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Settling and Waking Problems in Children on the Autism Spectrum

"My son has a terrible time getting to sleep, but then in the mornings, I have a terrible time getting him up and out the door for school. Any suggestions?"

Unfortunately, it seems that virtually all kids with Aspergers and High-Functioning Autism (HFA) are likely to suffer from disturbed sleep patterns at some point or another. Sleep problems can be divided into three main categories: (1) settling problems, where the youngster has difficulty going to sleep at the appropriate time, (2) waking problems, where the youngster wakes repeatedly during the night, and (3) arousal problems, where the child has a hard time waking up in the morning due to such a restless night.



Coping with settling/waking/arousal problems will require consistent reassurance on your part -- and a creative approach to your youngster's needs. Here are some tips:

1. Allergy and food sensitivities: Kids on the autism spectrum are perhaps more likely than their peers to be sensitive to foodstuffs (e.g., sugar, caffeine, additives, etc.), which can keep them awake. If your youngster frequently has sweet or caffeine-rich drinks and foodstuffs near bed time, then it is worth checking whether this could be disturbing his sleep.

2. Medication: Medical interventions are typically seen as a last resort in treating sleep disorders in kids because they can be habit-forming and do not treat the root cause of the problem. As a general rule, it is better to minimize the medication your youngster is on, but at certain times it may be desirable to have a mild sedative on hand (e.g., going on vacation). Some moms and dads have also found that using medication in tandem with a behavioral approach can help to restore a good sleep pattern. The combination is crucial, because without the behavioral intervention when the medical treatment ends, the youngster is likely to return to his old sleep patterns.

3. Melatonin: This is a hormone secreted by the pineal gland which has been shown to regulate sleep patterns. In kids with the disorder, their patterns of melatonin secretion may be irregular, so it is not that they don't produce it, but that they don't produce it at the right times of day. Some foods are rich in melatonin (e.g., oats, rice, sweet corn, tomatoes, plums, bananas and Brazil nuts).

4. Natural remedies: Many of the natural remedies available from health food stores are supposed to treat insomnia and other sleep disorders. These may have similar effects to conventional medicines but carry less risk of side-effects than conventional sedatives. You could also try contacting a homoeopath.

5. Removing stimulants from the diet: Changing your youngster's bedtime routine can be stressful, and if they are used to having certain drinks or snacks near bedtime, suddenly switching to something different may be counter-productive. However, you could change to decaffeinated drinks, replace ordinary chocolate with sugar-free chocolate bought in health food stores, use carob powder to replace cocoa and chocolate, switch to sugar-free drinks or replace sugar in drinks with sweetener or fruit sugar, which may help some kids. Alternatively, you could try gently phasing certain foods out over a period of days or weeks so that your youngster is consuming less and less sugar and caffeine overall without having anything suddenly taken away from them.

6. Lack of social sense: Kids with Aspergers and HFA may have difficulty understanding why and when they need to sleep. Problems with social cueing (i.e., learning why and in what order things should happen) are common in these children, and this may mean your youngster doesn’t make the connection between his family going to bed and his own need to sleep.

7. Establishing a routine: Kids on the spectrum respond well to routine and structure because it allows them to feel safe and in control. Whatever routine you try to impose needs to be something you feel comfortable implementing and that your family can agree on. It may take several weeks for it to alter your youngster's sleep patterns. It can help to present this routine visually, using a timetable for example, so your youngster knows exactly what to expect, including getting up in the morning. If the routine needs to be altered, it can then be explained visually. It may be that your youngster's timetable needs to be more detailed so that he is told exactly what to do when going to bed, for example, draw the curtains, get in to bed, turn light off, lie down, pull cover up, etc. It may also be worth setting aside some time to prepare for the next day in the routine. This could include getting the school bag ready or making a list/timetable of things that need to be done the next day.

8. Using relaxation techniques: Kids with Aspergers and HFA may not be able to articulate their need to unwind and relax, and they may feel more anxious and confused around bedtime. Relaxation techniques can be introduced in low-key, non-intrusive ways. Some possible techniques are as follows:
  • Adding a few drops of lavender oil to your youngster's bath or pillow.
  • Giving your youngster a massage. 
  • Introducing an hour's quiet time before the youngster's bedtime. 
  • Providing the youngster with a set time to talk about their day or their worries as part of the evening routine. 
  • Physically exhausting your kids is a good way of ensuring that they sleep! Many kids with Aspergers and HFA enjoy rough and tumble play, and although this may seem to be the opposite of the points made above regarding quiet time, it might be more effective for some kids. 
  • Relaxation aids such as music and yoga can be very useful. 
  • Some moms and dads have reported having lighting (e.g., a lava lamp) in the bedroom can be helpful.

9. Dealing with sensory issues:
  • It’s worth considering if smells in the room, or coming from other parts of the house, may affect children with heightened senses.
  • Some kids are exceptionally sensitive to light, so sleeping when there is even a very dim light on could be very difficult for them. Putting up thick curtains will block out as much light as possible in your youngster's room. 
  • Some moms and dads have found that their kids can be woken by very slight sounds at night. Ear plugs, or music playing on headphones, could be used to block out noise for those kids who are comfortable with wearing these.
  • The layout of the room may need to be adjusted. Although it may be comforting for some kids to have lots of their belongings around them, it may serve to be quite distracting for others. Even the colors of the room or pictures on the wall may be disturbing. 
  • Touch sensitivity is extremely common in Aspergers and HFA. Some kids experience certain types of touch as physical pain. Labels on bed clothes and different materials can also be uncomfortable. Some kids respond well to a weighted blanket, which is made from thick blanket material like a quilt with the pockets filled with beans.

10. Keeping a diary: If you think your youngster may have a sleep disorder and you want to get an idea of the extent of the problem, it is a good idea to keep a sleep diary as the initial step to solving the problem. If you decide to try any routines or behavioral modifications to help your youngster to sleep, then the sleep diary will allow you to see if what you are doing is working consistently, sporadically or not at all.


More resources for parents of children and teens with High-Functioning Autism and Asperger's:

==> How To Prevent Meltdowns and Tantrums In Children With High-Functioning Autism and Asperger's

==> Parenting System that Significantly Reduces Defiant Behavior in Teens with Aspergers and High-Functioning Autism

==> Launching Adult Children with Asperger's and High-Functioning Autism: Guide for Parents Who Want to Promote Self-Reliance

==> Teaching Social Skills and Emotion Management to Children and Teens with Asperger's and High-Functioning Autism

==> Parenting Children and Teens with High-Functioning Autism: Comprehensive Handbook

==> Unraveling The Mystery Behind Asperger's and High-Functioning Autism: Audio Book


==> Parenting System that Reduces Problematic Behavior in Children with Asperger's and High-Functioning Autism

Organization Skills for Children with Aspergers and High-Functioning Autism

"Any tips on how I can help my child get more organized? He loses and misplaces many things, including homework and school books, which is now affecting his grades. Help!"

Children and teens with Aspergers and High-Functioning Autism (HFA) often have deficits in what we call “cognitive function” (i.e., the intellectual process by which we think, reason, understand ideas, and remember things). So a child with Aspergers may have difficulties with:
  • “executive function” (i.e., he/she may be detail-focused and less able to see the whole picture)
  • predicting the consequences of an action (e.g., “If you do this, what will happen next?”) 
  • processing information 
  • understanding the concept of time

One or all of these four examples can affect Aspergers kid’s ability to organize, prioritize and sequence (e.g., if they struggle to understand the concept of time, they will have difficulty planning what to do over the course of a week).



Below are some ways in which children and teens with Aspergers and HFA can organize and prioritize daily activities and tasks. At first, parents may need to have a lot of involvement introducing the techniques and helping their child to get used to using them. Also, the techniques can be used in more than one place (e.g., at home and at school). Therefore, it is important that everyone who is using them (e.g., parents, babysitters, teachers, friends, etc.) uses them consistently. Over time, most children and teens with Aspergers will be able to use the strategies independently (although some may always need a certain degree of support).

Organizations Skills—

1. Be a coach: For the best results, you'll want to be a low-key coach. You can ask questions that will help your child get on track and stay there. But use these questions only to prompt their thought process about what needs to be done.

2. Color coding for tasks: Colors can be used to indicate the importance or significance of tasks (e.g., chores, homework, etc.), and therefore help to prioritize tasks and work through them in a logical sequence. For example, a note on the child’s bulletin board written in red could mean “urgent.” A note on the bulletin board written in green could mean “pending.” And a note written in blue is not important or has no timescale attached to it.

3. Lists: Lists, both written and pictorial, can help children with Aspergers in the same way as color coding. Lists can also be a good way of (a) registering achievements (e.g., by crossing something off when he/she has completed the task) and (b) reassuring the child that he/she is getting things done.

4. Make a plan: Decide on one thing to focus on first. You can come up with three things and let your youngster choose one (e.g., if homework or a particular chore has been a problem, that's the natural place to begin).

5. Praise progress, but don't go overboard: The self-satisfaction children will feel will be a more powerful motivator.

6. Sell your youngster on the idea of “staying organized”: Brainstorm about what might be easier or better if your youngster was more organized and focused. Maybe homework would get done faster, there would be more play time, and there would be less nagging about chores. Then there's the added bonus of your youngster feeling proud and you being proud, too.

7. Set expectations: Be clear, in a kind way, that you expect your children to work on these skills and that you'll be there to help along the way.

8. Social stories and comic strip conversations: Social stories and comic strip conversations can be a really good way of illustrating the consequences of an action and can help children to understand why it's good to be organized (e.g., what might happen if the child doesn't get his/her homework done).

9. Task boxes, envelopes and files: Children can store work or belongings in set places, so that they aren't misplaced or forgotten.

10. Teaching materials: You may find that certain teaching materials (e.g., sequence cards, games, timers, clocks, etc.) help some Aspergers kids to understand the concept of time and sequences. Materials like this can be adapted and used in different places (e.g., home and school).

11. Times of day, days of the week: It may be easiest to use times of day (e.g., morning, afternoon or evening) or days of the week (e.g., Sunday through Saturday) to help the child plan and organize tasks, social activities and other events (e.g., 5:00 PM is “homework time” … or Monday is “laundry day”).

12. Visual supports: Using pictures, written lists, calendars and real objects can all be good ways of helping Aspergers kids to understand what is going to happen – and when! For example, the child might have a daily timetable with pictures of a shower, clothes, breakfast, their school, dinner, a toothbrush, pajamas, and a bed to indicate what he/she will be doing, and in what order, that day. This can help children plan their day and organize themselves.

13. Get feedback: Be sure to ask your youngster's opinion of how things are going so far.

14. Start thinking in questions: Though you might not realize it, every time you take on a task, you ask yourself questions and then answer them with thoughts and actions. If you want to unload groceries from the car, you ask yourself:

Q: Did I get them all out of the trunk?
A: No. I'll go get the rest.

Q: Did I close the trunk?
A: Yes.

Q: Where's the ice cream? I need to put it away first.
A: Done. Now, what's next?

Encourage your child to start seeing tasks as a series of questions and answers. Suggest that he/she ask these questions out loud and then answer them. These questions are the ones you hope will eventually live inside your youngster's head. And with practice, he/she will learn to ask them without being prompted. So, work together to come up with questions that need to be asked so the chosen task can be completed. You might even jot them down on index cards. Start by asking the questions and having your youngster answer. Later, transfer responsibility for the questions from you to your youngster.

15. Digital devices:
  • Computer calendars can have important dates stored on them, or reminders about when to complete a certain chore.
  • Mobile phones can be used to store important information, or to act as a reminder.
  • Radios and televisions can be set to come on at a particular time as a reminder to do something. 
  • Instructions can be sent by text. Text messages lend themselves to this especially well since parents should keep instructions brief and simple. 
  • Hand-held voice recorders can be a useful auditory reminder of tasks, work, events or deadlines.


Obsessions in Children with Aspergers and High-Functioning Autism

"Why is my 6-year-old son (high functioning autistic) so engrossed in Minecraft, and how can I tell if it is an unhealthy obsession rather than just a fun time activity for him?"

CLICK HERE for the answer...

Potty-Training Children with Autism Spectrum Disorders: Special Considerations

"Any tips on potty training a child with an Autism Spectrum Disorder?"

Potty-training success hinges on physical and emotional readiness, not a specific age. Many children with Autism Spectrum Disorders (ASD) show an interest in toilet-training by age 2, but others might not be ready until age 3 or even older — and there's no rush. If you start toilet-training too early, it might take longer to train your youngster.



Is your ASD youngster ready? Ask yourself these questions:
  • Can your youngster pull down his/her pants and pull them up again?
  • Can your youngster sit on and rise from a potty chair?
  • Can your youngster understand and follow basic directions?
  • Does your youngster complain about wet or dirty diapers?
  • Does your youngster seem interested in the potty chair or toilet, or in wearing underwear?
  • Does your youngster stay dry for periods of two hours or longer during the day?
  • Does your youngster tell you through words, facial expressions or posture when he/she needs to go?

If you answered mostly yes, your youngster might be ready for toilet-training. If you answered mostly no, you might want to wait awhile — especially if your youngster has recently faced or is about to face a major change, such as a move or the arrival of a new sibling. A toddler who opposes toilet-training today might be open to the idea in a few months.

There's no need to postpone toilet-training if your youngster has a chronic medical condition, but is able to use the toilet normally. Be aware that the process might take longer, however.

When you decide it's time to begin toilet-training, set your youngster up for success. Start by maintaining a sense of humor and a positive attitude — and recruiting all of your youngster's caregivers to do the same. 

Next, follow these practical steps:
  1. If your ASD youngster has frequent accidents, absorbent underwear might be best. Keep a change of underwear and clothing handy, especially at school or in childcare.
  1. Some ASD children respond to stickers or stars on a chart. For others, trips to the park or extra bedtime stories are effective. Experiment to find what works best for your youngster. Reinforce your youngster's effort with verbal praise, such as, "How exciting! You're learning to use the toilet just like big children do!" Be positive, even if a trip to the toilet isn't successful. 
  1. After several weeks of successful potty breaks, your youngster might be ready to trade diapers for training pants or regular underwear. Celebrate this transition. Go on a special outing. Let your youngster select "big kid" underwear. Call close friends or loved ones and let your youngster spread the news. Once your youngster is wearing training pants or regular underwear, avoid overalls, belts, leotards or other items that could hinder quick undressing. 
  1. When you notice signs that your youngster might need to use the toilet (e.g., squirming, squatting holding the genital area, etc.) – respond quickly. Help your youngster become familiar with these signals, stop what he/she is doing and head to the toilet. Praise your youngster for telling you when he/she has to go. Teach females to wipe carefully from front to back to prevent bringing germs from the rectum to the vagina or bladder. When it's time to flush, let your youngster do the honors. Make sure your youngster washes his/her hands after using the toilet. 
  1. If your youngster resists using the potty chair or toilet or isn't getting the hang of it within a few weeks, take a break. Chances are he/she isn't ready yet. Try again in a few months. 
  1. Accidents often happen when ASD children are absorbed in activities that — for the moment — are more interesting than using the toilet. To fight this phenomenon, suggest regular bathroom trips (e.g., first thing in the morning, after each meal and snack, before getting in the car, before going to bed, etc.). Point out telltale signs of holding it (e.g., holding the genital area). 
  1. Place a potty chair in the bathroom. You might want to try a model with a removable top that can be placed directly on the toilet when your youngster is ready. Encourage your youngster to sit on the potty chair — with or without a diaper. Make sure your youngster's feet rest firmly on the floor or a stool. Help your youngster understand how to talk about the bathroom using simple, correct terms. You might dump the contents of a dirty diaper into the potty chair to show its purpose, or let your youngster see family members using the toilet. 
  1. If your youngster is interested, have him/her sit on the potty chair or toilet without a diaper for a few minutes several times a day. For males, it's often best to master urination sitting down, and then move to standing up after bowel training is complete. Create a potty-training social story, read a toilet-training book, or give your youngster a special toy to use while sitting on the potty chair or toilet. Stay with your youngster when he/she is in the bathroom. Even if your youngster simply sits there, offer praise for trying — and remind your youngster that he/she can try again later. 
  1. Occasional accidents are harmless, but they can lead to teasing, embarrassment and alienation from peers. If your toilet-trained youngster reverts or loses ground — especially at age 4 or older — or you're concerned about your youngster's accidents, contact his/her doctor. Sometimes wetting problems indicate an underlying physical condition (e.g., urinary tract infection, overactive bladder, etc.). Prompt treatment can help your youngster become accident-free. 
  1. Most ASD kids master daytime bladder control first, often within about two to three months of consistent toilet-training. Nap and nighttime training might take months — or years. In the meantime, use disposable training pants or plastic mattress covers when your youngster sleeps. 
  1. ASD children don't have accidents to irritate their moms and dads. If your youngster has an accident, don't add to the embarrassment by scolding or disciplining him/her. You might say, "You forgot this time. Next time you'll get to the bathroom sooner." 
  1. Have plenty of patience, keep it simple, and make it fun!

2024 Statistics of Autism in Chinese Children

Autism Spectrum Disorder (ASD) has emerged as a significant public health concern worldwide, and China is no exception. As of 2024, new rese...