Design a bedtime routine that can be a win-win situation for your autistic child and yourself. Bedtime can be one of those nightly events which many parents love or hate or both! It means that peace and quiet are soon ahead, but it also can mean that a huge struggle is about to proceed. Many children with autism have difficulties either transitioning to bed, falling asleep, or even staying asleep all night long. Any of these difficulties can increase stress and tension in your home. Keep in mind that no single suggestion will be for all children but getting the right amount of sleep will allow your child to perform better academically, encourage the development of motor skills, and allow them to maintain a better mindset. Not to mention, it’ll help you get a fuller night of rest, too!
Bedtime routine for children with autism
The first step to a healthy sleep starts with the daily routine. Be consistent. By creating a visual schedule, it helps to remind your child what they should be doing and what is to come. Take pictures of all events (e.g., dinner time at the table, bath time, reading books, and the child in bed), laminate the pictures and a piece of construction paper, and Velcro each picture either horizontally or vertically on the paper. When each event is completed, you can guide your child to take off the picture and point to the next event which helps them to actively check off their tasks.
Praise your child for successfully completing steps in their bedtime routine. Descriptive praise is when you tell your child exactly what it is that you like. For example, ‘I like the way you’ve found a spot for everything in your room’. This helps your child understand exactly what it is that they’ve done well. It’s also more genuine than non-specific praise like ‘You’re a good boy’. For younger children, you could use a reward chart.
A typical daily routine for better sleep
It is important for the daily routine to be consistent with time and order. Make sure your child wakes up every morning at the same time. They eat breakfast at the same time. Whatever the routine, keep it consistent so the child learns what to expect. A routine helps signal the body.
- Wake up at 7 am
- Brush teeth
- Take a shower
- Get dressed
- Brush hair
- Make bed
- Eat breakfast
- Eat lunch at 12 pm
- Exercise for 1 hour
- Plan activity
- Eat dinner at 6 pm
- Watch TV
- Play a board game with the family
- Read a few books to quiet down
- Put on pajamas
- Brush teeth
- Go to the bathroom
- Dim the lights
- Put on the white noise machine
- Give a massage
- Go to bed
Remember there are triggers that might enhance alertness during bedtime like caffeine. Caffeine can stay active in our body for up to 12 hours. Monitor caffeine intake as well sugar consumption in foods. Watching TV, videos, or playing on the computer, especially if the shows or games are scary or violent, can lead to kids with autism having more trouble sleeping.
Problems sleeping happen more often in autistic children who have restricted and repetitive behaviors (lining up toys, rocking, hand-flapping), anxiety, or sensory problems and can lead to having trouble paying attention, feeling restless, getting angry, and throwing tantrums.
Autism and the successful bedtime routine
It can’t be stressed enough, to stick to a routine. Make bedtime routine no more than 20 to 30 minutes. The bedtime routine should be calming like reading a book, singing a song, or a massage. You know your child best. What is calming for one child may be stimulating for another. Design an area that encourages sleep. Make sure to only use your child’s bed for sleep. Keep the temperature in the room less than 75 degrees Fahrenheit. Don’t leave lamps or overhead lights on overnight. Nightlights can be used to provide some light. Using a white noise machine will help your child from being disturbed by noise around them.
If your child has a hard time falling asleep, or wakes up in the middle of the night, first consider if they take naps during the day. You may want to reduce these naps so your child is more tired at night time. If your child wakes up in the middle of the night, be sure to keep the sleeping environment calm and do not allow him or her to play games or leave their room. This may take many sleepless nights by the parents but it will pay off in the end. It is important that your child learn the skill of falling asleep without a parent present. All children and adults wake briefly during the night but quickly put themselves back to sleep by reestablishing associations used at bedtime. So if your child needs a parent present to fall asleep at bedtime, he might need a parent to help him fall back asleep during the normal awakenings.
The time you invest in putting a sleep routine for your autistic child now will save you many, many hours in the long run and you won’t have to do it forever. Once patterns are established, you will be able to reclaim a large part of your evening for yourself.
Autism and bedtime routines: other considerations
It is important to address medical or psychiatric issues that potentially interfere with sleep. Your child’s medications might need adjustment if they affect his sleep. If your child suffers from a sleep disorder such as sleep apnea, sleep walking, sleep terrors, restless legs syndrome, they may need a referral to a sleep specialist. Some children with persistent insomnia will need further behavioral or pharmacological treatment to improve their sleep.
Children and Adults with autism tend to have signs of insomnia: It takes them an average of 11-15 minutes longer than most people to fall asleep. Many wake up frequently during the night. Some adults and children with autism have sleep apnea as well, a condition that could potentially cause them to stop breathing several times during the night.
Let Leafwing Center help with the daily routine for your autistic child, so you can have a successful bedtime routine. Our ABA therapists are trained in creating personalized plans that match your child’s ability levels.
Frequently asked questions about ABA therapy
What is ABA Therapy used for?
ABA-based therapy can be used in a multitude of areas. Currently, these interventions are used primarily with individuals living with ASD; however, their applications can be used with individuals living with pervasive developmental disorders as well as other disorders. For ASD, it can be used in effectively teaching specific skills that may not be in a child’s repertoire of skills to help him/her function better in their environment whether that be at home, school, or out in the community. In conjunction with skill acquisition programs, ABA-based interventions can also be used in addressing behavioral excesses (e.g., tantrum behaviors, aggressive behaviors, self-injurious behaviors). Lastly, it can also be utilized in parent/caregiver training.
In skill acquisition programs, a child’s repertoire of skills is assessed in the beginning phase of the services in key adaptive areas such as communication/language, self-help, social skills, and motor skills as well. Once skills to be taught are identified, a goal for each skill is developed and then addressed/taught by using ABA-based techniques to teach those important skills. Ultimately, an ABA-based therapy will facilitate a degree of maintenance (i.e., the child can still perform the learned behaviors in the absence of training/intervention over time) and generalization (i.e., the learned behaviors are observed to occur in situations different from the instructional setting). These two concepts are very important in any ABA-based intervention.
In behavior management, the challenging behaviors are assessed for their function in the beginning phase of the services. In this phase, the “why does this behavior happen in the first place?” is determined. Once known, an ABA-based therapy will be developed to not just decrease the occurrence of the behavior being addressed, but also teach the child a functionally-equivalent behavior that is socially-appropriate. For example, if a child resorts to tantrum behaviors when she is told she cannot have a specific item, she may be taught to accept an alternative or find an alternative for herself. Of course, we can only do this up to a certain point—the offering of alternatives. There comes a point when a ‘no’ means ‘no’ so the tantrum behavior will be left to run its course (i.e., to continue until it ceases). This is never easy and will take some time for parents/caregivers to get used to, but research has shown that over time and consistent application of an ABA-based behavior management program, the challenging behavior will get better.
In parent training, individuals that provide care for a child may receive customized “curriculum” that best fit their situation. A typical area covered in parent training is teaching responsible adults pertinent ABA-based concepts to help adults understand the rationale behind interventions that are being used in their child’s ABA-based services. Another area covered in parent training is teaching adults specific skill acquisition programs and/or behavior management programs that they will implement during family time. Other areas covered in parent training may be data collection, how to facilitate maintenance, how to facilitate generalization of learned skills to name a few.
There is no “one format” that will fit all children and their families’ needs. The ABA professionals you’re currently working with, with your participation, will develop an ABA-based treatment package that will best fit your child’s and your family’s needs. For more information regarding this topic, we encourage you to speak with your BCBA or reach out to us at [email protected].
Who Can Benefit From ABA Therapy?
There is a common misconception that the principles of ABA are specific to Autism. This is not the case. The principles and methods of ABA are scientifically backed and can be applied to any individual. With that said, the U.S. Surgeon General and the American Psychological Association consider ABA to be an evidence based practice. Forty years of extensive literature have documented ABA therapy as an effective and successful practice to reduce problem behavior and increase skills for individuals with intellectual disabilities and Autism Spectrum Disorders (ASD). Children, teenagers, and adults with ASD can benefit from ABA therapy. Especially when started early, ABA therapy can benefit individuals by targeting challenging behaviors, attention skills, play skills, communication, motor, social, and other skills. Individuals with other developmental challenges such as ADHD or intellectual disability can benefit from ABA therapy as well. While early intervention has been demonstrated to lead to more significant treatment outcomes, there is no specific age at which ABA therapy ceases to be helpful.
Additionally, parents and caregivers of individuals living with ASD can also benefit from the principles of ABA. Depending on the needs of your loved one, the use of specified ABA techniques in addition to 1:1 services, may help produce more desirable treatment outcomes. The term “caregiver training” is common in ABA services and refers to the individualized instruction that a BCBA or ABA Supervisor provides to parents and caregivers. This typically involves a combination of individualized ABA techniques and methods parents and caregivers can use outside of 1:1 sessions to facilitate ongoing progress in specified areas.
ABA therapy can help people living with ASD, intellectual disability, and other developmental challenges achieve their goals and live higher quality lives.
What does ABA Therapy look like?
Agencies that provide ABA-based services in the home-setting are more likely to implement ABA services similarly than doing the same exact protocols or procedures. Regardless, an ABA agency under the guidance of a Board-Certified Behavior Analyst follows the same research-based theories to guide treatment that all other acceptable ABA agencies use.
ABA-based services start with a functional behavior assessment (FBA). In a nutshell, a FBA assesses why the behaviors may be happening in the first place. From there, the FBA will also determine the best way to address the difficulties using tactics that have been proven effective over time with a focus on behavioral replacement versus simple elimination of a problem behavior. The FBA will also have recommendations for other relevant skills/behaviors to be taught and parent skills that can be taught in a parent training format to name a few. From there, the intensity of the ABA-based services is determined, again, based on the clinical needs of your child. The completed FBA is then submitted to the funding source for approval.
One-on-one sessions between a behavior technician and your child will start once services are approved. The duration per session and the frequency of these sessions per week/month will all depend on how many hours your child’s ABA services have been approved for—usually, this will be the number recommended in the FBA. The sessions are used to teach identified skills/behaviors via effective teaching procedures. Another aspect of ABA-based services in the home-setting is parent training. Parent training can take many forms depending on what goals have been established during the FBA process. The number of hours dedicated for parent training is also variable and solely depends on the clinical need for it. If a 1:1 session is between a behavior technician and your child, a parent training session or appointment is between you and the case supervisor and with and without your child present, depending on the parent goal(s) identified. Parent training service’s goal is for you to be able to have ample skills/knowledge in order for you to become more effective in addressing behavioral difficulties as they occur outside of scheduled ABA sessions. Depending on the goals established, you may be required to participate in your child’s 1:1 sessions. These participations are a good way for you to practice what you have learned from the case supervisor while at the same time, having the behavior technician available to you to give you feedback as you practice on those new skills.
As mentioned in the beginning, no two ABA agencies will do the same exact thing when it comes to providing ABA services; however, good agencies will always base their practice on the same empirically-proven procedures.
How do I start ABA Therapy?
In most cases, the first item required to start ABA therapy is the individual’s autism spectrum disorder (ASD) diagnosis report. This is typically conducted by a doctor such as a psychiatrist, psychologist, or a developmental pediatrician. Most ABA therapy agencies and insurance companies will ask for a copy of this diagnosis report during the intake process as it is required to request an ABA assessment authorization from the individual’s medical insurance provider.
The second item required to start ABA therapy is a funding source. In the United States, and in cases where Medi-Cal or Medicare insurances are involved, there is a legal requirement for ABA services to be covered when there is a medical necessity (ASD diagnosis). Medi-Cal and Medicare cover all medically necessary behavioral health treatment services for beneficiaries. This typically includes children diagnosed with ASD. Since Applied Behavior Analysis is an evidence based and effective treatment for individuals with ASD, it is considered a covered treatment when medically necessary. In many cases, private insurance will also cover ABA services when medically necessary, however in these cases, it is best to speak directly with your medical insurance provider to determine the specifics of the coverage and to ensure that ABA is in fact, a covered benefit. Additionally, some families opt to pay for ABA services out-of-pocket.
The next step to starting ABA therapy is to contact an ABA provider whom you are interested in working with. Depending on your geographic location, ABA agencies exist in many cities across the United States. Your insurance carrier, local support groups, and even a thorough online search can help you find reputable and properly credentialed ABA agencies near you. Our organization, LeafWing Center, is based in southern California and is recognized for aiding people with ASD achieve their goals with the research based on applied behavior analysis.
Once you have identified the ABA provider with whom you wish to work, they should help you facilitate the next steps. These will include facilitating paperwork and authorizations with your funding source. Once the assessment process begins, a BCBA (Board Certified Behavior Analyst) or qualified Program Supervisor should get in contact with you to arrange times in which interviews with parents/caregivers and observations of your loved one can be conducted. This will help in the process of gathering important clinical information so that with your collaboration, the most effective treatment plans and goals can be established for your loved one. This process is referred to as the Functional Behavior Assessment (FBA) and is elaborated on in different blog posts on our website. With regard as to what can be expected once ABA therapy begins, please read our blog post titled: When You Start an ABA program, What Should You Reasonably Expect from Your Service Provider?