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Sleep is something every child needs, but getting enough isn’t always easy. For neurodivergent kids, like mine, sleep can be especially tough to come by. As parents, we try all the things, follow the advice from friends and family, yet our kids still take forever to fall asleep, are awake for hours during the night or are up with or before the sun. It’s exhausting in every sense of the word. Luckily, there’s help.
Melisa Moore, Ph.D., DBSM, is an international expert on sleep and related psychological conditions in infants, children, adolescents and young adults. She is a licensed psychologist and board-certified in behavioral sleep medicine, and author of the recently published book, “The Good Sleep Guide for Neurodivergent Kids.” She is also a mom to a son diagnosed with ADHD and autism who experienced challenges with sleep.
As she struggled to help her son, she realized the resources she was looking for did not exist. “There was nothing that brought together accurate science with practical strategies while encouraging parents to give themselves some grace,” says Moore. “I know this quote is overused, but Toni Morrison said that if the book you want to read isn’t out there, you have to write it.” So she did, for two reasons. First to create a resource for other parents that she felt was missing. Second, to let parents know they are not alone.
As someone with lived experience and expertise in the field, she has a unique perspective to share. She can say yes, helping neurodivergent kids sleep is so hard, even for someone with resources and knowledge. “I had a lot of experience and I had a lot of colleagues that I could turn to. So I’m probably in the best position a person could be in when it comes to helping a child sleep. It was still so hard. And I wanted other parents to know it’s not hard because of something about you. It’s hard because it’s really, really hard,” said Moore.
Why do neurodiverse kids have trouble with sleep?
As the mom of a neurodivergent son, these sleep challenges are all too familiar to me. I asked Moore why neurodivergent kids struggle so much with sleep, and she said there are several reasons:
- Genetics. “Whatever caused the neurodiversity, whether it’s autism or ADHD or something else, that cause is largely usually genetic. So the genetic cause of neurodiversity might also be the cause of genetic sleep problems,” says Moore.
- Certain sleep disorders are more common in neurodiverse kids. “For example, in kids with ADHD restless sleep disorders are more common. Sometimes a circadian disorder can be more common. In Down syndrome, for example, obstructive sleep apnea is pretty common,” says Moore.
- Issues that cause sleep problems — but art not necessarily sleep disorders — are common in neurodiversity. For example, “things like constipation from picky eating or pain or eczema or allergies. They aren’t sleep disorders but they cause sleep problems,” says Moore.
The other issue that can cause sleep challenges for neurodiverse kids is circadian rhythm. Moore explained that circadian rhythms can be different in neurodiverse kids. It’s not necessarily a disorder, but something internally generated. When I told her in my son’s prefect world he would stay up until 3 a.m. and sleep until noon, she nodded and said yep, that’s his circadian preference, that’s genetic.
When should I get help from a sleep expert?
Since sleep can be a struggle for many kids, and new parents are always told to prepare to be exhausted for the foreseeable future, it can be hard to know when to seek professional help. Moore said that if your child “has any snoring, gasping, pauses in breathing, or wakes up with a headache in the morning, those are all reasons that you need to see a sleep physician and probably go to a sleep center.” If you don’t know where to turn to find a reputable sleep specialist, Moore suggests starting with these resources:
Moore also advises seeking help if your child is waking for hours at a time during the night (whether you are involved or not), is experiencing extreme restlessness when they sleep (perhaps all their covers are on the floor in the morning) or complains that their legs are bothering them at night. She also suggests getting help if, “you’re doing things that are healthy sleep habits and your child is just not responding the way you think they should.” For parents who feel like they just need more help, Moore encourages them to reach out to a professional in their area.
What can I do to help my child’s sleep?
One thing that can significantly impact your child’s sleep is a sleep routine. Each family’s sleep routine will look different, but Moore says they should follow the five S’s: Short, sweet, sensory soothing, streamlined and steady.
Short. Moore says you do not want a bedtime routine longer than 30 minutes, maybe 45 if there is a bath involved. Don’t let this drag on for hours.
Sweet. A bedtime routine should be filled with things your child likes and avoid the things they hate. For example, if your child has sensory issues which makes brushing their teeth a huge battle, a really thorough brushing at night might not be a great idea, since it causes stress and winds them up. Moore would suggest a quick brush at night, then focus on the deep clean in the morning. Parents should try to keep the metaphorical temperature low during this routine, so introducing things that your child really hates isn’t ideal. As Moore explains, “Imagine if you had to do your taxes right before bed?” Point taken.
Sensory soothing. Incorporate sensory elements that your child likes. People who study mindfulness often say that senses are the portal to the present. “So when you’re smelling something you really like, or petting the dog and the fur feels really good, or you have a special blanket, you’re not worrying about the past or the future, you’re experiencing that sense,” says Moore.
Streamlined. Try to avoid this familiar scenario: Upstairs to the bath, downstairs for a snack, upstairs to say good night, downstairs to get in bed. Moore says “everything during the 30-minute sleep routine should go in the direction of the bed.”
Steady. Keep your child’s bedtime routine consistent every night. But, when the routine gets interrupted (this is real life after all), Moore says the important thing is to not give up and try to get back on track as soon as possible. The goal is to move the needle in the right direction. It’s okay if things are not always perfect.
How can I help my teenager get better sleep?
Both of my sons are teenagers, so the nights of curling up with snacks and bedtime stories are a thing of the past. While they crave independence, I worry about their sleep — or lack thereof. I asked Moore what I can do to support my neurodivergent teen to get the sleep he needs.
She was not at all surprised by my question and, much to my surprise, told me she sees an increase in sleep struggles during two different stages. The first is infants and toddlers; the other is teenagers.
“There are some things stacked against teenagers and young adults. We know that the circadian rhythm shifts around puberty by about two hours, and that’s true everywhere all over the world — Hong Kong, Japan, Australia, Europe — it’s been studied everywhere. That two-hour delay is a normal part of development,” says Moore.
For example, a 10-year-old who had no problem falling asleep at 8:30 p.m. might struggle with such an early bedtime when they turn 12. “That’s a physiological thing,” says Moore. “And, people with ADHD tend to have a later circadian rhythm, and people with autism tend to have an inconsistent circadian rhythm. Those are the kind of things that might be more prominent at teenagerhood.”
According to Moore, one way to support teens’ sleep is to help them keep a consistent schedule. That means, teens should wake up at a similar time every day (within a two-hour window). If they wake up at 8 a.m. for school, they should wake up by 10 a.m. on the weekend (a tough sell to my teens, for sure!).
Moore encourages parents of teens to be involved in their sleep routine, and acknowledges that it’s tough, since we are constantly trying to figure out the right mix of independence and support. “I think being involved in their sleep is actually really helpful.” Moore says, “Even if it’s just to say: ‘You’re 16, but you have to get in bed before midnight.’ I would negotiate it, but I would still make sure that there was some kind of structure there.”
Moore also suggests a tactic that tends to work with teens — get someone else to tell them what you want them to do. They might not listen when you tell them to go to bed, but if they are a sports fan and they hear LeBron James wax poetic about the importance of sleep, you might notice their light turn off a little earlier.
Should I worry about sleep trackers and electronics at night?
It seems like products for tracking sleep are everywhere. From rings to apps to smart mattress pads, personal sleep data is easy to come by. But does it help? Moore isn’t convinced. She doesn’t recommend any apps or sleep tracking products, and thinks often the people or parents who are tracking that data, are not the ones who need to be. Plus, Moore thinks all that info can sometimes cause more stress.
However, Moore does feel that there is a time and place for sleep trackers. “If someone’s not speaking and we need to know about their sleep patterns, that might be a really good time to use it,” she says. “Or if you see your child go to sleep at 9 p.m., and you see them get up at 7 a.m. but they are falling asleep constantly during school, you might need to know what’s going on.”
Many parents worry about electronics impacting their child’s sleep. Moore says the impact of electronics are much more nuanced than we thought. Is it a great idea to fall asleep with electronics on? No. But, is it a problem if you are watching TV until your bedtime routine starts? Probably not. “We’ve known for many, many years that blue light stops your brain from producing melatonin,” says Moore. “But that’s temporary. And I think in the sleep world, we all kind of made the leap to blue light is bad for sleep. But when you really look at that, it’s not necessarily that way. The problem with electronics is that they push your bedtime later.”
What can I try tonight to help my child sleep?
If you are struggling with helping a neurodiverse child sleep, Moore says the first two things to focus on are establishing a bedtime and a routine. “If your child is neurodiverse, having a bedtime and a bedtime routine might not be as straightforward as it sounds, but I think that’s always the place to start,” says Moore.
She also advises parents to be aware of their child’s sleep associations. “That’s really important and a light bulb moment for many people; it was for me,” she says. The items you use to fall asleep (a sleep mask, special blanket, a bottle, noise machine, etc.) are what you will need to fall back to sleep during the night if you wake up. “Night wakings are completely normal. We all have four to six night wakings every single night. We don’t realize it because we are so efficient at getting ourselves right back to sleep most of the time,” Moore says. “But if you don’t have the situation you had to fall asleep, you’re more likely to wake up more.” Make sure your child has their blanket or stuffie or sleep mask when you head to bed, so they have a better chance of soothing themselves to sleep when they wake up.
Moore hopes that parents who read her book come away with some new ideas and strategies that will help everyone get more rest. She also hopes that parents feel supported and a little less alone. “Give yourself some grace,” she says. “We’re all doing the best we can and balancing a lot of different things.”
