myth.”

What is true is that children with ADHD or autism often struggle to make the adjustment from wakefulness into peaceful sleep. However, they still may need the same number of hours of sleep per night as other children. Toddlers and preschoolers generally need 10–13 hours of sleep per night, while teenagers need 8–11 hours of sleep to feel well-rested and function at their best.

What matters most, according to Dr. DiBattisto, is whether the current amount of sleep a child is receiving is resulting in daytime sleepiness or increased problems with behavior or mood.

What can cause or worsen sleeping problems in people with autism spectrum disorder?

“Issues like allergy symptoms, sleep apnea and reflux can all affect sleep,” said Dr. DiBattisto. “Time spent watching television or using hand-held devices like tablets or phones at bedtime or during the night can also affect sleep quality or make it more difficult for your child to fall asleep.”

Medications prescribed for ADHD can affect sleep onset, and in many children with autism spectrum disorder changes to routine can be immensely difficult to adjust to, and can affect their sleep patterns..

Can I give melatonin to a child who has trouble sleeping?

“Melatonin is considered a dietary supplement, so it isn’t as strictly regulated by the FDA as prescribed medication would be,” said Dr. DiBattisto. “However, it is generally safe and effective for children with sleep problems.”

Parents interested in using melatonin for their child should consult their doctor to see what dose would be appropriate. Dr. DiBattisto added that she would typically recommend it for children over the age of 3 who have significant sleep problems that have not improved with a consistent bedtime routine or avoiding electronics before bed.

What can caregivers do to help a child with autism spectrum disorder achieve better sleep?

“The best thing you can do, as a parent or caregiver to a child with autism spectrum disorder, is establish a consistent bedtime routine,” said Dr. DiBattisto.

The bedtime routine should be relaxing for the child and involve the same steps each night, such as taking a bath, brushing teeth, and reading a bedtime story. Keeping the bedroom at a comfortable temperature, using the child’s favored type of bedding, and keeping the room the same amount of darkness each night can also be helpful. White noise machines, a small fan, or calming music are good options. Put toys away to avoid distractions beyond a few books and a favorite stuffed animal or special blanket.

Avoid television or electronic devices within two hours of sleep, and while daily exercise can be helpful, don’t exercise too close to bedtime.

Rewarding and praising your child for following the routine and staying in bed may also be helpful. Dr. DiBattisto recommended free resources like the ATN/Autism Sleep Toolkit and Healthy Sleep Habits information from the American Academy of Pediatrics.