Adult with autism argues alone at night

By Peter J. Chung, MD
Peter J. Chung, MD

Today’s “Got Questions?” response is by developmental-behavioral pediatrician Peter Chung, of the Center for Autism & Neurodevelopmental Disorders at the University of California, Irvine. The center is one of 13 sites in the Autism Speaks Autism Treatment Network.

My adult son, who has autism, is up all night, walking around the house talking to himself and sounding like he’s arguing. During the day, he's fine and high functioning. Is he coping with loneliness this way? Might this indicate he’s being mistreated by bullies?

Editor’s note: The following information is not meant to diagnose or treat and should not take the place of personal consultation, as appropriate, with a qualified healthcare professional and/or behavioral therapist.

Helping an autistic child that constantly talks to himself or argues at night

Thank you for your question, which I’m sure is shared by many families. I can think of several possible reasons for your son’s behavior.

As always, it’s important to remember that every individual with autism spectrum disorder has his or her own idiosyncrasies and unique habits – as we all do. So while I’m happy to offer some general advice for understanding and addressing your son’s behavior, it’s no substitute for a personal evaluation by a qualified medical and/or behavioral specialist, as I’ll describe more below.

To start, I recommend approaching your son in a calm, non-confrontational way to invite him to talk about his night walking and talking. Keep in mind, he may be keenly aware that his actions are unusual. So he may feel embarrassed or defensive when questioned. If he’s open to talking about this behavior, you and he might gain insights by exploring several questions.

Questions to ask your child

Does he remember his night walking and talking the next day?

Sleep disorders are particularly common among people who have autism. They can include parasomnias, which involve abnormal movements, behaviors, emotions and perceptions while falling sleep, sleeping or waking up. Often, someone with such a sleeping disorder has little or no recollection of their nighttime actions the next day.

If it sounds like this could be the case with your son, I recommend talking with his primary care doctor and/or a sleep specialist about an examination called a polysomnogram. It combines measurements of heart rate, breathing rate, limb movements, oxygen saturation and brainwave activity during a night of sleep to evaluate for sleeping disorders.

The good news is that sleep disorders such as sleepwalking and sleep talking do not cause psychological harm, though sleepwalking can pose physical danger as the person isn’t fully awake.

Good sleep hygiene and a regular sleep schedule can help ease disordered sleep and their associated parasomnias. Sleep specialists in the Autism Speaks Autism Treatment Network have developed several Sleep Tool Kits for children and teens who have autism. I highly recommend these guidebooks, which can be downloaded free of charge.

Research suggests that melatonin, a hormone that regulates sleep-wake cycles, is low in some people with sleeping disorders. I recommend talking with your health-care provider about whether treatment with melatonin might be appropriate. For more information, see the Autism Speaks ATN/AIR-P tool kit Melatonin and Sleep Problems in ASD: A Guide for Parents

Does your son’s nighttime conversations consist of repeated dialogue?

Many people affected by autism like to review conversations to themselves. This can include repeating lines from their favorite movies, TV shows or YouTube channels. We call this “scripting.” Autism scripting a common repetitive behavior that can be a source of comfort when the person is anxious or excited.

In my practice, I see a number of people affected by autism who are aware that their “scripting” is socially inappropriate. So they wait until they are in a private, safe space such as their bedroom or the bathroom – or perhaps in your son’s case, at home after the family has gone to bed.

You may be able to tell if your son is scripting based on whether his dialogue consists of the same exchanges every night. He might also be able to tell you where the conversations come from if he feels comfortable disclosing that information to you. So here again, I encourage you to assure him that he’s not being reprimanded.

Another clue to possible scripting is the quality of his speech when he’s talking at night. Does the speech have a repetitive quality or an unusual cadence to it? Does it sounds different from his usual style of talking?

Scripting isn’t generally a problem as long as it’s not interfering with his daytime work, school and social activities. However, you may need to set limits if it’s interfering with your son – or you – getting sufficient sleep. So I recommend considering whether he’s having trouble staying awake or seems more irritable or unfocused during the day – all signs of sleep deprivation.

If needed, consider using a timer or a visual schedule to indicate when he needs to stop scripting and go to bed. If you can, create a safe space – like a room with calming or soothing belongings and activities – where he can script without disturbing other people in the home.“

How does your son feel about this behavior? Does it make him feel better or more anxious?

It’s possible that your son is processing his emotions and daytime experiences. That is, he might be re-living conversations that he’s had the previous day. Or, he might be rehearsing conversations for future use. If this is the case, his night talking and walking may be an important coping mechanism or a compensatory skill. In other words, this behavior may actually help him interact with his peers during the day.

By contrast, if the night talking increases his stress and anxiety, I think it’s important for your son to be evaluated for several mental health conditions that sometimes accompany autism. These include obsessive-compulsive disorder, schizophrenia, severe depression and psychosis. I encourage you to seek evaluation by mental health professional familiar with autism complicated by these conditions. Again, approaching your son in a non-threatening way is crucial to getting an honest response.

How long has this behavior been present?  Are there any associated changes in daytime behavior?

The possibility of a serious mental health condition is greater if your son’s nighttime habits started abruptly or came with a regression in his self-care or daytime behavior. You don’t seem to indicate this. But again, if you think the self-talking is associated with a change in mood and/or a general decline in function, I encourage a thorough evaluation by a qualified mental health provider.

Along these lines, I suggest talking with trusted individuals who interact with your son during the day. For example, his therapist, teachers, employer or other supervisors. How is he doing at school, work or his other day programs?

On the other hand, if your son has had these nighttime behaviors for six months or more without problems in the rest of his life, I would be reassured that this is not likely due to a serious mental health issue.

Every individual with autism is a complex person with a rich tapestry of strengths, challenges and unique characteristics. I hope that this response is able to help you and your son find ways to help him thrive and enjoy a great quality of life.