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Night Terrors in Children with ASD

One way to help make night terrors less prevalent is to improve a child’s sleep hygiene and establishing a night routine.

It is common for children with Autism Spectrum Disorder (ASD) and typically developing children to have trouble falling asleep or staying asleep. Some difficulties include irregular sleeping patterns (lying awake till late at night or waking up very early), sleeping lesser than the recommended hours for their age group, or constantly waking up in the middle of the night and being unable to fall back asleep.

In addition, night terrors are somewhat common in young children between 18 months to 6 years of age, and more common in boys. Night terrors are a type of sleep disturbance whereby children wake up in the middle of the night screaming or crying. This could negatively affect their quality of sleep, and ultimately affect their behaviour during the day. This article will look further into some of the causes of night terrors, and how to help a child with ASD who is experiencing this issue.

Why Do Children Experience Night Terrors?

The experience of waking up to the sounds of your child screaming in the middle of the night can be very distressing, and it can be stressful when your child is unresponsive to your attempts of soothing and calming them down. Nevertheless, it is unlikely to be a cause for concern or a sign of an underlying medical issue.

Night terrors are usually caused by the over-arousal of the Central Nervous System (CNS) during non-REM sleep (2-3 hours after falling asleep). The transition from non-REM sleep (deep sleep) to REM sleep (lighter sleep) is usually a smooth one. However, a child may be frightened or upset during the transition – resulting in a night terror.

What are some common symptoms of night terrors?

  • Suddenly sitting upright in bed

  • Sudden screaming or shouting in distress

  • Rapid breathing and/or increased heart rate

  • Sweating

  • Thrashing around in bed

  • Feelings of fear and upset

Night terrors are observed in children who are:

  • Overtired

  • Sick

  • Stressed

  • Experiencing anxiety

  • Sleeping in a new environment

  • Not getting sufficient sleep

  • Having too much caffeine

Children may only experience night terrors once or several times before they stop. They tend to disappear as the child grows older and their Central Nervous System matures.

How can I help my child?

Children with ASD tend to have difficulty regulating their emotions. It may be even more difficult for them to calm down or be comforted during a night terror episode. Although children tend to outgrow night terrors, it is helpful to engage in habits that can reduce risks or make them less prevalent. Treatment may not be needed for children who experience night terrors less than twice per month.

One thing that you can do is to ensure the safety of the child if they are having a night terror. When they arouse during an episode, children tend to be very disorientated and confused. They have a high risk of falling off the bed or hitting their arms or legs if they are flailing. Some may experience sleepwalking during night terrors. They may leave the room and trip over obstacles. Parents can cushion sharp edges of surrounding furniture (corner of the bed, a nearby table or cabinet), make sure there are no loose items strewn on their bedroom floor, and ensure they are unable to leave the room (extra security measures on their doors, etc.).

Another thing to help make night terrors less prevalent is to improve a child’s sleep hygiene and establishing a night routine. This includes avoiding caffeine (for example, in sugary drinks), going to bed around the same time every day, and creating a relaxing and stress-free sleeping environment. Parents can help to eliminate any distracting noises or lights present in their bedrooms, and making sure the temperature in the room is comfortable for the child.

If your child is over six years old and has frequent night terrors, parents can keep track of when night terrors tend to occur during the night. Take record of how long after a child falls asleep a night terror occurs (e.g., 2 hours after they fall asleep). Then, begin to wake your child up 15 minutes before the predicted onset of a night terror. Ensure they wake up quickly, and that they are fully awake for at least 5 minutes before allowing them to go back to sleep. Repeating this until the night terrors are less frequent/stop can help to disrupt the pattern of the onset of night terrors.

Night terrors can be very frightening for both the parents and child, especially when the child is unable to regulate their own emotions when feeling frightened and distressed. Parents need to remain calm during these episodes to help the child. Teaching the child emotion regulation skills may also be beneficial to helping de-escalate the situation. Do not be afraid to reach out for help when needed!

Written by Ashely.

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