Bedtime routines and sleep strategies improve sleep among autistic children

Behavioural sleep problems are common in children with autism spectrum disorder (ASD); however, evidence for the efficacy of behavioural sleep interventions is limited. 

Sleep strategies and simple bedtime routines can improve sleep in autistic children, reducing anxiety and enhancing family wellbeing, reveals Sleeping Sound study.

The  study has been published in the Journal of Child Psychology and Psychiatry,

The largest study of its kind into sleep problems in children on the autism spectrum, led by Monash University’s Professor Nicole Rinehart, found clinician-led behavioural interventions helped kids get a better night’s sleep. And the flow on effects were significant, resulting in better social, emotional and academic functioning in children, and less stress and improved mental health in their parents.

An estimated one in 70 Australians is on the autism spectrum, with 50 to 80 per cent of autistic children also suffering from significant sleep problems.

The Sleeping Sound study, published in the Journal of Child Psychology and Psychiatry, found that behavioural interventions were a practical way of managing sleep problems in autistic children, and could be easily embedded in the Australian healthcare system.

Professor Rinehart’s team engaged 245 autistic children aged between five and 13 years with moderate-to-severe sleep problems. The children and their parents participated in two 50-minute, face-to-face sessions with a paediatrician or psychologist, who prescribed tailored strategies for improving sleep.

The strategies included things like:

. Bedtime fading-temporarily adjusting ‘bedtime’ to the time when the child usually falls asleep and bringing the time forward in 15-minute increments.

. Graduated extinction-weaning the child off the need to have a parent in the room while they fall asleep by instead performing check-ins at regular, decreasing intervals.

. Bedtime pass-granting the child one ‘free’ pass to get out of their room each night.

Importantly, the children were involved in selecting and implementing the strategies; helping them engage with the task and overcome their resistance to change.

The two sessions were followed up by a telephone check-in two weeks later. The researchers found participants had fewer sleep problems three and six months after the sessions, and also noted small improvements in child emotion, behaviour and quality of life, together with parental stress and mental health.

The program built upon the previously successful Sleeping Sound intervention, developed by fellow researchers at the Murdoch Children’s Research Institute. The latest study also involved researchers from Deakin University, University of Melbourne, Sydney University and Monash Health.

Professor Rinehart, director of research at Monash’s Krongold Clinic, said the study showed behavioural sleep interventions could have a significant impact on children and their families.

“The research showed an improvement in not only sleep problems, but also the potential to reduce childhood anxiety. This was an important finding given the enormous impact that anxiety has on a child’s ability to function in everyday life,” Professor Rinehart said.

“We are particularly seeing a spike in sleep and anxiety disorders and school refusal post-pandemic, and so this brief intervention has the potential for wide-ranging positive impacts on children and their families.”

A further study, involving 60 families, is set to start in October via telehealth. The study could pave the way for sleep interventions to be included in telehealth more broadly, following the four-year extension of Medicare-subsidised access to psychological telehealth services, prompted by the pandemic.

“Clinical services delivered via telehealth were a lifesaver for many children and adolescents on the autism spectrum during the Melbourne lockdowns,” Professor Rinehart said.

“With digital healthcare platforms here to stay, we need to urgently harness the potential of this pandemic silver lining by working with the under-served disability community to understand what support they need and how to deliver it most effectively.”


Nicole Papadopoulos, Emma Sciberras, Harriet Hiscock, Katrina Williams, Jane McGillivray, Cathrine Mihalopoulos, Lidia Engel, Matthew Fuller-Tyszkiewicz, Susannah T. Bellows, Deborah Marks, Patricia Howlin, Nicole Rinehart First published: 13 March 2022

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