The Sleep/Anxiety Link in Autism & ADHD

sleep anxiety link in autism and asd

Takeaway: Sleep-deprived children tend to be more anxious, while anxious children are often sleep-deprived. And this gets magnified in children with autism and/or ADHD. If regular sleep schedules and relaxation techniques aren’t helping, consider contacting a specialist for guidance.

Sleep is vital for a child’s development and mental health.

For years, research has gradually revealed how important sleep is for children. It helps transition their short-term memories into long-term ones, recharges their ability to focus and learn, evens out their mood, gives their brain time to eliminate oxins, and even helps control things like blood pressure, weight gain, and more.

That’s why sleep-deprived children often have mood issues.

In an earlier post, we explored how many teens don’t get enough sleep. But teens aren’t the only ones with poor sleep. Younger children can also have issues like struggling to fall asleep, waking up frequently/early, or not feeling refreshed. Lack of sleep might make children groggy, but it also affects their mood. In particular, their anxiety levels rise because it’s only during sleep that the brain has a chance to calm down and recover from the day. (The slightly more technical explanation is that the REM part of a sleep cycle soothes the amygdala — i.e., the ‘fight or flight’ part of our brain.)

In effect, sleep deprivation can have the same effect on brain chemistry as many anxiety disorders.

Without adequate sleep, the body releases more stress hormones into the blood. And this increased stress then makes it harder for children to fall asleep. So, sleep-deprived children are locked in a vicious sleep/stress cycle similar to many anxiety disorders. Note that ‘sleep deprivation’ doesn’t have to be dramatic: simply losing an hour of sleep every night is enough to cause problems.

This sleep-anxiety connection becomes even more pronounced in children with developmental differences like autism.

Children with autism spectrum disorder (ASD) have brains that are structured differently. And this difference changes the way they experience the world. For example, they often find it harder to communicate, need have a routine, and are hypersensitive to sensory input. But they also have trouble with both sleep and anxiety. Research suggests that at least half (and often up to 80%) of all children with autism are diagnosed with sleep issues, compared to just 25% of non-autistic children. And 20% of children with autism show high anxiety levels, compared to just 9% of non-autistic children. So, the sleep-anxiety cycle can cause significantly more damage to children with autism.

Sleep issues seem to be built into an autism diagnosis. And by extension, so is anxiety.

Many common autistic traits fuel sleep and anxiety issues. For example, children develop a sleep routine by taking cues from their family — e.g., ‘My sisters are going to sleep, so I should go to sleep, too.’ But children with autism have trouble reading social cues, so they miss these sleep cues as well. Further, they often have long pre-sleep rituals which could delay bedtime, and they have trouble transitioning from one activity to another, so they struggle to begin their wind-down routine. Also, since they’re hypersensitive to stimuli, they’ll likely be woken up by simple things like a door banging or a parent kissing them goodnight. These sleep issues then potentially raise their anxiety levels, making them more likely to throw a tantrum, self-stimulate (e.g., rocking, spinning, or flapping their hands), or retreat further into the comfort of their daily routine.

But there’s a third piece to the sleep-anxiety-autism puzzle. And it’s to do with hyperactivity.

Children with autism are often hyperactive and have trouble staying focused. And it’s why about 30% of them get diagnosed with attention-deficit/hyperactivity disorder (ADHD). (To put things in perspective, only about 5-10% of non-autistic children get the same ADHD diagnosis.) A quick recap: ADHD is a brain difference that makes children hyperactive, inattentive, and impulsive. And just as with autism, these traits often lead to sleeping problems. For example, a child with ADHD is more likely to get overstimulated by a pre-sleep video game session than a child without ADHD. And this overstimulation will likely affect her sleep. Here’s where another vicious cycle pops up, though. Poor sleep leads to things like forgetfulness and trouble concentrating, but these are ADHD traits, too. So, ADHD affects sleep, which worsens ADHD.

That’s why it’s worth paying extra attention to your child’s sleep and anxiety if she has autism and/or ADHD.

To recap: sleeplessness and anxiety feed into each other. And children with autism or ADHD often sleep poorly. So, if your child has autism and/or ADHD, pay attention to her sleep routine and anxiety levels because they’ll tell you if she’s doing okay or not. As a reference, till age 3, children usually need about 12-14 hours of sleep. Then, till age 12, that need drops to about 10-12 hours. And with teenagers, it reaches a low at 9-9.5 hours. As a parent you would know your child is anxious if she becomes more irritable/argumentative, refuses to go to school, withdraws socially, starts fidgeting frequently (e.g., foot-tapping), and so on.

Finally, if you suspect your child is struggling, do consider asking for help.

As a first step, you can teach your child basic relaxation techniques and encourage her to stick to a bedtime routine. But it’s often not as simple as this. So, if you notice any troubling changes in your child’s behaviour, consider consulting a specialist. At The Ed Psych Practice, we offer face-to-face and online assessments, consultation, advice, and problem-solving strategies for parents, nurseries, schools, and universities in London. We have psychologists, paediatricians, and therapists who can help assess your child and offer guidance and support. To consult with us or set up an appointment:

Want to see how else you can help your child? You might enjoy some of our other posts.

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