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Sleep Problems in Teens on the Autism Spectrum

Question

I'm a single mother and don't know how to deal with my 13 yr old anymore. He doesn't want to go anywhere or do anything which is hard when you have to, and I am now homeschooling him due to trouble going to school. A big problem right now is sleep issues… he is so active at night and tired during the day. At the moment he is not falling asleep till about 1 or 2 am, and I've tried waking him up earlier to reset his body clock but I can't get him out of bed. I don't know how to get him back into a healthy sleep routine.

Answer

Studies find that approximately 73% of kids with ASD level 1 (high-functioning autism) experience sleep problems, and these problems tend to last longer in this group than they do for kids without ASD. For example, kids on the spectrum are more likely to be sluggish and disoriented after waking. Laboratory research has begun to describe the unique physiological presentation associated with sleep problems in kids with ASD, including disruptions in the sleep stage most associated with cognitive functioning (i.e., REM or Rapid Eye Movement sleep). In addition to physiological differences, some of the sleep difficulties in this population may be related to anxiety.

The impact of poor sleep is unequivocal. Poor sleep negatively impacts mood and exacerbates selective attention problems commonly found in kids with ASD, as well as impairing other aspects of cognitive function.
 

There is no one panacea to manage sleep problems in autistic kids. However, there are many interventions that are likely to be helpful. In general, moms and dads need to understand and be prepared for resistance to change that these kids often show. Moms and dads should also be prepared for problems to get worse before they get better as kids often initially challenge but then gradually become accustomed to new routines.

A good place to start an intervention targeted at improving sleep is changing lifestyle behaviors and environmental conditions that can influence sleep/wake patterns. These include exercise, napping, diet, and aspects of the bedroom and sleep routine.

Exercise & Activity—

The goal is decreasing arousal as bedtime approaches. To achieve this it may be useful to have a scheduled period before bedtime (approximately 30-45 minutes) in which the aim is calmness and relaxation. During that period, media such as television, computers, electronic games, and music should be limited as they can stimulate the youngster through activity, sound, and light. 
 
The availability of VCR and DVR technology makes it easier to control when kids can watch particular shows, thereby avoiding conflict over missing favorite programs that are shown in the late evening. The presence of televisions in kid’s bedrooms has been consistently associated with sleep problems and should be avoided at all costs. Likewise, computer access in a youngster’s bedroom is discouraged for sleep as well as for safety reasons.

In general, exercise during the day is associated with better sleep. However, exercise within 2-4 hours of bedtime can lead to difficulties in falling asleep, as it can disrupt the natural cooling process of the body that leads to rest at night. Having the youngster soak their body, particularly their head, in a calm bath that is as warm as can be tolerated 90 minutes before bedtime may be useful too. 
 
When the youngster gets out of the bath, core body temperature will drop rapidly; this is believed to help them to fall asleep faster. Using a waterproof pillow and avoiding the pulsation associated with showers is recommended. The use of progressive muscle relaxation, deep breathing and imagery exercises is the most widely researched treatment for insomnia in kids and may be useful for kids with autism as well.

Napping—

Controlled and limited (e.g., 20-30 minutes) napping is generally positive. However, longer daytime sleeping can be negative in that it makes it more difficult for the youngster to fall asleep at the ideal time in the evening. If the youngster’s sleep problems are associated with falling asleep, which is common for kids on the spectrum, it is advisable to avoid daytime napping.

Diet—

It is recommended that kids with sleep problems avoid all caffeine, alcohol, tobacco, high fat food, and monosodium glutamate (MSG). In contrast, food rich in protein may promote better sleep. Large meals within 2-3 hours of bedtime should also be avoided. A small carbohydrate/protein snack, such as whole wheat bread and low-fat cheese or milk before bedtime can be helpful to minimize nighttime hunger and stimulate the release of neuro-chemicals associated with falling asleep. For kids who often wake during the night to use the bathroom, and then have trouble falling back asleep, limited fluid intake in the 2 hours prior to bedtime is also recommended.

Melatonin is a natural brain hormone associated with sleep onset. There is some evidence that natural production of melatonin may be reduced in these young people on the spectrum. While melatonin supplements may be useful, a common side effect may be increased sluggishness in the morning. As discussed above, this is already a common problem for kids with autism. Use of melatonin and other alternative remedies should be discussed with a physician.
 

The Bedroom—

It is important that the bed and the bedroom are associated with sleep and are not associated with activity. When kids have sleep problems, it is highly recommended that their bed and bedroom activity be limited to sleep only. It is important to make sure that extreme changes in temperature are avoided during the night. 
 
Increasing light is associated with decreases in the release of the neuro-chemical melatonin which triggers sleep onset. Thus, it is important to get the sunlight flowing in the youngster’s room as soon as possible in the morning. Conversely, darkening the room at night is critical. When a youngster’s fear of the dark is an issue, behavioral psychotherapy may be necessary. We also recommend moving the clock so that the youngster is not watching the time while lying in bed.

Sleep Routine—

Setting and maintaining a regular time to sleep and wake may be critical. Moms and dads often make the mistake of allowing their kids to sleep much later on non-school days to “make up” for sleep. While this may be useful to a certain extent, allowing the youngster to sleep late in the day makes it difficult for them to fall asleep at an ideal time later in the evening. It is easier to wake a sleeping youngster then to force an alert youngster to go to sleep. Thus, we recommend that you keep your youngster on a regular schedule on non-school days and avoid drastic changes in the time that the youngster wakes. 
 
Likewise, having your kids go to bed when they are not tired conditions them to be awake in bed. It is recommended that you let your kids stay up until they are tired while maintaining their waking time in the morning. Then once they begin falling asleep within 10 minutes of going to bed, begin to move bed time earlier by 15 minutes at a time.

With carefully monitoring and patience, many moms and dads can make changes in a youngster’s life that promote better sleep. Improved sleep supports better mood, sustained attention and general health. However, for many families professional consultation is often necessary to design or maintain the appropriate intervention. When you need help, speak with other moms and dads of special needs kids about their experiences and ask your primary care doctor for referrals to a sleep expert.
 
More resources for parents of children and teens on the autism spectrum:
 
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COMMENTS:
•    Anonymous said…  She said she was a single mom I assume she has to work to provide... so she may not be able to adjust her schedule... I am single mom of HFA 11yr old with simular issues... and I am debating homeschooling but I am only one person !!!!
 •    Anonymous said… Exactly my thought. We have a 6pm rule. No electronics after that time. Increased his exercise, and it works for us. No drugs needed. X
 •    Anonymous said… Exercise, no electronics on in the house after 6 (a bored brain is a tired one), wake up same time every time with daylight, and same basic diet. We do a fruit/veg/chia smoothie to start the day. My son loves to seek electronics at night (all electronics blocked during certain hrs and collect xbox and remotes every night)
 •    Anonymous said… Go to your GP and try him on Melatonin, a natural hormone that helps us to sleep. We produce it in our bodies but some have less than others hence the difficulty sleeping. It may take a little while to find the right dosage that is agreeable to his body. My son is 13 and is on it. He was like a new born with sleep patterns until he was 6 yrs old. By 11 I was going nuts. He is much better now thank goodness and gets the rest that his body and mind needs to grow and function properly. You may have to restrict the internet/pc use at night and reward him with it during the day only so as to encourage him to sleep at night. The 'blue light' projected from the pc/laptop suppresses the normal secretion of melatonin and doesn't really help ones circadian rhythms. Getting off any electronic devices atleast an hour or two before regular bedtime allows the brain to begin the whole process of slowing down and releasing that melatonin. Look, I for one know that all of this information works but unless we as the parents/carers put it into practise, our kids will never do it. I'm not perfect, some days I forget to give my son his dose at the right time and then he's struggling to wake up at the right time the next morning and so I pay the price with his bad mood and getting to school on time etc. But we all have to start somewhere right? He was doing the school refusal thing last year and not wanting to leave the house or socialise at all. We enlisted the help of a psychologist who specialised in ASD and the school and recommitted to being the driving force behind implementing new routines. Baby steps was and is what it takes at the moment for my son and I. Its so tough for him especially I know, as I'm sure it is for your son but we have to push them out of their comfort zones for them to face challenges and grow from them. How else will they grow and learn? They wont! Plain and simple. Unfortunately its up to us. We become their "Executive Secretaries" as stated in the book "The Complete Guide to Aspergers Syndrome" by Tony Attwood.
 I think I have gone on too much already but I hope you will find what your son needs to help him sleep and learn and grow. Wishing nothing but joy and success for our special Aspies!!!
 •    Anonymous said… i also have a 12 yrs old with similar tendancies. Our Pead told us to avoid any Blue lights (whether that be in ceiling light or of electronics) after 4pm as it over stimulates their brain. I am now also trying reading before bed. I feel your pain
 •    Anonymous said… I could have written this about my (undiagnosed) 11 year old. She also is now totally not Going to school (it's always been an issue but is much worse lately), she doesn't sleep and basically stays up all night every night (sometimes until 5-6am). She gets into bed ok at around11-12 but won't/can't sleep. She is very aggressive verbally and physically towards me almost all of the time and is very anxious. She doesn't go out with her friends or actually talk to them at all anymore. (She's never had tons of friends but now doesn't talk to the ones she did have) I'm also a single mum and have w younger daughter who is really effected by all this. It's so hard! I can't really offer any advice I'm waiting on things happening from the countless referrals that have gone in to community peads, cahms, child psychologist, education physcholigist etc xx
 •    Anonymous said… I guess it doesnt work for everyone. If there is a physical activity or sport that he likes to do then try to do it everyday as it will help use up that 'boy' energy during the day. A bath or warm shower at night, a warm drink, reading some stories, di...See More
 •    Anonymous said… If you're homeschooling anyway flip your schedule to match his. Do schoolin the afternoon. Theres a whole raft of studies about teen boys needing to sleep later. Make wake up time 10am and shift things. If the way everyone else does things isnt working for you and him create your own path.
 •    Anonymous said… I'm not a Dr but have Aspergers girls and their consultants prescribed "Melatonin" it worked a treat to get their bodies back in a sleep routine and we only use it now if required. Hope this helps xx
 •    Anonymous said… I've had similar issues, and since I've started to listen to his feelings, I work around him more now allowing him to sleep in as many days as possible, he is amuck happier boy all round for it 🏻
 •    Anonymous said… Melatonin did nothing for our grand son any thing else
 •    Anonymous said… My 8yr old grandson exactly the same.Wont go to school awake all night and his mum and dad cant get help for him in newzealand its shocking I feel sad for you.
 •    Anonymous said… My Aspie son has just turned 17 and his sleeping patterns starting changing at about 13yrs old. I know how you feel and it's really hard. I'm now told by UK Social that my son is neglected and we can't parent him because we don't enforce his sleeping pattern and he lives for the Internet (it's the only form of Social life the poor boy has!). Can you flipping believe it! I don't know what to suggest tbh, because as you know it's not like parenting our sons when they were little boys where they knew bed time was bed time. It gets so much more challenging.
Maybe go onto "The National Autistic Society" website and go onto the Members Forum (you can browse as a "Guest"). There are so many parents in the same boat trying to manage their Teens through to Adulthood.
 •    Anonymous said… my daughter doesnt go to bed till 1 or 2 am every day.....Melatonin diesnt wirk for her she needed stronger stuff but ended up ODing on perscription stuff....now we just let her stay up and I wake her at 7:45 for school every day
 •    Anonymous said… My daughter had similar sleep pattern issues thru the early teens (although she did lots of drama classes in the evenings so socializing wasn't an issue). All teenagers naturally will stay awake later and sleep in. The beauty of home ed is we can accomodate their changed natural bio rhythms. I treasured my mornings to myself and we did educational stuff in the afternoons/evenings. Is there anything he would like enough to entice him out of the house? Other than saying don't worry, it will pass (it did with my daughter and I miss those precious me time mornings!) I don't know what to advise. But try not to worry too much about the sleep, it is normal and entirely natural during puberty, as is needing more sleep, instead explore ways to get him outside.
 •    Anonymous said… My daughter takes melatonin a half hour before bedtime I give her 4mg in apple juice and she takes it other wise she would be up all night long. She's 12 and has been taking it since she was 2. No more sleep issues ever
•    Anonymous said… My Dr put my son on Clonidine 0.1mg to help him sleep at night otherwise he would be up all night
 •    Anonymous said… My son is 11 and has a similar pattern. He has been on increasing doses of melatonin for 3 yrs. The problem is it us meant to only be given for a month then nothing then for another month, in an attempt to train the body. The breaks just send my son back into vampire mode within days. He was quite sick for a few day so Dr prescribed phenegan for anti nausea. This knocked him out.... you can buy over the counter from Boots, alot if chemists won't sell it to you though. But I found that boots did when I explained my son was aspie and it calmed him down. Understand this is only used when the melatonin is wearing off and body is used to it. I use it maybe once a month just so he gets a decent nights sleep @weekend.
Maybe worth a try as I know many Dr's don't like to prescribe melatonin unless forced. We get all his meds through Camhs xx
 •    Anonymous said… Should talk to you'r doctor about what you can give him to help him sleep.May be you should look into a therapist to go to for help with your son. Has help with me.
 •    Anonymous said… Society imposes routines that aren't fit for all, if he's feeling ok and is willing to take responsibility for himself and things that need to be done then maybe you could be more flexible. I say this because my 13yo son is in a similar position, I worry that he doesn't have a social life but he's much calmer out of school and no longer being bullied. I'm a single parent too and have to leave him home alone while I go to work, but he's safer there than he ever was in school.
 •    Anonymous said… This sounds similar to what we experienced through the middle school years. Puberty is challenging for anyone, seems even more so for young people on the spectrum for some reason. Maybe because there was no go to rule book to reference since most info out there refers to neurotypical teens. It could be depression as well. Hang in there.
 •    Anonymous said… Turn electronics OFF
 •    Anonymous said… Unless you were/are an Aspie teenage with sleep problems, you dont have a clue what its like, it is not their fault REMEBER that! you can feed them all the tablets and chemicals you want but at the end of the day it only masks one of the many issue that we have to deal with, they are not the instigator they are the victim of their own biology.
 •    Anonymous said… we do 3 mgs of Melatonin at night. I was amazed at how much it helped my 7 year old. You can take breaks on weekends and holidays if you want but during the week we use it each night. He even said, "mom! I actually slept last night!!!"
 •    Anonymous said… We use 2 mg Clonidine and 3mg Melatonin for years. It was a life saver!
 •    Anonymous said… We use melatonin 20 minutes before bed with a warning that the tv,electrinics/internet,will be off soon. After 20 minutes we remove tv remotes,game paddles,etc and turn off the lights. Works for us.
 •    Anonymous said… Yes!! This can be a problem. Our teenager must have a sleep aid.
 •    Anonymous said… Yes, melatonin does nothing for my sleepless son also 🙁
Post your comment below…
By

Learning to Parent a Child with a Diagnosis of Autism Spectrum Disorder [Level 1]

“Our son now 6 went for assessment last Friday after a lot of form filling on his history etc. and doing tests with him, they - like me - have come to conclusion he has all the signs of a child with Autism (high functioning). Now that I finally have medical proof of what I have suspected for years, where do I go from here? How can I make his day easier? Basic tasks are major hurdles.”


When moms and dads seek help for their youngster, they encounter varied opinions – he'll outgrow it, leave him alone, it is no big deal, he just wants attention, and so on. Many professionals try to work with the high-functioning autistic youngster as if his disorder is like other disorders, but it is quite different. In most cases, there is a great misunderstanding by many people of the needs of these special individuals.

Diagnosis can be difficult. For the inexperienced, recognizing the defining characteristics of Autism can be difficult, and misdiagnoses are quite common. This is further complicated by the fact that an Autistic youngster or teen has many of the same characteristics found in other disorders. These various characteristics are often misinterpreted, overlooked, under-emphasized, or overemphasized. As a result, a youngster may receive many different diagnoses over time or from different professionals.

For example, if a youngster with Autism demonstrates a high degree of attention deficit hyperactivity disorder (ADHD) - that might be the only diagnosis he receives. However, this is a common characteristic of Autistic kids. The same holds true if obsessive or compulsive behaviors are displayed – the youngster gets labeled with obsessive-compulsive disorder (OCD) instead of Autism.

The following traits are also commonly seen in those with Autism in varying degrees. However, just because these traits are there, it doesn't mean that the youngster should be diagnosed differently; these traits should be noted as significant features of ASD [level 1]:


•    Anxiety
•    Difficulty with pragmatic language skills
•    Hyperlexia (advanced word recognition skills)
•    Motor deficits
•    Oppositional defiant disorder (ODD)
•    Sensory difficulties
•    Social skills deficits

Professionals who do not have much experience with Autism have a hard time identifying the defining characteristics. For example, social skill deficits may be noted by a professional, but then they are often downplayed because the youngster or adolescent appears to be having appropriate conversations with others or seems to be interested in other people. But with an Autistic youngster, the conversations are not generally reciprocal, so the youngster must be carefully observed to see whether or not there is true back-and-forth interaction. Also, many Autistic kids have an interest in others, but you need to clarify if the objects of their interest are age appropriate. Do they interact with peers in an age-appropriate fashion? Can they maintain friendships over a period of time or do they end as the novelty wears off? These are the types of observations and questions that must be asked in order to ensure a proper diagnosis.

==> How to Prevent Meltdowns and Tantrums in Children with Autism Spectrum Disorder

Another example of an overlooked area is the narrow routines or rituals that are supposed to be present. This does not always manifest as obsessive-compulsive behavior in the typical sense, such as repeated hand washing or neatness, but rather in the insistence on the need for rules about many issues and situations. These kids may not throw tantrums over their need for rules, but may require them just as much as the person who has a meltdown when a rule is violated. In essence, there is no single profile of the typical Autistic individual. They are not all the same.

Because of these subtleties and nuances, the single most important consideration in diagnosis is that the person making the initial diagnosis be familiar with autistic spectrum disorders. They should have previously diagnosed numerous kids. To make a proper, initial diagnosis requires the following:

1. An evaluation by an occupational therapist familiar with sensory integration difficulties may provide additional and valuable information.

2. It is important to include a speech and language evaluation, as those with Autism will display impairments in the pragmatics and semantics of language, despite having adequate receptive and expressive language. This will also serve to make moms and dads aware of any unusual language patterns the youngster displays that will interfere in later social situations. Again, these oddities may not be recognized if the evaluator is not familiar with Autism.

3. The youngster should see a neurologist or developmental pediatrician (again, someone familiar with autistic spectrum disorders) for a thorough neurological exam to rule out other medical conditions and to assess the need for medication. The physician may suggest additional medical testing (blood, urine, fragile X, hearing).

4. You (both moms and dads) and your youngster should have sessions with a psychologist where your youngster is carefully observed to see how he responds in various situations. This is done through play or talk sessions in the psychologist's office and by discussions with both moms and dads. The psychologist may ask you to complete checklists or questionnaires to gain a better understanding of the youngster's behaviors at home and/or school. If the youngster is in school, the psychologist may call the youngster's teacher or ask her to complete additional checklists. The checklists or questionnaires used should be ones that are appropriate for individuals with Autism. It is important to determine the IQ level of your youngster as well. An average or above-average IQ is necessary for a diagnosis of Autism.

==> How to Prevent Meltdowns and Tantrums in Children with Autism Spectrum Disorder

O.K. My youngster has been diagnosed with ASD – so now what?

Parenting kids displaying Autism characteristic behavior will often require an approach which is somewhat unique to that of other kids. Finding the balance between understanding the needs of a youngster with Autism and discipline which is age appropriate and situationally necessary is achievable when applying some simple but effective strategies. These strategies can be implemented both at home and in more public settings.

General Behavior Problems—

Traditional discipline may fail to produce the desired results for kids with Autism, primarily because they are unable to appreciate the consequences of their actions. Consequently, punitive measures are apt to exacerbate the type of behavior the punishment is intended to reduce, whilst at the same time giving rise to distress in both the youngster and parent.

At all times the emotional and physical well-being of your youngster should take priority. Often this will necessitate removing your youngster from a potentially distressing situation as soon as possible. Consider maintaining a diary of your youngster's behavior with a view to ascertaining patterns or triggers. Recurring behavior may be indicative of a youngster taking some satisfaction in receiving a desired response from peers, moms and dads or teachers.

For example, a youngster with Autism may come to understand that hurting another youngster in class will result in his being removed from class, notwithstanding the associated consequence to his peer. The solution may not be most effectively rooted in punishing the youngster for the behavior, or even attempting to explain the situation from the perspective of their injured peer, but by treating the root cause behind the motivation for the misbehavior...for example, can the youngster be made more comfortable in class so that they will not want to leave it?

==> Parenting System that Reduces Defiant Behavior in Teens with Autism Spectrum Disorder

One of the means to achieve this may be to focus on the positive. Praise for good behavior, and reinforcement by way of something like a Reward Book, can assist. The use of encouraging verbal cues delivered in a calm tone are likely to elicit more beneficial responses than the harsher verbal warnings which might be effective on kids who are not displaying some sort of Autistic characteristic. If necessary, when giving directions to cease a type of misbehavior, these should also be couched as positives rather than negatives. For example, rather than telling a youngster to stop hitting his brother with the ruler, the youngster should be directed to put the ruler down.

Obsessive or Fixated Behavior—

Almost all kids go through periods of development where they become engrossed in one subject matter or another, but kids with Autism often display obsessive and repetitive characteristics, which can have significant implications for behavior.

For example, if an Autistic youngster becomes fixated upon reading a particular story each night, theymay become distressed if this regime is not adhered to, or if the story is interrupted. Again, the use of a behavior diary can assist in identifying fixations for your youngster. Once a fixation is identified, it is important to set appropriate boundaries for your youngster. Providing a structure within which your youngster can explore the obsession can assist in then keeping the obsession within reasonable limits, without the associated angst which might otherwise arise through such limitations. For example, tell your youngster that they may watch their favorite cartoon for half an hour after dinner, and make clear time for that in their routine.

It is appropriate to utilize the obsession to motivate and reward your youngster for good behavior. Always ensure any reward associated with positive behavior is granted immediately to assist the youngster recognizing the nexus between the two.

A particularly useful technique to try to develop social reciprocity is to have your youngster talk for five minutes about a particularly favored topic after they have listened to you talk about an unrelated topic. This serves to help your youngster understand that not everyone shares their enthusiasm for their subject matter.

==> Parenting System that Reduces Defiant Behavior in Teens with Autism Spectrum Disorder

Bridging the Gap Between ASD and Discipline and Other Siblings—

For siblings without the disorder, the differential and what at times no doubt appears to be preferential treatment received by an Autistic sibling can give rise to feelings of confusion and frustration. Often, they will fail to understand why their brother or sister apparently seems free to behave as they please without the normal constraints placed upon them.

It is important to explain to siblings or peers of Autistic kids and encourage open discussion about the disorder itself. Encouragement should extend to the things siblings can do to assist the Autism youngster, and this should be positively reinforced through acknowledgement when it occurs.

Sleep Difficulties—

Autistic kids are known to experience sleep problems. Kids on the spectrum may have lesser sleep requirements, and as such are more likely to become anxious about sleeping, or may find they become anxious when waking during the night or early in the morning.

Combat your youngster's anxiety by making their bedrooms a place of safety and comfort. Remove or store items which might be prone to injure your youngster if they decide to wander at night. Include in the behavioral diary a record of your youngster's sleep patterns. It may assist your youngster if you keep a list of their routine, including dinner, bath time, story and bed, in order to provide structure. Include an image or symbol of them waking in the morning to provide assurance as to what will happen. Social stories have proven to be a particularly successful tactic in decreasing a youngster's anxiety by providing clear instructions on how part of their day is likely to play out.

==> Unraveling the Mystery Behind High-Functioning Autism: Audio Book

At School—

Another Autistic characteristic is that kids will often experience difficulty during parts of the school day which lack structure. If left to their own devices their difficulties with social interaction and self-management can result in anxiety. The use of a buddy system can assist in providing direction, as can the creation of a timetable for recess and lunch times. These should be raised with class teachers and implemented with their assistance.

Explain the concept of free time to your youngster, or consider providing a separate purpose or goal for your youngster during such time, such as reading a book, or helping to set up paint and brushes for the afternoon tasks.

In Public—

Kids with Autism can become overwhelmed to the point of distress by even a short sojourn in public. The result is that many moms and dads with Autism simply seek to avoid as much as possible situations where their youngster is exposed to the public. While expedient, it may not offer the best long-term solution to your youngster, and there are strategies to assist with outings.

Consider providing your youngster with an iPad, or have the radio on in the car to block out other sounds and stimuli. Prepare a social story or list explaining to the youngster a trip to the shops, or doctor. Be sure to include on the list your return home. Consider giving your youngster a task to complete during the trip, or having them assist you. At all times, maintaining consistency when dealing with Autism and discipline is key. It pays to ensure that others involved in your youngster's care are familiar with your strategies and techniques, such as those outlined above, and are able to apply them.

Most importantly, don't hesitate to seek support networks for other moms and dads, and take advantage of the wealth of knowledge those who have dealt with the disorder before you. The assistance you can gain from these and other resources can assist you in developing important strategies to deal with problems with ASD [level 1] in a manner most beneficial to your youngster.

 

More resources for parents of children and teens on the autism spectrum:
 
By

Rituals and Obsessions in Children with ASD [Level 1]

Question

I work with a young boy with ASD, and we (the parents and I) are looking for ways to help the child with repetitive (perseverative) thoughts, i.e., he wants to know what his snack is for school. He will ask his mom, his mom will tell him, then he will ask again while getting dressed, then ask again while getting on the bus, then he screams from the bus window, "what’s for snack today?", then the school nurse will call and say he needs to talk to Mom or Dad because he needs to ask again.

Answer

You’re referring to obsessive thoughts. Rituals and obsessions are one of the hallmarks of ASD [High-Functioning Autism]. In order to cope with the anxieties and stresses about the chaotic world around them, kids often obsess and ritualize their behaviors to comfort themselves. 
 
While some kids may spend their time intensely studying one area, others may be compulsive about cleaning, lining up items, or even doing things which put them or others in danger.
 

How to deal with an ASD child's obsessions:

1. Be prepared for resistance by arming yourself with suggestions and alternatives to your youngster's behavior. A great way of doing this is by creating a "social story". Carol Gray's Social Stories site is a great resource for parents and educators alike to create books which will modify behavior in kids with autistic spectrum disorders.

2. Choose your battles wisely. Breaking an obsession or ritual is like running a war campaign. If not planned wisely or if you attempt to fight on many fronts, you're guaranteed to fail. Not only is it time consuming and tiring, it means you can't devote 100% to each particular area. 
 
So, if you have a youngster with a game obsession, a phobia of baths and bedtime troubles, choose only one to deal with. Personally, and I have had that choice, I dealt with the bedtime troubles. Using logic, a sleep deprived youngster certainly isn't going to deal with behavioral modification in other areas well. Plus, it was having an effect on his overall health. Deal with the worst first!
 

3. Communicate with your youngster to explain the effect that his or her ritual is having on your family as a whole. My son's 2am wake-up calls were affecting me mentally, emotionally and physically, and I told him so. I pulled some research off the internet about sleep needs and discussed this with him.

4. Speak to professionals for advice. Contact your pediatrician for recommendations for behavior therapists. Your local parent support groups and national associations, such as the National Autistic Society, will not only provide you support but the information you need to move forward with your youngster.

5. When breaking an obsession or ritual, examine the ways that you may have fed into this. With my son's bedtime activities, I found I was too tired to fight his waking up at 2am. While dealing with this ritual, I ensured I was in bed early myself so I had enough sleep in me to knock his night owl tendencies on the head.

6. When tackling any problem with any youngster, ASD or not, it's always best to remain calm at all times. Kids can feed off your anger, frustration and anxiety, so keeping a level head at all times is essential. If you feel a situation is escalating and elevating your blood pressure, take a step back and collect yourself.

 
More resources for parents of children and teens on the autism spectrum:
 

COMMENTS:

•    Anonymous said… Can anyone advise when a child is fixated on a place eg the park, they will ask from the min they wake all day long. This is usually only resolved by going to the park or trying to reason that another day/time would be better. Tia.
•    Anonymous said… Can he take/pack his own snack and bring it in? He would have more control and might help him feel less anxious..?
•    Anonymous said… Draw a pic of snack
•    Anonymous said… I think this sounds like ADHD. He is not holding onto the information long enough to understand its meaning. I say don't make more work for yourself or the parents. Allow him to choose his snacks at the grocery store and pack them himself every morning.
•    Anonymous said… It's his routine,comfort, his way of processing that he is on way to school and maybe not very able to cope with that.
My son will say every night 'are you coming in afterwards'.
He knows I will come in as soon as I've read my younger daughter he story. And I tell him. But he has to ask. It's just what he does. Much to everyone's annoyance...that's his routine. Maybe it's because he needs me to say it to settle in his bed? Maybe he is checking? Maybe it's his comfort?
But, he asks every night and that's that!
•    Anonymous said… My son gets stuck on getting things he wants ie video games . He will basically badger us over and over about the thing he wants. When he earns it he will move onto something else he wants. I am not sure if this is bipolar mixed with Aspergers?
•    Anonymous said… Some good ideas here. You could also try giving limits to when he can ask and then reducing the number to once. So he can ask 3 times before school and no more. Then reduce to twice then once. All with the rule clearly stated and warning of it reducing. I found limiting things very effective. It may be the asking that is the obsession rather than the snack itself. Good luck.
•    Anonymous said… Take a picture and print it off
•    Anonymous said… Take a picture of his snack with his cell phone or tablet. Of he doesn't have one, plan ahead, take a picture of it, print it and let him put it in his pocket or put it in a lanyard with his lunch card. That way he can look at it for the answer.
•    Anonymous said… This is when I worry a child will be misdiagnosed with OCD. He can't process his snack for some reason, it's not obsession. The ideas above to help him process are great ideas.
•    Anonymous said… Try writing it on sticky notes and post them in the places he usually asks, his bedroom, bathroom, and kitchen. Also give him a note for his pocket too. I had to do this for my son and when he would ask, I would just point to the note. He got to the point where he would look for the note instead of asking. I also like the picture idea. My son was/is very visual. He remembers better if he can see the actual item. Hope this helps.
•    Anonymous said… We also take pics of things she needs to part with so she can look at them anytime (iPad) no clutter!
•    Anonymous said… We went thru this in second grade and started using a see through bag so he could learn to how to find the answer in his own. Worked like a charm. Keep laughing it helps
•    Anonymous said… Write it down for him and stick it in his pocket.Beware and prepare him that it could change if they are out of said snack.I get around the time thing like that.Ex.....I plan to be there at 12:00 but it could be 12:ish......ish is my favorite thing to add because it builds flexibility.

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How to Diffuse Meltdowns in a Child on the Autism Spectrum

Question

I'm looking for some ways to diffuse a meltdown, and what I should do after its over …my daughter screams, cries, swears at me …tells me she hates me and I’m the worst mum. I am getting better at not getting angry back, but it seems to enrage her more when I don't react... It leaves me mental drained... I feel the more this happens the more I don't feel the mother daughter connection (it sounds so awful). I love her, but I just want my little girl back.

Answer

The visible symptoms of meltdowns are as varied as the high-functioning autistic kids themselves, but every parent is able to describe their youngster’s meltdowns behavior in intricate detail.

Meltdowns can be short lived, or last as long as two hours. They can be as infrequent as once a month (often coinciding with the lunar cycle/full moon) or occur as frequently as 4-6 times a day.

Whatever the frequency and duration, an autistic youngster having meltdowns is difficult for parents/care-givers/teachers to deal with.

Meltdowns in autistic kids are triggered by a response to their environment. These responses can be caused by avoidance desire, anxiety or sensory overload. Triggers need to be recognized and identified.
 

So how do we deal with meltdowns? What should you do when meltdowns occurs?

An adults’ (parents/care-givers/teachers) behavior can influence a meltdown’s duration, so always check your response first.

1. Calm down
2. Quiet down
3. Slow down
4. Prioritize safety
5. Re-establish self-control in the youngster, then deal with the issue

1. Take 3 slow, deep breaths, and rather than dreading the meltdowns that’s about to take place, assure yourself that you’ve survived meltdowns 1000 times before and will do so this time too.

2. Keep your speaking voice quiet and your tone neutrally pleasant. Don’t speak unnecessarily. Less is best. Don’t be “baited” into an argument. (Often autistic kids seem to “want” to fight. They know how to “push your buttons”, so don’t be side-tracked from the meltdowns issue).

3. Slow down. Meltdowns often occur at the most inconvenient time e.g. rushing out the door to school. The extra pressure the fear of being late creates, adds to the stress of the situation. (Autistic kids respond to referred mood and will pick up on your stress. This stress is then added to their own.) So forget the clock and focus on the situation. Make sure the significant people in your life know your priorities here. Let your boss know that your youngster has meltdowns that have the capacity to bring life to a standstill, and you may be late. Let your youngster’s teacher know that if your youngster is late due to meltdowns that it’s unavoidable, and your youngster shouldn’t be reprimanded for it.

4. Prioritize safety when your youngster is having meltdowns. Understand that they can be extremely impulsive and irrational at this time. Don’t presume that the safety rules they know will be utilized while they’re melting down. Just because your youngster knows not to go near the street when they are calm doesn’t mean they won’t run straight into 4 lanes of traffic when they are having a meltdowns. If your child starts melting down when you’re driving in the car, pull over and stop. If your youngster tends to “flee” when melting down, don’t chase them. This just adds more danger to the situation. Tail them at a safe distance (maintain visual contact) if necessary.

5. When your kiddo is calm and has regained self-control, he will often be exhausted. Keep that in mind as you work through the meltdowns issue. Reinforce to your youngster the appropriate way to express their needs/requests.
 

Remember that all behavior is a form of communication, so try to work out the ‘message’ your youngster is trying to convey with their meltdowns, rather than responding and reacting to the behavior displayed.

Ways to help your autistic youngster calm down:

1. Another effective mediation method is to have the youngster sit or lay down with eyes closed and visualize a scenario that the youngster chooses. It should be something that is comforting to the youngster such as a fun vacation or a day at the park. Talk the youngster through the meditation and tell the youngster to feel as if the scenario is actually happening. Have the youngster picture him or herself interacting with other kids in a positive manner. This will plant the idea into the subconscious and can help with the youngster's actual peer relationships.

2. Establish a certain time as quiet time. This can be after dinner a little before bed time. Kids with autism like routines and this is a good way to help him or her to get used to settling down for the evening. The youngster can read or draw or write his or her thoughts during this time. Writing can be very effective in helping the youngster learn self expression.

3. Have the youngster listen to classical or soft music. Just having this type of music playing in the background at home can create a sense of calm.

4. Have the youngster meditate. There are two ways to do this. One way is to have the youngster sit or lie down with eyes closed and take long slow deep breaths in through the nose and hold his or her breath for four seconds and then slowly exhale through the mouth. You can guide your youngster through this by saying, "Take a long, slow deep breath in through your nose, hold, hold, hold, hold your breath. Now slowly breathe out through your mouth." Try this for ten minutes either right before bed time or first time in the morning.

   
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How to Avoid "Negative Reinforcement": Tips for Parents of Children with ASD


Negative reinforcement requires the child to work for the removal of an in-place, unpleasant consequence. The child's goal is to get rid of something that is unpleasant rather than to earn something that is desirable. In a negative reinforcement model, instead of working to earn a positive consequence, the child works to distance himself from an aversive consequence.

Negative reinforcement is often used by parents to manage problem behaviors in their child with ASD level 1 or High-Functioning Autism. Teachers inadvertently pay attention to the child who may not be complying and withdraw their attention contingent on the child's compliance. Surprisingly, this strengthens rather than weakens the noncompliant behavior.

The next time a similar situation occurs, the child again will not comply until confronted with the aversive consequence (i.e. the parent’s attention). Negative reinforcement is often seductive and coercive for moms and dads. It works in the short run, but in the long run, is likely to strengthen rather than weaken the undesirable behavior.
 
==> How to Prevent Meltdowns and Tantrums in Children with Autism Spectrum Disorder

Behaviors that in-and-of themselves may not be negative become negative reinforcers when paired with certain events. For example, the parent approaching her child who is not doing his homework becomes a negative reinforcer, even though the action itself (i.e., the parent walking up to the child) does not have a negative connotation.

Researchers found that negative reinforcement was rated by parents as the most frequently used behavior intervention. Kids with autism often experience negative reinforcement because of their temperament, which makes it difficult for them to complete tasks – their consequent learning history reinforces them for beginning, but rarely for finishing.

A number of simple, effective ways exist to deal with this problem. If you, the parent, are using negative reinforcement, pay attention to your child until the homework or chore is completed. Although this too is negative reinforcement, it teaches the child that the only way to get rid of the aversive consequence (i.e., your attention) is not just to start – but to complete the task at hand. As an example, when homework is to be completed, you may move your child's study area to the room you will be in until that particular piece of work is completed.

A second alternative involves the use of differential attention or ignoring. The term differential attention applies when “ignoring” is used as the negative consequence for exhibiting the undesirable behavior and “attention” is used as a positive consequence for exhibiting the competing desirable behavior. This is an active process in which the parent ignores the child engaged in an ‘off-task’ activity, but pays attention immediately when he or she begins working.

Many parents avoid interaction with their youngster when she is ‘on-task’ for fear of interrupting her train of thought. It is important, however, to reinforce the child when working so that a pattern of working to earn positive reinforcement rather than working to avoid negative reinforcement is developed.

Moms and dads need to make a distinction between ‘off-task’ behavior that ‘disrupts’ and ‘off-task’ behavior that ‘does not disrupt’. Differential attention works effectively for the latter. However, when the child is ‘off-task’ and disturbing his sibling, you may find that being a negative reinforcer holds an advantage in stemming the tide of an ‘off-task’ behavior that involves other children as well.

Differential attention alone has been demonstrated to be ineffective in maintaining high rates of ‘on-task’ behavior and work productivity for kids with HFA and AS. Many factors other than parent-attention maintain and influence child behavior.
 
==> Parenting System that Reduces Defiant Behavior in Teens with Autism Spectrum Disorder

Differential attention is a powerful intervention when used appropriately. Once the strategy of ignoring inappropriate behavior is employed, it must be continued despite escalation. If not, the parent runs the risk of intermittently reinforcing the negative behavior, thereby strengthening its occurrence.

For example, if you decide to use differential attention for your child's out-of-seat behavior while at the dinner table, but become sufficiently frustrated after he is out of his seat for 10 minutes and respond by directing attention to him, the behavior will be reinforced rather than extinguished. The 10 minutes of ignoring will quickly be lost in the one incident of negative attention. If the parent shouts, "You need to sit down!" …the child has received the desired attention by persisting in a negative behavior.

Researchers have evaluated rules, praise, and ignoring for inappropriate behavior in kids on the autism spectrum. Inappropriate behavior decreases only after praise is added. These “special needs” kids perform as well as “typical” kids with a continuous schedule of reinforcement, but perform significantly worse with a partial schedule of reinforcement (e.g. reinforcement is provided only sometimes), which is typically found in most homes.

Praise is important for the development of other attributes (e.g., self-esteem, general attitude, motivation toward academics, etc.). In addition, the opposite is also true: A large amount of punishment can negatively affect emotional development and self-esteem.


Resources for parents of children and teens on the autism spectrum:
 

==> Videos for Parents of Children and Teens with ASD
 
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