Jade Taktak and Mark Chapman look at sleep – the process and the issues.
We need good sleep to live and function optimally. The brain transitions through different sleep stages overnight, and these stages come under two broad categories: rapid eye movement (REM) sleep and non-rapid eye movement (NREM) sleep. These stages occur in a cycle, roughly every 90 minutes, until awakening.
Total sleep and the precise proportions of NREM and REM sleep are impacted by lots of factors, including age and, most noticeably, deep sleep decreases with age. As well as getting older, difficulties associated with Autism Spectrum Condition (ASC) and Attention Deficit Hyperactivity Disorder (ADHD) can significantly impact children’s sleep.
A typically developing, school-age child often requires 10 or 11 hours of sleep. However, many children with ASC and ADHD appear to need less. It is important to keep this in mind as putting a child to bed too early to get more sleep may make falling asleep harder.
Sleep problems are common in children with ASC and ADHD. These include problems falling asleep, less restorative sleep, and early morning waking. Sleep difficulties in ADHD seem to increase with age, whereas those in ASC do not. Those with ASC or ADHD tend to get caught in a disruptive feedback loop of having difficulty falling and staying asleep, which worsens certain autistic features (eg repetitive behaviours) and ADHD features (eg inattention and impulsivity) and makes sleeping even harder.
Possible reasons for disturbed sleep for children with ASC or ADHD include:
- Difficulty winding down before bedtime
- Increased anxiety
- Irregular secretion of the sleep hormone, melatonin
- Comorbid neurological conditions (eg epilepsy)
- Sensory differences (eg increased sensitivity to light)
- Signs of sleep deprivation including sleeping at inappropriate times, mood changes,
- difficulty paying attention, thinking and memory issues and making poor or risky decisions.
If sleep deprivation becomes chronic, this can increase the risk of physical health problems (eg weight changes, decreased pain threshold, and immunodeficiency) and mental health disorders (eg depression and anxiety).
Impact on education
Sleep deprivation can impact several aspects of a child’s life, including their learning and social interaction at school. As children with ASC or ADHD are more prone to sleep difficulties and deprivation, the impact of this on their education can be elevated.
Sleep deprivation and memory
It is thought memories are solidified during the deep stages of sleep. If a child’s quality of sleep is reduced, whatever they have learnt during a school day is not retained overnight, and so is more easily forgotten. Also, when sleep-deprived, children can struggle to make memories in the moment, leading to difficulty learning new concepts and accessing previously learned information.
Sleep deprivation and focus
A lack of sleep notably reduces reaction time. For a child at school, this means delayed responses to questions, lack of class participation, and difficulty concentrating. They are also more easily distracted as they do not have the capacity to filter out irrelevant information. As their attention is easily directed away from the information they should be memorising, plenty of time can be lost to a lack of focus.
Sleep deprivation and social interactions
Alongside learning, children in a sleep-deprived state can struggle to interact well with their peers and develop friendships. If a child is easily agitated and experiences mood swings due to sleep deprivation, the person on the other side of the interaction will start to form a negative perception of them. If this is repeated, peers will begin distancing themselves, impacting a child’s self-esteem. This can result in a pattern of negative behaviour, such as truanting. Children with ASC or ADHD already find it much more difficult to pick up on social cues and navigate social interactions. With the lack of energy associated with sleep deprivation, it can become even more difficult for them to adapt and integrate with their peers.
It may be difficult to distinguish between what is a result of sleep deprivation, and what is a result of difficulties associated with ASC and ADHD. For example, inattentiveness and distractibility are commonly associated with ADHD, but are also worsened by poor sleep. Consequently, it is important to pay attention to common physical signs such as daytime sleepiness and dark circles under the eyes. Also, ensure to monitor any changes over time. If a child has always isolated themselves from peers and struggled to participate in class, ASC is likely underlying this, with sleep deprivation exacerbating the difficulties.
Jade Taktak Assistant Psychologist
Dr Mark Chapman is a Clinical Neurodevelopmental Psychologist working with the CAMHS Neurodevelopmental Assessment Service