I have a young child with autism who wakes up in the night and wanders around the house. I’m afraid he might get outside while I’m asleep. How can I keep him safe while the rest of us are sleeping?
Today’s “Got Questions?” response is by pediatric psychologists Melissa Campbell (left) and Elizabeth Pulliam, of Arkansas Children’s Hospital and the University of Arkansas for Medical Sciences.
Thank you for your question. We hear similar concerns from many parents of children who have autism. Research suggests that up to 80 percent of children with autism suffer from disordered sleep. Frequent nighttime wakening is one of the most common issues.
This becomes dangerous when paired with the autism-associated tendency to wander away from safe places. So, your concern is a real one that’s taken seriously by therapists and healthcare providers familiar with these and other autism-associated health conditions.
To start, we want to encourage you to consult with your child’s pediatrician about all sleep concerns, including night awakenings and wandering. Your pediatrician can rule out any medical issues that could be affecting sleep and evaluate whether your child would benefit from seeing a sleep specialist.
At the same time there are some tried-and-true strategies you can take at home to both help your child stay asleep through the night and reduce or prevent wandering.
Fostering better sleep
Autism Speaks has a set of three excellent sleep guides developed by sleep and behavioral experts in the Autism Speaks Autism Treatment Network. You can download them free of charge from the Autism Speaks website.
Download these and other Autism Speaks tool kits for families and health professionals here.
Sleep hygiene strategies
These guides include some basic “sleep hygiene” steps you can take to prepare your child for better sleep and a successful night.
* Make sure your child is getting enough physical activity during the day. This will help them tire and fall asleep better at night. But limit rigorous activity in the hour immediately before bed.
* Limit caffeine (colas, chocolate, etc.), particularly in the afternoon and evening
* Keep a regular and predictable bedtime routine. For instance, a bath, brushing teeth and a bedtime story.
* Dim lights and avoid electronic screens (TV, computer, tablets, smart phones) at least an hour before bedtime. This helps cue your child’s body that it’s time to sleep. This includes the body’s release of melatonin, a hormone that fosters sleep.
* If your child needs some degree of background noise to fall asleep, opt for quiet music, a fan or a white noise machine. Avoid TV.
* Keep a consistent bedtime and wake-up time for your child. When you must stray from these scheduled times, try to avoid doing so by more than an hour. This will help your child’s body stay in rhythm with a solid sleep-wake cycle.
* A good sleep environment is quiet, dark and cool. Even a small light can interrupt quality sleep. If your child prefers to fall asleep with a nightlight, consider one that automatically turns off after a set time. To avoid your child waking up over-heated, turn down the thermostat to around 65 degrees.
* Some children with autism benefit from sleeping with a weighted blanket, which may help them to settle their bodies and feel comforted.
A visual schedule
Many children - and adults – with autism do well with visual schedules. A visual schedule for a bedtime routine can outline the basic steps of the bedtime routine with pictures. Parents can refer to this schedule as they go through the bedtime routine.
Learn more about visual supports and download the Autism Speaks ATN visual supports tool kit here.
For older children who understand concepts of time, 10-minute and 5-minute warnings can ease the transition from play time to bedtime.
Practicing these sleep hygiene strategies can help your child sleep through the night.
When it comes to addressing wandering, we want to keep the goal safety at the forefront. To that end, let’s start with preventing access to things that could harm your child should he wander in the night. Certainly, this includes keeping a child from wandering outside by installing locks and alarms on all external doors and windows.
We do NOT recommended locking children in their rooms, as this can pose a great hazard in an emergency and understandable panic in a child. However, some parents have success with a baby gate across the bedroom doorway for very small children or a secured half-door for somewhat older children.
Here are some outside the bedroom strategies to consider:
* Install door alarms on all outside doors. The alarms need to be loud enough to wake you if your child opens the door. But it can be a simple bell or affordable electronic door alarm from a hardware store that you can easily install yourself.
* Consider installing childproof door handles or door-handle covers on doors to the outside and those that open into rooms that are dangerous for an unsupervised child (e.g. kitchen or basement). If your child is small, you might simply install a sliding chain or deadbolt on these doors at a height above his reach.
* Use solidly secured baby gates at the top and bottom of staircases.
Limit potential dangers
* Place potentially dangerous objects out of sight and out of reach.
* Install child-proof electric socket protectors throughout accessible areas of the house along with cushioned protectors for sharp corners such as those on tables.
* Anchor heavy furniture to the wall to prevent it from falling should your child try to climb it.
When wandering happens
When you become aware that your child is out of bed, calmly but firmly return him to his bed with as little talking or other attention as possible. For young children or children with receptive language difficulties, you may have to physically guide them to their bed.
We don’t recommend bringing your child into your bed as a solution to wandering, as this can further disrupt sleep for both of you.
We know that children with autism are much more likely to wander from home (or other safe places) than are other children. If your child tends to wander away from home or school, it’s important to contact your local law enforcement and provide your child’s name, picture and contact information, along with a clear description of his special needs. Consider having your child wear a medic alert bracelet to notify first responders that your child has autism. Include all your contact information. Watches or bracelets with GPS tracking are another option.
For additional safety tips, first responder alert forms, checklists and other resources and safety materials, please see Wandering Resources page on the Autism Speaks website. These resources include a link to the Autism Wandering Awareness Alerts Response and Education (AWAARE) collaboration, of which Autism Speaks is a member.