Sleep Problems
Assessing and treating difficulty falling asleep, frequent night wakings, and other sleep disturbances in autistic children and children with related developmental disabilities.
What Are Sleep Problems?
Sleep problems are common among children generally, but especially prevalent among autistic children, and they affect the wellbeing of both the child and the family. What clinicians often call sleep disturbances or sleep disturbance covers a range of patterns, from occasional difficulty settling at night to a persistent, disruptive pattern that affects the whole household.
Childhood sleep problems, and sleep disturbances in childhood more broadly, are well understood through behavioral science. With individualized, function-based assessment, many children can build the skills that support settling into sleep independently and staying asleep through the night.
Common Types of Sleep Problems
Most sleep-related concerns FTF addresses fall into one of four patterns.
Difficulty Falling Asleep
Taking an unusually long time to fall asleep, sometimes an hour or more after bedtime, is one of the most common patterns seen in autism and sleep disturbance. It often has a behavioral component: the child typically hasn't yet built the independent settling skills needed to fall asleep without a parent or caregiver present.
Frequent Night Wakings
Waking multiple times a night, and needing help settling back down each time, is a well-documented pattern within sleep disorder in autism presentations. Like other autism sleep issues, frequent night wakings are usually maintained by what happens after the child wakes, whether that's attention, comfort, or being allowed to leave bed.
Short Sleep Duration
Some children fall asleep without much trouble but don't stay asleep for long, leading to a short overall sleep duration that affects mood, learning, and behavior the following day. This is one of the more overlooked forms of autism and sleep disturbance, since the bedtime routine itself may look fine.
Reluctance to Enter Bed or Sleep Independently
Resistance to getting into bed, or needing a parent or caregiver present to fall asleep, is one of the most common patterns FTF addresses. Like other sleep-interfering behaviors, this pattern often improves with a structured, gradual, function-based plan tailored to the child and family.
Why Sleep Problems Develop
Sleep problems are not inevitable for autistic children, but they occur more often in this population than in typically developing children.
Most sleep disturbance follows the same behavioral principles as other learned patterns: a child's difficulty falling or staying asleep is often maintained by what happens in response to it, whether that's a parent's presence, comfort, or a change in routine.
Addressing the environmental variables influencing sleep is usually more effective than addressing the sleep itself in isolation.
Who Is Affected
Sleep disturbances are common in children generally, but they're especially prevalent among autistic children, children with intellectual disability, or other developmental disabilities. Addressing sleep concerns early can meaningfully improve quality of life for the child and the whole family.
Our Three-Step Process
At FTF, we train professionals in the assessment and treatment of sleep problems, with the aim of building capacity in your personnel to support the parent and caregiver implementers who carry out treatment day to day. The content and duration of consultation is flexible and tailored to each professional's needs, delivered through the same three-step process: training, synchronous assessment support, and asynchronous treatment support.
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Step 1: Training
The first step is training on the assessment and treatment of sleep problems as they relate to a specific client's needs, delivered via Zoom or through a workshop, including FTF's Going to Bed Without Tears course.
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Step 2: Synchronous Assessment Design and Implementation Support
FTF Consultants and your team collaboratively develop comprehensive behavioral interventions within a bio-behavioral conceptual system. The process starts by identifying the variables influencing a child's sleep problems, then developing a personalized intervention from those findings.
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Step 3: Asynchronous Treatment Design and Implementation Support
From there, an FTF Consultant provides weekly consultative support via Zoom videoconferencing, typically completed within a 6-week period, to support your organization's personnel as they implement the sleep treatment.
Frequently Asked Questions
Are sleep problems common in autism?
Yes. Sleep disturbances are one of the most frequently reported concerns among families of autistic children, though they also occur in the general population.
Can sleep problems be addressed without medication?
Yes. Behavioral, function-based approaches address the environmental variables affecting sleep directly and can be effective on their own or alongside medical care. FTF trains and supports the professionals who guide families through this process, and we recommend ruling out medical contributors with your child's pediatrician first.
How long does the consultation process usually take?
Most engagements are structured around a 6-week period of active consultative support, though timelines vary by child and organization.
Do parents need to be involved in treatment?
Yes. FTF trains professionals to support the parent and caregiver implementers who carry out the sleep treatment plan day to day.
Get Support / Work With FTF
Whether you're a clinic looking to build internal capacity for addressing childhood sleep problems or a school supporting a family through a sleep-related concern, FTF can help your team do it well. Explore our Going to Bed Without Tears course or get in touch to talk through your organization's needs.
Tell Us How We Can Help
To help us design an organizational training, provide on-site implementation support for your staff, and schedule follow-up video conferencing, tell us about you, your organization, and your goals.
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