How can we reduce problems with sleep?

Many children (and parents) struggle with establishing a regular, healthy sleep routine. This is especially true when our children have additional needs because they often have dysregulations in their neurotransmitter levels or are particularly sensitive to external stimuli. They may also be affected by circadian rhythm disorders or be genetically predisposed to certain sleep issues.

We’re going to consider the main ways we can help our children get in to a regular sleeping pattern and to make sure they are getting good quality, restorative sleep.

Environmental Factors

Behavioural Solutions

Natural & Herbal Sleep Solutions

Melatonin

Melatonin is one of the things I’m most asked about by sleep-deprived parents. Some consultants will prescribe liquid or tablet melatonin supplements. Some parents choose to order if over the internet from place such as Biovea, but others prefer to try to increase the melatonin levels naturally. Here are some of the best way to do so, according to Our Paleo Life:

There are many things one can do to naturally increase melatonin levels without supplements. The biggest one has to do with lights.

1. Take A Break From Technology

The best way to repair your circadian rhythm, experts say, is to stop using technology for a prolonged period of time. One week was found to be the perfect amount of time to normalize sleeping patterns for a group of participants who were asked to go camping for a week.

You can try to not touch any technology at home for a week but let’s face it, in today’s world it is nearly impossible to avoid technology at home. Even if you don’t want to watch TV, your spouse or your children might and that’ll tempt you to watch too.

The best solution is to plan a getaway for the whole family and turn off all the technology. If you must use it, designate only one or two hours in the middle of the day for it. Plus, leaving technology behind is a great way for the family to bond face to face.

2. Start Dimming Lights Early

Most people make the mistake of thinking melatonin starts when they turn off the lights to go to sleep, but this is not true. Melatonin levels increase when your body starts to sense there is less light.

What you can do to aid this process is by dimming the lights in your house and bedroom earlier. At least one hour before bedtime, start to turn off the lights in the house that you do not need and only leave on the ones that are crucial.

If you only have one light in your bedroom, consider getting a desk lamp or installing a light

dimmer so you can control the amount of light you can have in your room. By reducing the intensity of the light in your house way before bedtime, you’ll be signaling to your body to get ready for bed and this should help the chemicals going.

3. Reduce Exposure to Blue Lights Before Bed Time

We’re all guilty of this. Scrolling through our phones before bedtime but this is probably one of the worst sleeping habits anyone can have. The blue light emitted from your phone screen is distinctly harmful to melatonin production.

It’s not easy to put away the phone though, we know. What we suggest is for you keep the phone outside of your bedroom. Leave it charging in the kitchen or in the living room and let your friends and family know that you are trying to reduce phone usage before bedtime so they don’t call unless it’s an emergency.

Also: pro tip – blue blocking glasses at night. Check out Amazon for a bunch of options.

4. Cut Back on Social Media

Similar to point number three, social media is one of the reasons why many people are addictedto their cell phones and computers. If you find yourself scrolling through social media for hours before bedtime, stop.

5. Eat A Healthy Diet

While this seems like a generic piece of advice, a healthy diet is crucial to better sleep. In fact, did you know all plants have a certain amount of melatonin in them? That’s because plants, like us, also rely on light to grow.

Foods that have a high amount of naturally occurring melatonin are:

  • Tart cherries
  • Asparagus
  • Tomatoes
  • Sweet potato
  • Pomegranate
  • Olives
  • Nuts and seeds

Foods that are rich in tryptophan, magnesium, calcium, and B6 are also known to promote sleepiness.

6. Increase Relaxation

Another way to induce sleepiness at night is to increase relaxation and this could mean different things for different people. For example, music might relax one person but might stimulate another.

Here’s some ideas:

  • Take a bath
  • Essential oil diffuser
  • Play soothing music
  • Use a sound machine that plays white noise
  • Drink non-caffeinated herbal tea
  • Stretch
  • Search, Ponder and Pray

Anxiety & sleep

The last point on that list is very important for our children. Many of them struggle with anxiety and/or depression. Being able to process their emotions and anxieties can have a dramatic affect on the quality of their sleep.

The Therapist’s Aid website has some great worksheets, so does Twinkl.

Have a look at our previous post about anxiety workbooks and worry eaters if you feel anxiety is an issue for your child or young person.

Do you have any sleep management tips you’d like to share with other parents? Let us know in the comments!

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The impact of sensory processing issues and how to help

Sensory processing issues are a common comorbidity of neurodevelopmental disorders such as autism and ADHD. But what does the term ‘sensory processing’ actually mean and how does it manifest? How can we help our children when they are suffering from sensory overload or sensory-craving to the point of injuring themselves?

Some children receive a diagnosis of Sensory Processing Disorder (SPD). In the UK, this is usually diagnosed after an assessment with Occupational Therapy or Peadiatrics. However, in this article, we will use the more generic term of ‘sensory processing issues’ or ‘sensory processing difficulties’ because many children are affected by sensory dysregulation but don’t have a specific diagnosis of SPD.

What do these terms mean?

Hypersensitive

being overly responsive to sensory input, can lead to sensory-avoiding behaviour (see below).

Hyposensitive

being under responsive to sensory input, can lead to sensory-seeking behaviour (see below).

Sensory craving

is described as when one is “driven to obtain sensory stimulation, but getting the stimulation results in disorganization and does not satisfy the drive for more”. It can become excessive and even dangerous; such as in cases of repeated head-banging.

Hyperarousal

involves heightened baseline levels of autonomic arousal. The child is already in a heightened state of arousal so it doesn’t take much for them to become seriously overwhelmed.

Hypervigilant

involves scanning the environment for threat-relevant stimuli, and preparation for potential threat. In the case of children with sensory processing issues, they may seem to always be on the alert and extremely anxious about the possibility of sudden loud noises.

Sensory overload

this happens when you’re getting more input from your senses than your brain can sort through and process. Multiple conversations going on in one room, flashing overhead lights, or a loud party can all produce the symptoms of sensory overload. But when there’s competing sensory information, your brain can’t interpret it all at the same time. For some people, this feels like getting “stuck”; your brain can’t prioritize what sensory information it needs to focus on. Your brain then sends your body the message that you need to get away from some of the sensory input you’re experiencing. Your brain feels trapped by all the input it’s getting, and your body starts to panic in a chain reaction.

Have a look at these videos by The National Autistic Society to see how sensory overload can feel:

‘Make It Stop’

‘Can You Make It To The End?’

This causes the ‘flight or fight’ response of the sympathetic nervous system to be triggered. Have a look below at the difference between the sympathetic nervous system and the parasympathetic nervous system & the vast array of systems they can affect.

When we experience sensory overload, our sympathetic nervous system is activated. To help calm a child down during sensory overload, we want to reduce the input they are receiving and try to activate the parasympathetic nervous system instead.

These activities stimulate the vagus nerve and encourage the body to calm down. It can be really effective to implement some of these strategies when our children are struggling. Try a few and see which work best for you.

How many senses do we have?

Most people with automatically respond with “Five”, but we actually have at least eight.

Let’s look at each sense in turn. We will see how to spot whether our children are under or overly responsive to various types of stimuli, and also what adjustments we can make to help them.

The Auditory System

A healthy functioning auditory system allows children to respond appropriately to what they hear. For example, they may turn their head when their name is called, or follow verbal directions given by a teacher. They would also be able to filter out irrelevant noises (such as another child tapping their pen, or the buzz of an electric light). Some children however, may be hyper or hyposensitive to the sounds that they hear and this can affect their behaviour.

The Visual System

A healthy visual system allows the child to filter out inconsequential things they can see, and also to pay attention to information that is important. Some children are overly sensitive to visual stimuli; this is particularly true of children on the autism spectrum.

They may benefit from a reduction in visual stimuli, as demonstrated below.

As seen here, the TEACHH workstation method is very effective for children who are hypersensitive to visual stimuli.

Some children are under sensitive to visual stimuli and may need bright colours and visual stimulation to keep them engaged.

The Tactile System

The tactile system is the sense of touch. A healthy tactile system allows us to process temperature, feel pain, differentiate pressure and texture. When the tactile system is well regulated, a child is able to filter out unnecessary tactile input; such as a breeze blowing in their face. They are also able to tolerate a variety of textures, such as different fabrics of clothing.

A child who is overly sensitive to tactile input may present with the following behaviours:

Children who are under responsive to tactile input may benefit from the following strategies:

The Gustatory (Oral) System

The sensory receptors in our mouths allow us to perceive temperature, texture (e.g. smooth like yogurt, hard like a crisp, or a mixture of textures like cereal with milk), and taste (e.g. sweet, salty, bitter, sour).

Our brains also receive lots of proprioceptive information from the joint of the jaw as we bite and chew different foods that provide different types of resistance (e.g. a crunchy carrot, chewing gum)

Children with a healthy oral system are able to eat a variety of foods, including a range of tastes and textures. They would also not need to seek out extra oral sensory input such as chewing on clothes, in order to regulate their behaviour.

A child with dysregulation in the gustatory system may demonstrate some of the symptoms below:

Alerting and calming activities can help to regulate the gustatory sensory system.

The Olfactory System

A child with a healthy olfactory system is able to tolerate smelling foods and other odors in his environment.  He can even tolerate unpleasant odors (within reason) without extreme reactions.  A functioning olfactory system helps a child know the difference between “good” smells – those that are safe, pleasant, or associated with positive emotions – and “bad” smells – those that are dangerous, displeasing, or reminders of negative experiences.

Children who are hypersensitive to smells may demonstrate the behaviours below:

Some children may crave olfactory input and would benefit from trying some of these activities:

The Proprioceptive system

What is the proprioceptive system?

When children move and play, their muscles stretch and contract.  Proprioception refers to the way joints and muscles send messages to the brain to help coordinate movement.

This sense also allows us to grade the force and direction of our movements – our bodies instinctively know to apply more effort when lifting a heavy box and less effort when lifting a piece of paper.  While the vestibular system tells the brain about balance and moving against gravity, the proprioceptive system helps us coordinate the movement of our arms and legs in an efficient manner to play and move without even having to look.

A functioning proprioceptive system allows a child to write with a pencil without pushing so hard that he breaks the tip or take a drink from a paper cup without crushing it in his hand. A functioning proprioceptive system allows children to move, play, and explore in a smoothly coordinated and efficient way – not too gently, not too rough.

To help regulate the proprioceptive system, sensory circuits; a sensory diet and heavy work can be very beneficial.

The Vestibular system

The vestibular system has to do with balance and movement and is centered in the inner ear.  Each of us has vestibular organs located deep inside our ears. When we move our heads, the fluid in these organs moves and shifts, constantly providing us with information about the position of our heads and bodies in space (spatial awareness).

When our vestibular sense is fully functioning, we are secure and organized enough in our bodies to be able to attend and respond to all of the other senses we encounter daily.  A child with a well-developed vestibular sense feels confident and safe during movement activities, even if his feet are off the ground.  He is able to start and stop movement activities calmly and with control.  He is comfortable with climbing, swinging, somersaulting, and jumping – knowing that his body will adapt and that he will be able to maintain his balance and keep himself from falling or getting hurt.

The Interoceptive system

So how can we help our children with sensory processing issues?

Apart from using the sense-specific strategies above, children with sensory processing disorders can be really helped by the use of sensory circuits and a specifically-tailored sensory diet.

Both programs take time to organize and implement so we will have a blog post dedicated to each one individually. Subscribe to have them delivered straight to your inbox!

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Helpful links:

Subtypes of SPD

Hypervigilence: symptoms, causes and strategies

Anxiety disorders & sensory over-responsivity in children

OT & self-regulation

Heavy work activities & sensory processing disorder

Autistic Women & Girls

How many autistic women do you know? Probably more than you think. Autism is typically thought of as something which affects mostly males but recent research shows that it could be affecting just as many females; it’s just that they don’t exhibit the same signs.

Girls and women with autism tend to ‘mask’ socially. That is, they mimic other people as a way of blending in but they also don’t show their true feelings or opinions. As you can imagine, this becomes exhausting and means they may well go unnoticed and undiagnosed for many years.

So what are the signs of autism in girls?

Challenges with Social Skills

According to Katherine G. Hobbs, a researcher and journalist for Autism Parenting Magazine, “One of the more classic symptoms of the autism spectrum can be seen when looking at difficulties involving social interactions. This is much easier to spot in men as girls and women tend to adapt to social situations more naturally than men.

It is inherently easier for autistic girls to mimic the behaviors of others when it comes to certain interactions at least initially.

This can change in the teenage years. During puberty when social interactions become more complex and the requirement to start understanding social cues becomes more important, the social difficulties of girls with Asperger’s syndrome become more obvious.

For example, young girls with Asperger’s might perform at an average to an excellent level at school, even socializing at what appears to be an age-appropriate level. “Some girls with Asperger’s will manage to keep their difficulties under wraps at school, but might have ‘meltdowns’ at home, where they feel safe to relax and release the feelings that they have been squashing down all day.”

Subtle clues such as difficulty maintaining eye contact during social interactions or escaping difficult events through mental processing or daydreaming can provide clues that girls may be autistic.”

Visual Thinkers

While we may associate boys on the spectrum as being predominantly visual thinkers, this can apply to girls too. In fact, one of the most famous women with autism is Dr. Temple Grandin and she pioneered revolutionary concepts in animal care due to her ability to think in pictures. In her book Thinking in Pictures, she writes about how this has proved to be such an advantage: “I think in pictures. Words are like a second language to me. I translate both spoken and written words into full-color movies, complete with sound, which run like a VCR tape in my head. When somebody speaks to me, his words are instantly translated into pictures. Language-based thinkers often find this phenomenon difficult to understand, but […] visual thinking has enabled me to build entire systems in my imagination… I value my ability to think visually, and I would never want to lose it.” It is now widely recognized that many women and girls on the spectrum tend to also think and process information visually, rather than verbal thinkers.

Sensory Issues

Many women with autism experience issues with “filtering” sensory input, which can lead to an overload of information and the need to focus intently on one thing in order to avoid being overloaded.

People with ASD may be highly sensitive and over-responsive to sounds, sights, smells, touch, and tastes. Many women are particularly sensitive to the feeling of clothes and makeup, pulling off clothing tags and opting for comfortable clothes over fashionable clothes and shoes every time. 

According to Claire Jack Ph.D. , some signs of sensory processing issues may include:

  • Disliking tags in clothes
  • Being sensitive to high-pitched noises
  • Finding some sensations (such as wool or nylon) difficult to cope with
  • Disliking tight or uncomfortable clothes or shoes
  • Choosing practical clothes over “attractive” clothes
  • Disliking feeling of foundation or lipstick
  • Disliking feeling of substances on fingertips (e.g. fruit, dirt, roughness)
  • Being affected by bright lights
  • Feeling overwhelmed in supermarkets/shopping stores
  • Feeling overwhelmed or disliking being hugged/kissed by acquaintances
  • Desire for spatial organisation, such as colour coordination
  • Disliking loud environments (such as concerts)
  • Having a strong reaction to certain scents (such as perfume)
  • Strong aversions to types of foods

(Please note that this list is not exhaustive and may be indicative of a different condition.)

Special Interests

My favourite researcher into the presentation of autism in girls and women is Tania Marshall MSc, an Australian psychologist who has produced a extensive profile of women on the spectrum. What is particularly interesting about her research is the sheer number of cases she has studied and the variety of ways autism presents. In Dr. Tony Attwood’s book ‘The Complete Guide to Aspergers Syndrome’, there is mention of how a girl with autism may have similar interests to other girls her own age; it’s just the intensity and dominance of the interest in her daily life that is different. I feel also, though, that women and girls on the spectrum do tend to have a variety of special interests and those interests are not quite so idiosyncratic as the ones we may see in boys on the spectrum.

Here is an excellent list of possible special interest from Tania Marshall’s profile of women with autism:

  • Current research shows that individuals on the Spectrum do not have “restricted interests”, but rather a lifetime of interests that can vary. A special interest may involve the person’s career, Anime, fantasy (think Dr. Who, superheroes, and Harry Potter), just to name a few, writing, animals, reading, celebrities, food, fashion, jewelry, makeup, tattoos, symbols and TV Series (think Game of Thrones). This is not inclusive
  • May attend ComicCon, SuperNova, love dressing up as a character.
  • Ability to “hyperfocus” for long periods of time involved in the special interest, without eating, drinking or going to the toilet, is able to hyperfocus on her special interest for hours, often losing track of time
  • Loves and revels in solitude, peace, and quiet. Solitude is often described as “needing it like the air I breathe”
  • An intense love for nature and animals
  • Often not interested in what other people find interesting
  • May collect or hoard items of interest
  • Introspection and self-awareness. Many women spend years trying to understand themselves, reading self-help and psychology books and wonder why they feel so different, from another planet or that the “Mothership has dropped me off on the wrong planet”.
  • Justice Issues
  • May know every lyric to a song or every line to a movie from repetitively watching them or listening to them

It’s a sad fact that many girls on the spectrum are not diagnosed until they are shows signs of depression, anxiety or other mental health issues. They may even end up being misdiagnosed with a completely different condition. Thankfully, awareness of the way autism presents differently in girls and women is increasing, and with it, hopefully, the tools and therapies to help will increase also. I urge anyone who feels they, or a family member, may have autism to look at Tania Marshall’s blog post “Moving Towards a Female Profile“.

What is ASD?

ASD stands for Autistic Spectrum Disorder.

The ICD-11 is the most commonly used manual for autism diagnosis in the UK and it describes autism like this:

“A group of disorders characterized by qualitative abnormalities in reciprocal social interactions and in patterns of communication, and by a restricted, stereotyped, repetitive repertoire of interests and activities. These qualitative abnormalities are a pervasive feature of the individual’s functioning in all situations” ( IInternational Statistical Classification of Diseases and Related Health Problems 10th Revision, 2016)

It puts childhood autism, Asperger syndrome, atypical autism and other pervasive delays under the same grouping. This is because all of these syndromes have a developmental delay that affects their social interaction and social communication. The other aspects of the developmental delay affects which diagnosis is received.

The DSM-5 (Diagnostic and Statistical Manual, version 5) is not as commonly used in the UK, but the diagnostic criteria do appear a little easier to understand. As the ICD-10, it specifies the social interaction and social communication difficulties, as well as “restricted and repetitive patterns of behaviour, activities or interests” (DSM-5, 2013).

So that all sounds quite complicated and a little wordy, what does it actually mean for us?

  • Social interaction :  lots of our children on the spectrum struggle with non-verbal communication. They don’t understand body language or facial expressions easily. This means it can be really hard for them to cope in social situations because  they are constantly trying to unlock the puzzle of what is being said to them, as well as being overwhelmed by all the ‘extra’ non-verbal information.
  • Social communication: this is language that is used in social situations (National Autistic Society, 2008) Our children may have delayed speech development, they may not understand when we speak to them, or they may use repetitive phrases and sentences that they have overhead (echolalia). They can also take idioms a bit literally: saying “It’s raining cats and dogs” has sent my son to the window on many an occasion.
  • Restricted and repetitive patterns of behaviours, activities or interests: Are any of your children obsessed with Thomas the Tank Engine, The Gruffalo, the colour red or anything else that is just the best thing ever in their world? Our children often have obsessions and they struggle with change. This means they may have the same fascination for many years, or they may like to walk the same route to school every day, or where the same colour pants on Saturdays.

There is another aspect to this as well, and it’s something that in recent years has really come to the front of studies in Autism: sensory issues.

For a long time, the diagnostic criteria for autism was the ‘Triad of Impairments’: social interaction, social communication and inflexibility of thought (Autism in the Early Years, 2010). However, recently this was changed to the diad of impairments.

  • Social communication and social interaction difficulties
  • Restricted and repetitive patterns of behaviours, activities or interests, including sensory behaviour.

Many of our children have trouble with sensory processing. They may find certain noises unbearable, some visual stimuli can be too much (eg. when the lights are too bright), they may seem to overreact to certain tastes and textures, and may engage in ‘sensory seeking behavior’ such as spinning round in circles or flapping their hands. I know with my eldest, he is very particular about the texture of clothes that he wears and is especially sensitive to certain foods. He has had the same packed lunch for the last five years, and you know what? It’s not a battle worth fighting. He has food he enjoys and he growing healthily so although I encourage him to try a new thing on at least three separate occasions, there is no point in putting us both through the stress of food he can’t cope with.

References

American Medical Association, (2016), International Statistical Classification of Diseases and Related Health Problems 10th Revision, Chicago, IL, USA.

American Psychiatric Association, (2013). Diagnostic and statistical manual of mental disorders DSM-IV-TR. 1st ed. Washington, D.C.

National Autistic Society, (2008), NAS EarlyBird Programme Parent Book, London, England.

Cumine et al, (2010). Autism in The Early Years. 2nd ed. Oxfordshire, England.

© Peta Slaney, 2020, All Rights Reserved.