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Sleep Issues and Children with Autism Robert F. Gulick, MFA BCBA Linda Hartken, MS BCBA April 17, 2012 LEADERS Lake Erie Autism Diagnostic Educational.

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Presentation on theme: "Sleep Issues and Children with Autism Robert F. Gulick, MFA BCBA Linda Hartken, MS BCBA April 17, 2012 LEADERS Lake Erie Autism Diagnostic Educational."— Presentation transcript:

1 Sleep Issues and Children with Autism Robert F. Gulick, MFA BCBA Linda Hartken, MS BCBA April 17, 2012 LEADERS Lake Erie Autism Diagnostic Educational & Research Services

2 25% of adults have sleeping problems 25% of kids have severe sleeping problems 80% of kids with Autism have difficulty sleeping

3 “When children don’t sleep well, the parents end up having 2 full-time jobs in a 24 hour day.” V. Mark Durand, Sleep Better

4 Honesty and Helping the Child All of us have issues Add Autism to the mix=very difficult You should receive compassion, honesty about what is best for your child, and patience from your BSC Try to be honest about attachment issues with your child so the therapist knows where you are coming from emotionally Slow and steady always wins Sleep is a crucial contributor to a good day It can wreak havoc on a home if all are not getting enough sleep

5 Effects of Sleep Deprivation Decreased motivation to learn or participate in daily tasks Decreased ability to concentrate Boring and repetitive tasks increase agitation Decreased ability to tolerate change Decreased overall mood

6 Sleep Issues in Children with ASD Getting to sleep –Alone –In own bed Sleeping through the night Refusal to nap

7 The Function of Sleep Non-Compliance Attention –missing Mommy and/or Daddy Tangible –missing out on toys, food, or other activities that cannot come to bed with you Escape –fears the dark being alone –perceives being in bed as an aversive

8 What do Typical Kids Do? Bedtime routine –warm bath –story time –cuddle time –lighting –clothing

9 What do Typical Kids Do? Verbal rules –able to understand deferred contingencies “If you go to sleep, then tomorrow we can…” Learn to settle themselves down so that sleep can occur

10 What do ASD Kids Do? Bedtime routine –can be effective –compliance problems can interfere –consistency!! Verbal rules –generally do not have language to support the understanding of these deferred rewards

11 What do ASD Kids Do? Often never learn to self-calm so that sleep can occur –Drop over in midst of toys or drift off while watching movie –Require someone to lie down with them and hold them –Medication Need for sleep? –anecdotal evidence suggests that some ASD kids can get by on very little sleep

12 Parent Contingencies Sleep Deprivation can be Debilitating –Affects work, relationships, parenting, mental health, and physical well being –Tried and failed traditional approaches –Desperation - “Whatever works” Play til collapse Sneak into bed Car seat

13 Sleeping Through the Night Most people awaken during the night If you have not learned how to self-calm and get to sleep, you’re likely not going to be able to get “back to sleep” once awakened.

14 Sleeping Through the Night If you have been “tricked” into your own bed, then awakening in the middle of the night can be: –frightening (“Where’s my Mommy?”) –angering (“Where’s my movie?”) Requires most parents to repeat the bedtime ritual again –lie back down with them –give them access to movie, toys, food until they fall back asleep –or….back in the car we go!

15 This can create an unending cycle of fatigue and frustration for both parties.

16 Nap Refusal Related directly to self-calming deficits seen in the ASD population Also related to the possibility that ASD kids might not need as much sleep as neurotypical kids.

17 Nap Refusal Napping at Preschool –Takes it to yet another level the child’s existing self- calming deficits and reduced need for sleep are brought into a new environment –Novel distractions –Mom and Dad not present –Bedtime rituals missing

18 Nap Refusal Result –Resistance, Tantrum or Aggression –Disruption of other students’ attempts at sleep –Inadvertent reinforcement of problem behaviors opportunity for attention following misbehavior opportunity for escape from the demand of napping following misbehavior opportunity for “redirection” to preferred tangibles following misbehavior –All in the name of “QUIET”

19 What to do??? Medications –Antihistamines (e.g., Benadryl) Short-term improvements (quicker sleep onset) Improvements are temporary (few sleep thru night) Side effects (paradoxical arousal, hang-over) –Antihypertensives (Tenex, Clonidine) Short-term improvements 4-hour duration (re-dose) Side effects (blood pressure)

20 What to do??? Medications –Melatonin Hormone produced naturally in body Production is stimulated by onset of darkness Appears to have dual effect –Sedating agent –Regulating sleep-wake cycle Now synthesized for oral use –Over the counter availability

21 What to do??? Medications –Melatonin Limited research Some have shown it to be effective Anecdotal reports from parents Long term effects? Currently classified as a “supplement” –Not regulated by FDA –Not tested for composition or impurities Need more efficacy studies before it will be routinely prescribed by physicians

22 Behavioral Interventions Unmodified Extinction Graduated Extinction Extinction with Parent Presence Positive Bedtime Routines

23 Unmodified Extinction “Let her cry..” –Establish regular bedtime and bedtime routine –Place child in bed –Do not attend to the child until morning Illness or danger are only exceptions –Produces rapid results Worse of crying usually fades within 3 nights –Side effects and difficulties Extinction burst and spontaneous recovery Socially unacceptable and difficult to do

24 Graduated Extinction Gradually reducing parental attention Two versions –Parents wait for progressively longer periods of time before responding to their child –Parents respond immediately, but gradually decrease the amount of time they spend attending to the child

25 Graduated Extinction Advantages –Positive results within first week –Easier for parents to tolerate Disadvantages –Can shape up longer periods of crying

26 Extinction with Parent Presence Parent sleeps in same room with child for 1 week while using unmodified extinction Parental presence expected to reassure the child Advantages –Rapid results and reduced parent anxiety Disadvantages –Requires parents to change sleeping arrangements –Does not teach the child to fall asleep independent of parental presence

27 Positive Bedtime Routines Teaching procedure –Teach appropriate pre-bedtime behaviors and sleep onset skills –Temporarily move bedtime later in the evening to more closely coincide with the child’s natural sleep onset time (increases probability of rapid sleep onset) –Institute a positive and enjoyable pre-bedtime routine that teaches the child to engage in relaxing activities (bath, story, cuddle time)

28 Positive Bedtime Routines Each activity is followed by praise and encouragement signaling the transition to the next activity (building a chain) Once the chain is established and the child is falling asleep quickly, the child’s bedtime is systematically moved earlier in the evening until reaching the pre- established bedtime goal

29 Positive Bedtime Routines Advantages –Prevents long bouts of crying –Fewer bedtime struggles –Reduced parental anxiety –“Errorless “ procedure Disadvantages –Time commitment –Parent resistance to changing bedtime to a later time

30 Sleep Better by V. Mark Durand (1998)

31 Take Away Points Sleep is similar to dieting, in that medications may help, but the most effective results come from hard work. There are several research-backed methods for addressing sleep issues with our kids. Contact a qualified behavior analyst to serve as your guide. Need to address it now because you want to definitely avoid…

32 “H” is for Hell

33 ?


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