Many children diagnosed with autism spectrum disorder (ASD) experience irregular sleep patterns, commonly in the form of delayed sleep onset, frequent nighttime awakenings and reduced sleep duration. These problems occur in 40 to 80 percent of children with ASD, compared with 10 to 20 percent of typically developing children.
Because many children with autism cannot maintain sleep during the night, they experience impaired alertness, behavioral issues and exacerbation of their ASD symptoms during daytime hours. Not surprisingly, the result often is a high level of parental stress and impaired parent-child relationships.
What’s the Root Cause?
Recent research suggests that circadian rhythms – internally generated activity cycles based on 24-hour intervals – appear to be abnormal in children diagnosed with autism. This has been linked to irregular levels of melatonin, a neuro-hormone synthesized from serotonin and located in the pineal gland, the endocrine gland that produces melatonin.
- Normally, melatonin levels rise at night and return to baseline in the morning, during daylight hours. In children with ASD, however, it appears that diminished melatonin secretion occurs. This impairs the natural biological tendency for sleepiness during the night and wakefulness during the day.
Sleep irregularities are very common in children with ASD. The most common related issue appears to have a behavioral basis, as in the case of children who have not learned appropriate ways to get to sleep or stay asleep. They may stall or refuse to go to bed or complain of sleeplessness. The second most common issue seems to be related to circadian patterns; for instance, delayed sleep, the inability to fall asleep or wake at a desired time, or irregular sleep/wake patterns.
Final critiques of research on this issue indicate that behavioral sleep problems in children with ASD may be the result of the related challenges of impaired circadian systems and/or irregular melatonin levels.
- Studies have tested melatonin levels in the blood of children during 24-hour cycles. Results showed that children with autism demonstrated profound sleep disturbances compared with typically developing children. Researchers conclude that the pineal gland may be damaged in children with ASD.
Implications for School Psychologists
As a school psychologist, you can take a lead role in working with children and families who face melatonin-related sleep disorders. It has been found that these youngsters may experience impaired cognitive abilities, as well as low adaptive skills. Thus, they may exhibit a decline in perceptual and verbal competencies or deficits in typical activities such as eating, toileting or practicing good hygiene – all of which are essential to healthy functioning in a school environment.
- Be aware of the issue. With consistent teacher feedback, screen students for sleep problems and provide the right support. Ongoing teacher/psychologist collaboration is critical.
- Psychological interventions will vary based on individual manifestations of sleep dysfunction. Behavioral modification strategies, parent education and medications are more commonly used with elementary aged students. Cognitive-behavioral therapy and emphasis on relaxation techniques may be more appropriate for adolescents.
The Cobb Pediatric Therapy team is made up of experienced therapists who can provide you with the latest developments and updates to enhance your school-based psychologist career – as well as employment opportunities in the Atlanta area and beyond. Contact us today to learn more.