Sleep Help for Children with Autism/ADHD

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Sleep Help for Children with Autism/ADHD

Healthylife Pharmacy24 November 2017|4 min read

Sleep problems are common in autism spectrum disorder (ASD) and attention deficit hyperactivity disorder (ADHD). Poor sleep quality and lack of sleep worsens daytime behaviour and core symptoms of ASD and ADHD, but also contributes to parental stress levels.

The biggest sleep problems in these groups include:

  • Difficulty falling asleep
  • Waking frequently throughout the night
  • Restlessness and poor sleep quality
  • Inconsistent sleep routines
  • Waking early in the morning

Autism and ADHD

Attention Deficit Hyperactivity Disorder (ADHD) and Autism Spectrum Disorder (ASD) are among the most prevalent neurodevelopmental disorders. ADHD is characterized by deficits in attention, organization, activity levels and impulse control and is classified into three subtypes—inattentive, hyperactive/impulsive and combined presentation. 


Autism spectrum disorder is characterized by persistent deficits in social communication and interaction across multiple contexts (deficits in social-emotional reciprocity, non-verbal communication and developing relationships), as well as restricted, repetitive patterns of behaviour, interests, or activities.

Children and adolescents with ADHD are found to have a variety of sleep problems. 

Autism/ADHD and sleep

Sleep onset insomnia (taking a long time to fall asleep) is among the most common sleep problem in ASD and ADHD. In ASD several studies have also reported sleep maintenance insomnia, shortened sleep time, bedtime resistance and sleep related anxiety as common issues. While there have been reports of parasomnias such as sleepwalking, nightmares, night terrors, and night time crying, these appear to be less prevalent in children with ASD. On the other hand, night time disruptive behaviours such as grunting, laughing, and head banging are more common in these children.

Research has found that ADHD is associated most commonly with sleep onset insomnia, bedtime anxiety, intermittent awakenings, sleep-related disordered breathing, parasomnias and daytime sleepiness or napping.

Why does this occur?

Sleep problems in ADHD and ASD appear to be multifactorial and it is speculated to be an expression of the intrinsic deficits of these disorders. However, given the similarities in the nature of sleep problems in each disorder and their increased severity in combined ADHD and ASD, common underlying reasons may include the following:


Circadian rhythm disorders—melatonin is a hormone produced by the pineal gland which is responsible for circadian physiology, particularly in sleep initiation and maintenance.

It is believed that alterations in melatonin and reduced serotonin activity are responsible for insomnia-related disorders in ASP and ADHD.

Environmental factors – such as exposure to light, meal times, social cues and bedtime rituals play a significant role in the initiation of sleep.

It is observed that children with ASD and ADHD have faulty transmission of entrainment cues, disorganized behaviours, and an inability to transition from state of stimulus-seeking alertness to the passive state of sleep.

Medications, such as stimulants used to treat symptoms of hyperactivity/impulsivity or anxiety may also worsen sleep issues.

Obstructive sleep apnea (OSA) and sleep disordered breathing (SDB)—these conditions are more prevalent in ADHD and ASD than in the normal population. Studies have indicated that the presence of SRBD has a significant impact on the worsening of the core symptoms of ADHD and ASD.

Parasomnias— the cause of parasomnias in ADHD and ASD is complex, but is largely related to increased fragmentation of sleep, changes in non-Rapid Eye Movement NREM sleep and rarity of REM sleep. The behaviours suggestive of parasomnias often include night-terrors, waking up confused or screaming, increased motor activity (sleepwalking) and enuresis (bedwetting).

What can help better sleep?

Suggestions to improve sleep quality and time for kids with ASD and ADHD include:

  • Setting a regular sleep-wake schedule
  • Implementing a calming bedtime routine
  • Having a structured transition to sleep
  • Avoidance of caffeine (soft drink, coffee, tea and chocolate)
  • Use the bed only for sleeping and
  • Consistent place/bed for sleeping
  • Avoid naps, exercise, large amounts of water and electronic media soon before bedtime

Other things to consider include light in the room, external noises and the comfort of bedding and pyjamas. The use of weighted blankets or specific tools such as ball blankets have been shown to reduce sleep onset latency, intermittent awakenings and individual variability in sleep parameters.

L-theanine

L-theanine is an amino acid isolated from green tea. It has the ability to reduce anxiety and induce relaxation.


It achieves this by upregulating GABA and modulating serotonin and dopamine levels in the brain. Clinical studies involving adults and children with ADHD who took L-theanine experienced improved sleep efficiency, less wakefulness after sleep onset and reduced morning fatigue.

Another major benefit of L-theanine is enhanced cognitive performance.

Magnesium

Magnesium assists in reducing anxiety and promoting sleep. It is involved in the methylation of serotonin to make melatonin, playing a role in sleep quality. It may also reduce restlessness of the body and mind during sleep. As well as supplementation, magnesium can be added to baths or applied topically.

Nervine herbs

Herbs such as chamomile, passionflower, lemon balm and valerian have been traditionally used in children to promote calm behaviour and restful sleep. They could be given as a warm tea, sweetened with stevia or xylitol after dinner. For older children a tablet can be crushed and a smaller dosage added to food or drink.

References

Singh K, Zimmerman AW. Sleep in Autism Spectrum Disorder and Attention Deficit Hyperactivity Disorder. Semin Pediatr Neurol. 2015 Jun;22(2):113-25 https://www.ncbi.nlm.nih.gov/pubmed/26072341

RamtekkarUP.DSM5 Changes in Attention Deficit Hyperactivity Disorder and Autism Spectrum Disorder: Implications for Comorbid Sleep Issues. Children (Basel). 2017 Jul 27;4(8) https://www.ncbi.nlm.nih.gov/pubmed/28749421

Lyon MR1, Kapoor MP, Juneja LR. The effects of L-theanine (Suntheanine®) on objective sleep quality in boys with attention deficit hyperactivity disorder (ADHD): a randomized, double-blind, placebo-controlled clinical trial. Altern Med Rev. 2011 Dec;16(4):348-54 https://www.ncbi.nlm.nih.gov/pubmed/22214254

Hechtman L (2014). Clinical Naturopathic Medicine. Churchill Livingstone, Australia