Sleep Advice for Neurodivergent Children and Young People
By Dr Freya Spicer-White, Chief Clinical Officer and Pankhuri Pilania, Assistant Psychologist
Sleep is important for everyone. Sleep is especially important for young people because it supports their mental and physical development. However, research has shown us that for young people who are neurodivergent, sleeping well every night might be particularly difficult. Approximately 80% of young people with a Special Educational Need or Disability will struggle to sleep. In this helpsheet, we offer advice and guidance for parents and carers to support young people to get a better night’s sleep.
Why is sleep important?
When children and young people are asleep hormones are released in their bodies to repair any damage and promote growth, their brains process and embed any new learning and their immune system become stronger. Lack of restful sleep can cause both tiredness and hyperactivity, both of which can have a negative impact on the young person’s day.
Young people who get a good and effective night’s sleep are generally happier, alert and more attentive during the daytime.
How much sleep do children need?
The amount of sleep a young person needs varies for each individual and the amount of sleep required will change as they grow up. Between the ages of 4 to 9, a young person will need between 11 and 10 hours of sleep, between 10 to 14 years old around 10 to 9 hours and over 15 around 8 and a half hours.
Regardless of the age of the young person, it is important to identify their effective pattern and timings of sleep.
When does sleep become a problem?
A lack of sleep becomes a problem if it has a negative impact on the young person’s quality of life. When a young person is not sleeping through the night, this can also have an impact on those caring for them, because they are also being deprived of sleep.
Types of sleep difficulties…
There are different types of sleep difficulties, and it is helpful to identify the problem for the young person. Sleep difficulties may relate to the following:
- Falling asleep
- Staying asleep and waking during the night
- Sleepiness during the day
- Night terrors or sleepwalking
What can impact a good night’s sleep?
- Diagnosed conditions – especially those that may feature hyperactivity; lots of young people with ADHD might be physically active before bedtime but they also may be mentally active. They might struggle to sleep because they can’t switch their brains off.
- Day time activity – children who sleep during the day or those who don’t get enough day-time activity maybe not feel tired or need to sleep as many nighttime hours.
- Environment –their bedroom might have too many distractions, bright lights, too much noise, or an overly warm temperature.
- Food and drink – Caffeinated drinks such as tea, coffee or fizzy/energy drinks may disturb sleep. Some neurodivergent children also have gastrointestinal problems so they may experience discomfort after eating, which might also disturb their sleep.
- High anxiety and arousal – If a child or a young person is anxious, which could be related to their neurodivergence, their arousal system may stay active longer and therefore it might take them longer to get to the ‘rest and digest’ state.
- Lack of routine – All children and young people find reassuring routines to help them settle to sleep useful but an Autistic child might find a lack of a bedtime routine very upsetting and stressful.
- Melatonin levels – Melatonin is a hormone produced in the body which normally helps regulate sleep-wake cycles. It is thought that melatonin levels may be irregular in neurodivergent children and young people where they may produce melatonin but not enough or not at the right times of the day. Melatonin can also be affected by substances like caffeine.
- Physical illness – Illness or discomfort including reflux, toothache or eczema can make settling for bedtime difficult. Neurodivergent children and young people have experienced the physical sensations of illness more intensely causing more disruptions or they may have reduced sensation, for example not realising they have a fever but are still wrapped up tightly.
- Screen use before bed – the blue light that screens give off is processed like sunlight so our brains stop producing the sleep hormone, melatonin.
- Sensory issues – Many neurodivergent children and young can be hypersensitive to sensory experiences e.g. sound, touch, smell, taste or vision. This can be both distracting and distressing and makes the process of falling asleep very difficult. For example, the feel of a blanket or the sound of people nearby could be distressing.
- Social cues – Neurodiverse children and young people may not pick up on the social cues that lead up to bedtime which means they don’t understand what needs to happen so they need help to know why and when they need to sleep.
- Transition – Some neurodivergent children and young people may struggle with transitions between a ‘doing activity’ and ‘calming bedtime activity’ and therefore need plenty of time and reassurance around bedtime to support the transition.
What helps?
Here are some ideas and techniques to help your child get a better night’s sleep.
Use a sleep diary
Try a sleep diary to record their sleep and wake cycle over a 2-week period, use this to try and spot any obvious problems or patterns. If any new routines are started a sleep diary will also help you to see if what you’re doing is working.
Have a sleep routine
A bedtime routine should be no more than thirty minutes and be consistent so that the child or young person can easily predict what is going to happen. The routine can include things that relax such as a story or music. It is important to avoid any stimulating activities before bedtime like watching TV, computer games or play. It may be helpful to have an identifiable ‘end point’ that the child or young person can become familiar with that marks bedtime e.g. a familiar phrase like ‘Sleep time (name)’. If the child or young person then struggles to go to sleep, this phrase can be repeated.
Visual routines
Neurodivergent children and young people respond well to structure and routines that are visually presented. Consider creating a visual routine so that the child or young person is aware that it is bedtime. You can use photos, drawings or words, whichever the young person prefers.
Limited communication after routines
Limit your interaction after the sleep routine. Any interaction when the child gets up or cries could be seen as an expected response, a hard habit to break! Keep your interaction simple and do not engage with them too much e.g. don’t talk, play or make too much eye contact, guide them back to bed, briefly soothe and then leave them to sleep again.
Sleeping alone
It is important that children and young people learn to sleep on their own. Parents and carers can consider using a graded approach where they will gradually build on their distance away from the child or young person. For example moving from lying on the bed to sitting on the bed, and then perhaps to standing in the doorway and then standing outside of the room.
Sleeping in bed
It is important that children and young people are encouraged to go to bed when they are drowsy and before they go to sleep. Try not to let them fall asleep on the sofa and then carry them upstairs to bed. Their bed needs to be understood as a safe place, where we go to sleep.
Avoid naps
Naps are good for preschool children but they could be interfering with sleep for older children, try to reduce or avoid these during the day.
Exercise
Having some exercise during the day, especially outdoor activities, can make it easier for children and young people to fall asleep and children who exercise tend to have deeper sleep. However, try to avoid exercise too close to bedtime as it could make sleep more difficult.
Control food and drink
Avoid caffeine and snacks in the lead-up to bedtime. Caffeine is found not only in coffee but also in tea, chocolate and some fizzy drinks.
Relaxation
This of activities of that you can do together that will be relaxing and that will encourage self-soothing and relaxation. Relaxation activities could be:
- A warm bath
- A gentle foot, hand or scalp massage
- Quiet calm music
Environment
Neurodivergent children and young people often have sensory issues and are sensitive to noise, light or touch. Minor environmental modifications and alterations can improve these issues. For example:
- Reduce distractions e.g. toys, electronics, pictures
- Reduce noise
- Use gentle lighting and darkness for sleep
- Consider the feel of bedding or clothing, for example, does the child prefer a heavier blanket or do they dislike the feel of a label in clothing
- Consider if any smells may be unsettling or relaxing.
Medication
Children and young people can be prescribed medication to improve their sleep. Medication is only considered when other strategies have been tried but have been unsuccessful and when the lack of sleep is having a significant impact on the child or young person. If medication is considered, then it is only prescribed via consultation with a Specialist Paediatrician or Psychiatrist with expertise in the management of sleep.
Sleep problems in childhood are common, especially in neurodivergent young people.
As a parent/carer of a neurodivergent young person, don’t forget to look after yourself! If you are going to help a young person improve their sleep, think about the support you may need and how to get the timing right to ensure you are able to use a calm, consistent approach.