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Summer sensory survival kit for parents and carers

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Summer sensory survival kit for parents and carers

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Teaching your child to use the toilet correctly can be a difficult task, whether they are on the autism spectrum or not. But if your child is autistic, the process of developing a toilet routine can take longer, and involve its own particular challenges. This guide provides some useful steps that will hopefully make your toilet training a success.

When to start

Choose a time when you have few engagements and are feeling relatively stress free. Some indicators of a good time to start are:

if your child has begun to become aware of needing to go to the toilet

if you notice changes in their behaviour patterns, such as appearing distracted or fidgeting when they are wet or have soiled

if they let you know when they need changing

if you have observed that your child is aware that they have started/finished weeing or pooing

if your child has shown an interest in using or used the toilet themselves without being prompted

if your child can avoid having a wee or poo accident for one or two hours at a time (ie has improved bladder/bowel control).

Developing a toileting routine

Remember that independent toileting is the ultimate aim and may take many months but there will be many small steps and successes along the way. As well as physical factors associated with toilet training, there are social factors to consider. It is rare for an autistic child to have the social motivation to want to be like mummy/daddy/friend and use the toilet. After using nappies for a number of years, your child might not see the point in starting to use the toilet. It's important to remember that all children are different and they will not all respond to the same teaching techniques.

Children on the autism spectrum often like routine. You can build upon this desire for predictability to develop a successful toilet training routine.

When changing your child's nappy, do this where the toilet is so they can start relating toileting activities to the bathroom.

Your child may behave differently than normal when their routine is changed so let everyone who cares for them know why there could be a change in behaviour. It is often easier not to use a potty as part of toilet training to avoid a possibly difficult change from potty to toilet.

Ensure everyone working with your child starts toilet training at the same time and follows your agreed approach. Send in any equipment to nursery/school which you use at home, for example a toilet seat they may use to make the seat smaller. Also remember to send spare clothes, plastic bags to put any wet clothes in and wet wipes. It is important that you have clear lines of communication during this time so having a home/school book to share concerns and successes is vital.

Observe your child over a few days to see when they do a wee or a poo. Identifying a regular pattern can help you take your child to the toilet with an increased likelihood of them doing a wee or poo. This then leads to positive reinforcement.

Continue to take your child at set times based on your observations. If they wet themselves at another time, take them to the toilet as quickly as possible and try to get them there so some of the wee goes into the toilet. Ignore the wetting and positively reinforce that the wee has gone into the toilet and continue the rest of the toileting routine.

Use a visual sequence beside the toilet to help your child understand what is expected of them, for example: trousers down, pants down, sit on the toilet, wee/poo in the toilet, wipe (you may need to show how many squares of paper to take), pants up, trousers up, flush toilet, wash hands. The sequence can either be in the form of photographs, pictures or the written word - whatever is most suitable and motivating for your child. You may need to create a way of removing or covering over each symbol as the step is completed to show that it is finished and to move on to the next step. There are some examples of visual supports on the Do2Learn website.

Make sure any pictures or instructions are very clear so there is no misunderstanding. For example, if you are teaching your son to stand and wee in the toilet, show an outline drawing of him standing and weeing in the toilet. If you are teaching sitting, show a picture of him sitting and weeing in the toilet.

Show your child a photo or drawing of the toilet and say 'your child's name, toilet', take them into the toilet, follow your visual sequence for undressing and sit your child on the toilet. Even if they do not open their bowel or bladder, continue to follow the visual sequence as if they had.

Use a laminated visual sequence above the sink at eye level for hand washing.

Teach toileting as a whole routine from communicating the need to go to the toilet, using the toilet, to drying hands, rather than just sitting on the toilet.

Keep the sequence of behaviours the same every time. Often when an activity is anticipated, the child is more receptive to it.

Concentrate on tackling one behaviour at a time; it's very difficult to change two behaviours at once.

Decide whether or not and how to praise your child for successfully following the toileting routine. Some children enjoy and respond to social praise ('well done', or a tickle), others respond better to an object. Some children find praise difficult and keeping a calm, structured routine with a preferred activity after toileting may work better.

Dressing and undressing

Dress your child in comfortable clothes they can easily manage themselves such as elasticated waistbands on trousers and skirts or dresses that are not too long.

Motivate your child to wear underwear by buying pants with their favourite cartoon or television programme characters on them.

Use 'backward chaining' to teach new skills. This involves breaking a skill down into smaller steps, teaching the last stage of the sequence first. So if you were teaching your child to pull up his trousers, you would pull them up to his hips and then he would pull them up to his waist. Next time, you would pull them up to just under his hips and he would pull them over his hips and waist. This is a particularly good way of teaching new skills as it raises your child's self-esteem as they have taken the final step of the task themselves to complete the sequence.

Hand washing

Follow the same steps each time: sleeves up, tap on, wet hands, squirt soap, rub hands together, rinse hands, turn off tap, shake hands, dry hands.

Stand behind your child and physically prompt them if necessary, slowly withdrawing.

Avoid using verbal prompts as your child can become dependent on these without you realising. Instead let your child refer to a visual sequence as a reminder.

You may wish to teach your child to use the cold tap only. Beware that if you teach them to use the hot tap independently at home, when they go into other settings and wash their hands, the water may be too hot and could burn them.

Boys - sit or stand?

When deciding whether to teach a boy to sit or stand to urinate, ask yourself the following questions:

Can they distinguish between when they want to wee and poo?

Do they have the co-ordination, focus and control needed to aim?

If they learn by imitation, is there someone they can watch?

If the answer to any of the above is 'yes', then they are probably able to be taught to stand to urinate. To start teaching them to aim, it can be useful to put a piece of cereal (preferably one they don't eat as this could lead to confusion) down the toilet so they have something to aim for and concentrate on. You can also purchase a variety of fun toilet target stickers online.

Bowel control

Bowel control is usually learnt after bladder control. Some children can find bowel movements very frightening and not understand what is happening. It can help to get a book with pictures to explain the digestion process.

Some children find the feel of a full nappy comforting, and may enjoy the sensory feeling of the weight of the nappy. Find alternative ways to replace these feelings so you can continue toilet training. Give your child a means of requesting the activity eg being wrapped in a warm, heavy blanket and fit it into their routine.

Sit your child on the toilet, keep the nappy on but with a hole cut in the bottom, slowly cut away the nappy each time until they are able to go without the nappy at all. To start with, they will still have the feeling of a security around their waist which in turn will enable them to feel relaxed enough to poo on the toilet.

Habit training

Some children are toilet trained through habit. Habit training is effective for children who may: lack awareness, not understand the significance or meaning related to physical sensations, be limited by decreased or absent physical sensations or have unsuccessfully tried toilet training before.

Habit training involves training the body to go at set times. Take your child to the toilet at set times throughout the day, every day.

As before, observe your child to discover the best times to take them to the toilet.

Make sure your child feels relaxed enough to open their bladder/bowels while they sit on the toilet. Having the tap running in the background can help enable your child to wee for example.

Sometimes having a toy to handle - not one which causes excitement - can be useful to both keep your child on the toilet and relax them. Keep certain toys/books for just when they are sitting on the toilet.

If your child lacks awareness or sensation, they may have to be taught a strategy before getting off the toilet, to avoid accidentally weeing on the floor. Encourage them to slowly count to ten out loud when they have finished weeing before allowing them to get up, or give them a sand timer to look at.

To help your child to independently manage their own toileting routine when they are older, you can buy watches which you can set to vibrate at certain times throughout the day. You can then teach your child when the watch vibrates, they are to go to the toilet.

Environment

Ensure the bathroom is a calm, relaxing environment to encourage independence and success with the complete toileting routine.

Remove all distractions which are not associated with toileting to help your child understand what is expected of them while in the toilet.

Make the bathroom as comfortable as possible, adding foot supports, side rails and a smaller toilet seat if necessary.

Encourage independence by ensuring that everything in the bathroom is at the right level for your child eg soap and towels.

Think about your child's sensory needs and make changes to reduce their anxiety. Does the soap smell too strong for them? Does the noise of the extractor fan bother them? Does the water temperature need to be adjusted? Is the lighting too bright?

Make sure your child can sit comfortably on the toilet with hips and knees flexed at a 90 degree angle and have feet flat on a secure object.

Night-time

Once your child is mostly dry during the day you will be able to start night-time toilet training.

Have a set bedtime routine which does not change with weekends or holidays.

Limit the amount your child eats and drinks before bed, having no fluid an hour before bedtime, but ensuring your child has enough fluid throughout the day.

Take your child to the toilet before they go to bed. They then may need to be taken once during the night. You could fit this in with your routine by taking them before you go to bed.

If they are unable to keep dry during the night, you may need to try different times in the night to take them.

Use products to protect bedding.

Schools and early years settings

Admission to school should not be refused simply because a child has difficulties with continence. A school that does this may be at risk of disability discrimination (alternative legislation operates in Northern Ireland).

Further tips

Giving a drink 10 to 15 minutes before toileting can help increase the chances of your child successfully doing a wee on the toilet but avoid giving too much as this creates an unnatural routine.

Decide if you are going to teach your child to shut the door as part of the whole toileting routine or only in certain situations.

Avoid using childlike terms for toileting as your child may find it difficult to change language later in life.

If your child has a fear of flushing the toilet, you may wish to remove this from the visual sequence and leave it until the end of the routine - after your child has dried their hands. They then may need to stand in the doorway while you flush the toilet and gradually stand closer each time until they are able to flush for themselves. Playing calming music to drown out the noise of the flush or explaining with pictures what makes the noise when the toilet is flushed may also help.

When your child is in a car, ensure they have a protector to sit on to stop the car seat from being soiled by accidents. Avoid drinks before long car journeys.

Be aware that some children will hold onto their wee/poo until they have their nappy put on, for example if they know they always have a nappy on before going in the car they may wait until it is put back to release their bowel/bladder.

A range of absorbent pants and swimwear for older children is available.

Once your child is toilet trained at home, you will want to teach them to use toilets when out. When visiting new places, show your child where the toilets are and use the same routine as you do at home. Use the same picture and toy or book they may have for toileting at home.

Some children smear their poo. Read our guide on smearing for strategies to try (link to new guide in behaviour section).

Further information

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Toileting - a guide for parents and carers

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This guide provides some useful steps to help make toilet training an autistic child a success.

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Our guidance aims to help you address common eating difficulties for autistic people.

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AET guidance: Positive relationships between home and school

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AET guidance: Positive relationships between home and school

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We are the UKs leading charity for autistic people and their families. Since 1962, we have been providing support, guidance and advice, as well as campaigning for improved rights, services and opportunities to help create a society that works for autistic people.

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Slides and resources from a webinar which explored practical Ideas for sensory regulation in the classroom for children who are autistic, ADHD or who have other sensory differences.

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Some autistic children find the demands of school, and the school environment, almost unbearable, leading to absence or 'school refusal'. It's a term that some people feel unfairly implies the child or young person has a choice, when in fact they may not be simply unwilling, but actually unable to tolerate school.

School absence or refusal can be ongoing until the reasons behind it have been identified and addressed. Here we look at reasons that could be behind this. We also suggest strategies to try at home and school to help maintain school attendance or reintegrate your child back into school.

What are the added pressures of the school environment?

Autistic children and young people can face additional pressure at school. For example, they may:

lack the complex social skills that come naturally to others, struggle to make and keep friends or might experience bullying

have difficulty coping with the curriculum. This could be because they have difficulty processing information and understanding questions and text

struggle to cope with the demands of a school timetable because they have difficulty organising and prioritising

experience sensory differences which can make it hard to tolerate some aspects of the school environment, like noises, smells and lighting

strive for perfection in their work and see anything less as a failure

get into trouble with teachers for unintentionally being rude, inappropriate or not respecting authority

take things literally, which might mean that they misunderstand a teacher's instructions, or aren't able to join in with classroom jokes

find sudden changes to their routine difficult

find transitions difficult, like moving classroom or changing teacher

find that unstructured time, like breaks and lunchtime, cause anxiety at school

experience difficulty with a particular subject or member of staff

struggle with anxiety and find it hard to be apart from family, or away from the familiar routines of home.

Parents have a legal duty to make sure that their children have a suitable education by regular attendance at school, or otherwise. If your child is unwell due to stress or any other condition that means they'll be absent for longer than a few days, you should get a medical certificate from a health professional. If your GP can't provide this, you may need to approach another health professional, like someone from  Child Adolescent Mental Health Services (CAMHS). You should also let the school and the local/education authority know and discuss arrangements for alternative education.

How can I find out why my child's refusing school?

Explore what your child thinks about their experiences at school. For example, rather than ask how their day has been, which could be answered by an ambiguous 'OK', ask what their favourite lesson was that day. You could also ask them to score parts of their day. For example, 'how much did you enjoy playtime today with a score of one of ten'. And follow up, 'that's a lower score than yesterday. What made you enjoy it less? Visual supports may help.

Consider whether there could be a pattern to their absences. Are they trying to avoid a particular situation, lesson or person that makes them anxious?

Speak to a member of staff at school who knows your child well, and ask for their help. Your child may be showing signs of anxiety in school at particular times.

Alternatively, your child may display different behaviour at home than in school. They might bottle up their emotions until the end of the school day and release them when they're at home, where they feel fully loved and accepted.

Understanding your child's behaviour may be difficult. You may find our information on behaviour helps.

Consider whether your child is being bullied, or if they could be misinterpreting the actions and intentions of others as hostile when they're not.

Consider gender issues. For example, autism may present differently in girls. For children who don't use verbal or written communication, schools should consider:

the views of parents, carers and others who know them well

a behaviour diary

a home/school communication book.

Strategies you could try at home

If your child becomes reluctant to go to school, it's important to take action early. Some of these strategies may help:

Encourage them to communicate with you about the problem. Using visual supports may help. Ask your child to rate events or places at school on a scale from 'not scary' to 'very scary'. This may help you to see when and where the problems occur and help build your child's resilience.

If you have an understanding of the reasons behind their reluctance, share it with school staff.

Create a 'worry book' for your child to record their anxiety during the school day. If appropriate, read the book together as part of their evening routine. You can then help them deal with any worries by suggesting how to cope with them in the future.

Identify strategies to regulate, reduce and monitor emotions and reduce stress, for example exercise, visual stress scales such as a stress thermometer or traffic light system.

Reward and praise any progress on specific tasks, like completing something they find difficult, putting on their school uniform or walking past school.

Provide structure at home by using visual supports.

Try to help them develop their social skills.

Help your child to understand the benefits of education.

Strategies to discuss with the school

The help your child needs will depend upon the causes of their anxiety. For example, there may be a specific problem which requires immediate action from school, like bullying.

Here are some other triggers and strategies to consider:

School environment. Many autistic children and young people have sensory differences. There are specific strategies that can help with this, like providing a calm and quiet place, a suitable workspace or wearing ear defenders. They may need support from an occupational therapist to help identify and manage sensory issues.

Does your child need more, or different support at school? They may need help with transitioning between lessons, or might benefit from specialist input from a speech and language therapist to help them understand social situations.

Use the understanding you have of your child to identify coping strategies that can be used in school. Discuss these with the person responsible for special educational needs (SEN) or additional support needs (ASN). This could be something like time out cards, stress scales or other interventions.

Ask the school to make reasonable adjustments at the start and end of the school day. For example, your child could be met at the school entrance by a member of staff they feel comfortable with, be given time to engage in hobbies/interests, or be allowed to leave before other pupils.

Ask the school to consider extra breaks for your child during the school day. Perhaps they could be redirected to a different activity, have a quick run outside, or retreat to a quieter area of the school.

Your child might like the opportunity to discuss their feelings at the end of each school day. Ask your child's teacher or support assistant to go through the timetable with them and ask them to mark each lesson out of ten. For those lessons they score low, ask them why.

Suggest to school that they use your child's interest to help them learn. For example, if your child is interested in dinosaurs perhaps a lesson to count could involve counting dinosaurs. Talking about their interest can help to bring them into conversations and build positive relationships with staff.

Ask the school if there are ways they can reward your child for small improvements in achievement.

When supporting your child in going back to school after a period of absence, it may help to start off on a part-time timetable and build up gradually. This can be better than your child feeling pressured to complete a whole day, and then not coping.

Increasing the school's autism awareness

Ask the school if they'll consider organising autism awareness training for all staff, including break and lunchtime support supervisors.

It could also help if the school creates opportunities for all pupils to develop an understanding of medical conditions, SEN or ASN and disabilities. This could be a school assembly where information on many additional needs, including autism, can be presented without highlighting any particular pupil. This will help others to view autism in a positive way and is likely to benefit everyone in the school community. It might help not only your child, but also other autistic children and young people at the school.

Teachers working with autistic children and young people may find it helpful to sign up for our Autism practice - education: a monthly newsletter for teachers and education professionals (both mainstream and specialist).

Returning to school

Schools should try to identify and address sources of stress and reduce anxiety levels. This will help your child re-engage with their education by feeling safe in the classroom and accepted by those who support them.

Any period of transition, including returning to school, can cause anxiety so careful preparation will be needed to help your child manage this change.

Involve them in the process and arrangements, including details that might seem trivial, such as:

which room they'll go to first

what time they'll go there

how long they'll be there

why they'll be there

what will happen next.

A visual timetable may help

Before your child can access learning, work may need to be done on their emotional wellbeing, reducing stress and increasing self-confidence.
What if this doesn't resolve the problem?
If you feel your child needs more support to help them return to school and progress, you should consider getting extra help for them in school.

If anxiety or other mental health conditions are contributing to your child's difficulty with attending school, ask your GP to make a referral to CAMHS. They have a team that can advise you on psychiatry, clinical psychology, counselling and other therapies.

The school could involve the Education Welfare Officer. It's their job to work with schools, pupils and families to support regular school attendance.

If your child continues to struggle to attend school, you may decide to choose a different school or consider home education.

Pathological Demand Avoidance (PDA)

If your child has a profile of pathological demand avoidance (PDA) then talk to school about appropriate interventions. The standard ones used for autistic children and young people will need to be adapted to take your child's PDA into account.

The PDA Society has useful information (see our useful resources below). You could also suggest that school staff read more about helping children with PDA at school.

Useful resources

You might find this PDF, from the Autism Education Trust, useful:  School stress and anxiety - how it can lead to school refusal and impact on family life.

You may like to suggest to your child's school that to help other pupils learn about autism, the school could use the National Autistic Society's learning resources for schools and the Autism Education Trust's guide Promoting autism inclusive attitudes.

The PDA Society has useful information for  families and carers, along with educational and handling guidelines for  education settings.

If you need to find local autism services (schools, counsellors, local groups, diagnostic services) in your area, you can search on our Autism Services Directory - please browse by categories and refine by your local area.

Our online community is a place for autistic people and their families to meet like-minded people and share their thoughts and experiences.
Find your local branch
We have 117 local branches led by amazing volunteers. They are places to meet other autistic people and their families and to find out what's going on in your area

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A guide for parents or carers of autistic children with advice on how to help your child go to school.

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Soothing Rhythm Breathing - Compassion Focused Therapy Exercise #LewisPsychology

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Birmingham Women's and Children's NHS Trust

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What Is Autistic Masking? | Autism And Me

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Background

Definitions and classifications

Gender identity is the private sense and subjective experience of one's gender. For most, a natural understanding develops from a child's early months and years without difficulty or conflict and is in line with the gender that is assigned at birth. For some, however, there can be a growing feeling of incongruence between their external body and internal experience. This can result in significant distress and a desire to change.

This phenomenon is a recognised disorder in childhood (as well as in adults) and diagnostic classifications are outlined in both DSM-5 as 'Gender Dysphoria' and ICD-10 as 'Gender Identity Disorder of Childhood'.

Epidemiology

Whilst considered rare, the actual incidence of Gender Dysphoria (GD) or Gender Identity disorder (GID) in the child and adolescent population is difficult to ascertain due to the lack of epidemiological studies and problems with differing criteria across the globe. Rates of referrals at all ages are increasing. A survey of 10,000 people undertaken in 2012 by the Equality and Human Rights Commission found that 1% of the adult population was gender variant to some extent. We know that Gender Dysphoria in adults knows no cultural boundaries, although it may be more hidden in some, and there is nothing to suggest that it is any different in child and adolescent populations.

It was once thought to be more common in natal boys, however, over recent times the number of girls presenting has increased and some studies report more equal numbers. The sex ratio seems to change according to age with a higher male: female ratio in under 12s compared with over 12s where the ratio is close to 1:1.

In comparison to adults, there are differences in the fluidity and variability in the outcomes within the child and adolescent population. In a minority of prepubertal children with GID, this will persist into later life although many will develop a homosexual orientation. In adolescents, a higher proportion will pursue gender transition although there are also high rates of homosexuality.

GID in Autism Spectrum Disorder (ASD)

This is an area which has sparked some interest, but there has been limited research thus far. Reports from gender identity clinics and some studies suggest a putative link, revealing higher rates of co-occurrence than would be expected by chance alone.

Preliminary results from a recent surveillance study of children and adolescents in the UK and Ireland reported ASD in 17/105 (16%) of new cases of GID over a 19 month period. One study from the Netherlands found ASD in 6.4% of children referred to a Gender Identity clinic and 9.4% in the adolescents referred. The Tavistock and Portman NHS Foundation Trust, which provides a Gender Identity Development Service for under 18s in the UK, estimate around 10% of their referrals have ASD. This finding is interesting and relevant for diagnosis and management and raises important theoretical questions.

In order for us to try and understand this further it may be helpful to outline 'typical' gender development and see how having ASD may impact upon this.

Gender identity development is influenced by biological, psychological and social variables. Kohlberg (1966) proposed that a child moves through three stages of increasing complexity.

1. Gender identity: By two a child is able to self label.

2. Gender stability: By four the child understands that gender remains the same across time.

3. Gender constancy: By seven a child understands that gender is independent of external variable such as the way people have their hair or dress.

In gender schema theory, a child creates a cognitive structure which is used to organise information about an object, person and situation. Information is 'made sense of' by matching their pre-formed schemas. It is therefore perhaps understandable that a child with ASD and associated difficulties such as with social interaction, communication and theory of mind deficits may struggle to form an understanding of their often ambiguous environment in order to reach an awareness of their own gender. If development is delayed at an earlier stage, for example if there is an associated intellectual disability, they may display more rigidity in their gender beliefs.

Within the literature exploring the area of ASD and GID a number of theoretical explanations have been discussed. Whilst some of this research comes from child and adolescent populations, some is also extrapolated from adults.

It has been suggested that a confusion of identity in ASD may expand to gender related problems. The sense of 'not belonging' in ASD is a common experience with those who have GID, thus GID may arise due to their ill-defined sense of being different from others.

'An adolescent with ASD who always had the feeling of being different from his peers in childhood, but had no history of childhood cross gender behaviour, became convinced that this feeling was explained by gender dysphoria. He had hoped that his communication problems would alleviate by taking hormones'. Another proposed theory is linked to difficulties with social and interpersonal relationships. There are reports of it arising as a consequence to bullying, difficulties in 'conventional' sexual relationships, abuse, sexual difficulties, or a paraphilic consequence of impairments in social interaction.

It has been suggested that GID could be regarded as a sequel to Asperger Syndrome (AS) in natal females arising from male emotional and cognitive traits due to AS. One would expect in this case natal females with ASD to outweigh natal males with ASD in referrals to GD clinics, however, this does not appear to be the case in the literature or clinical practise (although there have been no confirmatory studies around gender ratio in this specific area).

Some may view GID and associated behaviours as part of the unusual interests and preoccupations seen in ASD. However, such gender related behaviours, which include: mannerisms, attitude, interests, preoccupations and self identification show a broad spectrum rather than the restricted repertoire seen in ASD. Could GID be an obsession/ compulsion in ASD linked to behavioural rigidity and obsessionality? Parents often report that their child is obsessed by issues surrounding gender. However, being in preferred gender role is in itself ego- syntonic (excluding any social difficulties and anxieties which may arise). A case in the literature of a girl with ASD found her OCD symptoms resolved with medication, but the gender related ideas persisted.

Sensory preferences have been noted in some individuals. There are reports of fascinations in typically 'feminine interests' such as silky, soft and glittery textures and materials, bright and shiny substances and long hair. This could potentially explain some cross gender behaviours in natal males.

Clinical experience and the literature appear to support the co-occurrence of GID and ASD. Successful treatment also seems possible, however, it is important to take the neurodevelopment disorder into account. The Tavistock and Portman service accept referrals of young people with ASD. Whilst unpicking the inter-relatedness of GID and ASD is a complex task, positive outcomes are reported. This area increases in complexity if an individual has an additional intellectual disability and/or limited verbal skills. In clinical practise, best interest decisions have been made in non-capacitous individuals.

Going forward

Assessment and treatment

Assessment of children and adolescents presenting with GID must be comprehensive and include their family. Important considerations are the high rates of co-existing internalising disorders such as anxiety and depression, and/or externalising disorders such as oppositional de ant disorder, in addition to the possibility of neurodevelopment disorders such as ASD. Adolescents with GID are at a high risk of self harm and suicide attempt especially in the over 12s.

An important focus of treatment is to explore an individual's gender identity. Clinicians have a crucial role in alleviating distress, fostering recognition, acceptance and openness in order to break the 'cycle of secrecy' that surrounds this issue for so many of those affected. Families, who themselves may be experiencing a mourning process, may need support to move away from a binary view of gender, to manage uncertainty and sustain hope.

Treatment aimed at trying to change a person's gender identity and expression to become more congruent with their natal gender has been attempted in the past without success and is not considered ethical.

Following assessment and diagnosis of a child or adolescent with GID subsequent treatment follows a staged approach.

Stage 1: Further exploration of the nature of gender identity

Stage 2: Reversible interventions - hormone blocking from 15 years (12 years in research)

Stage 3: Partially reversible interventions - cross sex hormones

Stage 4: Irreversible interventions - surgical procedures (not considered before 18)

Conclusions

Gender identity can be viewed as a developmental milestone. Rates of referrals to GID clinics are increasing. Whilst evidence base is limited it suggests a higher rate of GID in those with ASD. This raises important theoretical questions about the neurodevelopmental mechanisms at play. Assessment and treatment of those affected is complex and requires an individualised approach however the literature also supports treating GID in those with ASD in accordance with international standards.
Conflicts of interest
The author has declared that she has no competing or potential conflicts of interest in relation to this article. The views expressed here are those of the author and do not necessarily reflect those of the Association for Child and Adolescent Mental Health.

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Gender identity and children with autism spectrum disorder - ACAMH

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Gender identity is the private sense and subjective experience of one's gender. For most, a natural understanding develops from a child's early months and years without difficulty or conflict and is in line with the gender that is assigned at birth. For some, however, there can be a growing feeling of incongruence between their external body and internal experience.

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Resistance to demands is a characteristic experienced by and observed in some autistic people. It is sometimes labelled as Pathological Demand Avoidance (PDA), but there is debate about the evidence for and usefulness of this label.

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Author: Kock et al (2019)

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Title: "It's Not Just in My Head, and It's Not Just Irrelevant": Autistic Negotiations of Menopausal Transitions | SpringerLink

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Title: Masking in Autistic Females | AUTISTIC MASKING

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Title: Autism and Relationships Part 1: Friendships | AUTISM IN GIRLS

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Title: 9 Childhood Autistic Traits in Girls | EARLY SIGNS OF AUTISM

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Title: I was Groomed as an Autistic Teen | AUTISM IN GIRLS

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Title: 10 More Female Autistic Traits | AUTISM IN GIRLS

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Title: Autism and Periods (+ Period Underwear Review and My Biggest Meltdown Ever) | AUTISM IN GIRLS

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Title: Autism in Women: How My Late Diagnosis Allowed Me to Fully Accept Myself (@potentia.neurodiversity)

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Title: PARENTING WITH AUTISM: The Final Straw that Led Me to Seek Diagnosis // Autism in Women

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Title: Autistic and Pregnant | Managing The First Trimester

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Title: Autism traits in girls and women⎥Autistic traits I struggle the most with⎥#actuallyautistic

Source: YouTube

Author: neurodivergent me, 2021b

Title: Pregnant & Autistic⎥1st trimester update⎥My experience being pregnant as an autistic woman

Source: YouTube

Author: neurodivergent me, 2021c

Title: 8 autism traits in girls & women, explained by an autistic woman⎥AUTISM IN GIRLS

Source: YouTube

Author: Ruby Woods, 2020

Title: My Autism Diagnosis Journey - Female With ASD

Source: YouTube,

Author: Erin R, 2022

Title: Adult Female Autism Diagnosis: My Experiences

Source: YouTube

Author: Meghan Levaughn, 2021

Title: Unmasked: Living With PMDD & Autism

Source: International Association for Premenstrual Disorders

Author: A Is For Aoife Not Autism, 2021a

Title: Autism and Periods

Source: blog

Author: A Is For Aoife Not Autism, 2021b

Title: Autism and Puberty

Source: blog

Author: Sara King, 2021

Title: My experiences of pregnancy, birth and motherhood as an autistic mum

Source: Royal College of midwives

Author: Hannah Clarke, (accessed Aug 2022)

Title: What is it like to be a woman on the spectrum?

Source: Neurodiverging

Author: Danielle, (accessed Aug 2022)

Title: Episode 11: A Struggling, Undiagnosed Autistic Girl in the 1990s

Source: Neurodiverging

Author: Carly Ott, 2017

Title: Autistic And Pregnant

Source: The Art of Autism

Author: April Griffin, 2016

Title: Gender Identity Issues And Females On The Spectrum

Source: The Art of Autism

Author: Alicia Trautwein, 2020

Title: Autistic and pregnant

Source: Motherfigure

Author: Rhi Lloyd-Williams, 2021

Title: AUTISM INTERVIEW #170: RHI ON AUTISTIC PREGNANCY, CHILDBIRTH, AND MOTHERHOOD

Source: Blog

Author: Alicia Trautwein, 2020

Title: The Challenges of Being an Autistic Mother with Autistic Children

Source: special educational needs

Author: Lucy Parker, 2019

Title: The truth about being autistic and a mother

Source: Motherly

Author: Lana Grant, 2017

Title: Autistic Women, Pregnancy and Motherhood - Lana Grant

Source: Spectrum Women

Author: Linda Hollenberg, 2021

Title: The Autistic Doula: Navigating the sensory challenges of motherhood

Source: Reframing Autism

Author: Autistic Women Everywhere, accessed September 2022

Title: AUTISTIC WOMEN EVERYWHERE

Source: Autistic Women Everywhere

Author: Sarah Vanis, accessed September 2022

Title: AUTISTIC WOMEN EVERYWHERE

Source: Autistic Women Everywhere

Author: Vanessa Hughes, accessed September 2022

Title: AUTISTIC WOMEN EVERYWHERE

Source: Autistic Women Everywhere

Author: Suzie Ramsay, accessed September 2022

Title: AUTISTIC WOMEN EVERYWHERE

Source: Autistic Women Everywhere

Author: Janey Klunder, accessed September 2022

Title: AUTISTIC WOMEN EVERYWHERE

Source: Autistic Women Everywhere

Author: Esther Whitney, 2022

Title: Personal Account: Breastfeeding as an Autistic Parent

Source: Autistic Parents UK

Author: Ruth Jenks, 2021

Title: Relationships with Healthcare Professionals (HCPs) during pregnancy, birth and the postnatal period

Source: Autistic Parents UK

Author: Keara Farnan, 2018

Title: Why It's Hard to Find a Boyfriend as an Autistic Woman

Source: The Mighty

Author: Nicole Seaward, 2021

Title: Autistic Womxn - Relationships

Source: Grit and Flow

Author: Hope Whitmore, 2015

Title: "Are You Angry With Me?": Dating as an Autistic Woman

Source: The Toast

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More women and girls than ever before are discovering that they are autistic. Many had been missed or misdiagnosed due to outdated stereotypes about autism. But that is slowly changing.

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"Autism therapy typically focuses on ridding individuals of "autistic" symptoms such as difficulties interacting socially, communication problems, sensory chall

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AET guidance: Working together with your child's school

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AET guidance: Working together with your child's school

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Ambitious about Autism is the national charity for children and young people with autism. We provide services, raise awareness and understanding, and campaign for change. Through TreeHouse School, The Rise School and Ambitious College we offer specialist education and support.

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Our advice and guidance gives some reasons an autistic person might smear their faeces, and strategies to address this.

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GOOD AUTISM PRACTICE REPORT PRACTITIONER GUIDANCE

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GOOD AUTISM PRACTICE REPORT PRACTITIONER GUIDANCE

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Autism specialist and autistic adult Sarah Hendrickx discusses the topic of anxiety and autism in education. Sarah suggests instead of seeing anxiety as a separate and distinct issue we should focus on anxiety coming from an autism root and tackle it from this perspective.
It should come as no surprise that autistic children and young people experience anxiety, especially at school. If we think about it, school is the place where they are going to experience the most people, most potential change and least amount control. They have to go, day after day with little choice about who, what and when. School takes up almost half of a child's waking hours and is set in a physical environment that may not be easy for those with sensory differences. And we haven't even mentioned play-time.

The triggers for anxiety can be many and varied but usually have a root which can be attributed to autistic processing, such as:

social understanding with peers and teachers

unspoken social or work task requirements

unexpected change.

Something which I see causing anxiety in children I have worked with is rules which make no sense and which the autistic child will question in a way that other children often do not:

Why do we have to do assembly?

Why do I have to shake the vicar's hand?

Why do I have to sing?

These children are not argumentative or challenging; they are confused and trying to overcome their confusion by seeking more data. Imagine a world where you have no choice but to follow rules that you don't know exist until you get them wrong, and rules which have no logical function. How would it feel? Constantly terrifying. You have no idea what comes next and how soon you will be told off for doing something that you didn't know shouldn't be done.

These triggers can also be cumulative. A morning which starts badly with a missed bus, a forgotten lunch or a strange teacher can escalate into a whole day of fear, uncertainty and anxiety for the child, which in turn makes learning very hard.

To have the mental capacity to think, process and utilise incoming information becomes impossible if you are constantly on edge wondering:

what will happen next (because you cannot guess)

what you are supposed to be doing (because the teacher failed to give you sufficient instructions)

why your classmates are laughing (because you didn't get the joke).

You end up becoming on red alert, fight or flight mode, where survival is all.

For this reason, and for the general well-being of our autistic young people, it is essential that we understand that their autistic thinking makes coping in a non-autistic world more difficult and scary.

Trying to deal with their anxiety in isolation is not the answer. Telling someone 'don't be silly', or to 'calm down', or 'you don't need to worry about that' doesn't work. Think about times when you have been concerned or upset and you've been told to 'calm down'. I am guessing that it made you do the opposite and feel like screaming at your well-intended pacifier! This approach can often make us feel that our worries are being trivialised and not heard, and that we are wrong and foolish to have them. This may be a message that our autistic child hears a lot: your view of the world is wrong and foolish.

What works better is to listen and begin at the starting point of the child. If the child is anxious about something, let's start there, in their world and not in our world where it all makes sense. Let's accept their right to feel anxious. Let's tap into this empathy thing and take a moment to imagine what it feels like to be that child.

The approach which makes most sense to me is that we need to be one step ahead and try to predict the upcoming situations and events that might cause anxiety to this individual child. The better you understand how your children are affected by their autism, the more relaxed they will feel because you will 'get them'. For example, if the child struggles with new people, warn them in advance, show photos of the new person, give them some details about the new person which they might find interesting - make the person less 'new', less unknown and more predictable. If the child finds verbal communication stressful, give them other means to get their thoughts across, music, drawing, Lego, computer graphics. It's all common sense really.

If you understand autism, you can work out how to fill in the cognitive gaps that result from living in a non-autistic world and it is these that can result in anxiety. The problem is not the child; it's the illogical, flexible, changeable world they are forced to live in.

Supporting the autism will lead naturally to reduction in the crippling and miserable anxiety that many of our autistic children and young people face simply at the thought of going to school. These are often naturally curious children who love knowledge and want to learn. We just need to make sure that school is an environment which allows them enough capacity to be able to do so.

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Sarah Hendrickx discusses the topic of anxiety and autism in education.

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Our Young Ambassadors are a group of young people aged 16-24 who are passionate about creating a world that works for autistic people.

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Connecting young people and their families with the mental health support they need.

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Since 2016, this group of young people, ages 15-25, have shared their voices and lived experiences to steer, influence and advise the work we do. As well as advising on AET materials and strategy, Panel members speak at events, co-deliver training and support autism education networks.

Find out how this group of young people are supporting, co-producing and advising the AET.

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Helping you support autistic children and young people since 2007

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Northumbria Healthcare NHS Foundation Trust Sensory Processing Service

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Children's Occupational Therapy Sensory Processing Service for children and young people living in Northumberland.

This service is delivered by Northumbria Healthcare NHS Foundation Trust and is based at Wansbeck General Hospital.

Our overall aim is to support parents, carers, education staff and other professional groups to understand how sensory processing can impact on daily life.

The service will provide information on how to modify activities and the environment to support participation in activities of daily life for children and young people with sensory processing challenges.

Our amazing senses

Our senses help us to perceive the world and to interact with other people. We have five external senses; these are known as vision, taste, touch, smell and hearing. We have a further three internal senses which are less well known. These internal senses are vestibular, proprioception and interoception.

Tap or hover over the icons to reveal the pop up.

What is Sensory Processing?

For most children the development of their sensory processing occurs as part of our typical development and they learn to respond appropriately to sounds, smells, movement etc.

We all have some sensory processing differences. For example, some of us like very strong tastes and smells and others avoid them. As long as we can manage to take part in the things we want and need to do these sensory processing differences don't matter.

For some children their sensory development is delayed or disordered, and they struggle to take part in everyday childhood activities. For example, they are so distressed by noise they can't go to a friend's party or they hit out when someone brushes up against them as they experience it as painful.

Meet the team

The team consists of a Clinical Specialist Occupational Therapist, Senior Occupational Therapist, and an Occupational Therapy Technical Instructor.

Sandra

Clinical Specialist Occupational Therapist

Sandra graduated from Northumbria University as an Occupational Therapist in 2002. She has experience of working in acute physical and mental health settings before going on to specialise in Paediatrics in 2008.

She has completed further post graduate training in sensory processing and achieved a Master's degree in Developmental Disorders in 2018. Sandra has extensive experience of working with children and young people who have complex health and sensory needs and enjoys supporting individuals to achieve their full potential.

Karen

Occupational Therapy Technical Instructor

Karen started working for Northumbria Health Care in 2004. She has a wealth of experience in working in health care and recently transferred to Paediatrics as an Occupational Therapy Technical Instructor.

Her goal each day is to ensure she delivers high quality care to all the children and families with whom she works. Working in the Sensory Processing Service allows the opportunity to help children and families in the local area. She finds working in the sensory processing team very interesting and rewarding.

Who is this service for?

Children and young people who are experiencing day-to-day difficulties with processing sensory information can access Northumberland's Sensory Processing website for support, strategies, and information.

If additional support is required a referral can be made to the Occupational Therapy service where parents / carers will be offered an initial telephone consultation. Referrals to the service must be completed by an approved professional and meet the following service criteria:

The Service for any child or young person aged 0-18 years, or up to 19 years if still in full time education and living in Northumberland.

Registered with a Northumberland General Practitioner.

Parent/Carer consent has been obtained for the Referral.

Sensory Processing strategies have been trialled to help improve engagement in daily living activities but have not been fully successful and further support is required.

Sensory Processing challenges continue to have a significant and ongoing impact on mental health and/or physical wellbeing in relation to participating in daily living activities.

Children / young people who are receiving support from the Children and Young People's service (CYPS) who require sensory support may be redirected to CYPS to receive support around their sensory processing needs.

How to access?

Children, Young People and Parent/Carers can access sensory processing resource information and online workshops.

Northumberland Children's Occupational Therapy Service

Child Health Centre, Woodhorn Lane, Ashington, Northumberland, NE63 9JJ

01670 564050

Referral Form

To access a parent/carer telephone triage consultation a referral will need to be completed by an approved referrer into the service, such as:

Medical Staff - Paediatric Consultant or General Practitioner.

Health Professionals such as Physiotherapist, Occupational Therapist, Community Nurse, Health Visitor or School Nurse.

Social Worker

High Incidence Needs Team (HINT)

If you have any questions or queries, please do not hesitate to contact the department on 01670 564050.

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About us - Northumbria Healthcare NHS Foundation Trust Sensory Processing Service

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Support and information for parents and carers of children and young people who experience difficulties with processing sensory information.

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The Safe Place Meditation: Compassion Focused Therapy (10 minutes)

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A strategy used by some autistic people, to appear non-autistic. This can have a devastating impact on mental health, sense of self and access to an autism diagnosis.

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We look at the connection between autism and gender identity, and hear stories from non-binary and transgender autistic people.

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AET guidance for school governors: Exclusions 

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AET guidance for school governors: Exclusions 

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Dr. Barry Prizant is a speech-language pathologist with more than 50 years experience as a researcher and international consultant for autistic and neurodivergent individuals and their families. He is an Adjunct Professor of Communicative Disorders at the University of Rhode Island and Director, Childhood Communication Services (a private practice). Previously, he served as Associate Professor in the Department of Psychiatry in the Brown University School of Medicine, and held a tenured professor appointment at Emerson College. Publications include 5 books, most notably Uniquely Human: A Different Way of Seeing Autism (2015; 2022) and The SCERTS Model manuals, an educational approach implemented in more than a dozen countries. He has published 150 scholarly chapters and articles and serves on numerous professional advisory boards for journals and professional organizations. Barry has presented more than 1000 seminars and keynote addresses internationally, including two invited presentations at the United Nations for World Autism Awareness Day. His career contributions have been recognized with honors from Brown and Princeton Universities, the Autism Society of America and the American Speech-Language-Hearing Association.

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Uniquely Human: The Podcast - Uniquely Human: The Podcast

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Uniquely Human: The Podcast, a show that illuminates and celebrates Autism and Neurodiversity. Hosted by Barry Prizant and Dave Finch.

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In this strikingly honest collection, developed from a pioneering new research project, autistic teachers and other autistic school professionals share their stories of the challenges and successes of their careers. Contributors challenge assumptions and stereotypes whilst highlighting the unique strengths autistic sta

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If you google autism and sleep, most of the advice you get is on how to help your Autistic child get sleep. Don't get me wrong, this is great, and my kids certainly have their fair share of sleep struggles! But what strikes me is the lack of resources for Autistic adults struggling with sleep! Autistic sleep problems don't magically go away when we become adults. Many Autistic adults continue to experience insomnia, circadian rhythm disorders, sleep apnea, restless legs syndrome, and more!

So even though sleep issues and autism co-occur at high rates, it is often overlooked in adults. As an Autistic person myself, I understand-both personally and professionally-how difficult this can be for someone. Let's look at the data:

If you want to do more of a deep dive into neurodivergence and sleep issues, you can see my deep dive article on it over here, including tips for improving sleep and working with sleep vulnerabilities.

Autism and Sleep Rundown

Sleep problems are one of the most common co-occurring conditions for Autistics. Here is a rundown of the infographic details: ⁠

50-80% of Autistic children experience sleep disorders (compared to 9-50% of neurotypical children) ( Reynolds et al., 2019 ).

Autistics are more likely to have a circadian rhythm sleep-wake disorder (CRSWDs). Many Autistics have a mutation within the CLOCK gene, which impacts circadian rhythm. Despite this growing body of literature, Autism is rarely considered when a person is diagnosed with CRSWD.

Autistic people are more likely to have a mutation in genes regulating melatonin resulting in a "flat melatonin curve." Thus our bodies often do not feel tired or send the same level of tired cues at night, and we may feel sleepier during portions of the day/upon waking ( Furfaro, 2020).

On average, it takes autistics 11 minutes longer to fall asleep.

Autistic people are more likely to experience insomnia which includes everything from difficulty falling asleep to night waking and early morning rising ( Furfaro, 2020 ).

Autistics are more likely to experience parasomnias, including sleep paralysis (waking but not being able to move), sleepwalking, and night terrors/sleep terrors⁠.

On average, Autistic people spend roughly 15% of their time asleep in REM (while neurotypicals, on average, get 25%). REM sleep is where we consolidate learning and memory and is important for a host of physical and mental health things⁠ ( Buckley et al., 2010 ; Neumeyer et al., 2019 ).

Repetitive behaviors & hyperactivity increase w/ poor sleep (which can make sleep more difficult).

Implications of Poor Sleep

Sleep is foundational for our physical and mental health. Our brains work hard when we sleep! They are storing our new learning and memories in long-term storage; they are detoxing our brains and releasing new neurotransmitters we need to feel refreshed.

Sleep and Neurotransmitters

During sleep, our brains release certain chemicals called neurotransmitters. These chemicals help regulate our mood, help us learn, grow and regulate our sleep-wake cycle. For example, when we're sleeping, our brains release

✦ Serotonin, which helps regulate our mood and makes us feel good.

✦ Acetylcholine, which is important for memory consolidation, learning, and attention

✦ Melatonin, which regulates the sleep-wake cycle and helps us feel sleepy

✦ Growth hormone, which helps the body grow and repair

When we don't get enough sleep, our brains don't get the chance to release these chemicals. And that can lead to a whole host of problems! When we're sleep-deprived, we're more likely to feel grumpy, anxious, and irritable. Plus, it's harder for us to focus and learn new things.

On the other hand, lack of sleep can lead to an increase in the levels of cortisol throughout the day, which is a stress hormone that can contribute to feelings of anxiety and difficulty relaxing. It also disrupts our circadian rhythm.

On the flip side, when we have enough good-quality sleep, it helps to maintain a balance in these hormones, which can improve our mood and overall mental well-being.

The Detoxing Benefits of Sleep

During sleep, the brain not only releases new chemicals, but it also cleans up from the day. It detoxifies certain chemicals, similar to how a cleaning cycle runs during the night while you sleep. If you ever wake up feeling refreshed and ready to start the day, it's likely because your brain was working to clear away certain chemicals and hormones while you slept. This process helps keep the brain and body functioning properly.

One of the main things it's cleaning up is a chemical called adenosine. Adenosine is like a sleepy chemical that builds up in your brain throughout the day. But while you sleep, your brain works to clear it out, so you wake up feeling more alert and less groggy.

Another thing your brain is cleaning up while you sleep is a chemical called glutamate. Glutamate helps with learning and remembering things. But when you're awake, your brain uses a lot of it. So, at night, your brain works to clear away any extra glutamate you don't need so that you're ready to learn and remember new things again in the morning.

Implications of Autism and Sleep

Beyond the typical health risks associated with sleep deprivation, sleep deprivation causes additional struggles for Autistic people, such as increased sensory sensitivities and executive functioning struggles.

Sensory Sensitivities

Sleep and sleep deprivation can have a significant impact on sensory sensitivities. When we are well-rested, our brains are better able to process and filter sensory input, allowing us to better tolerate and manage our sensitivities. Adequate sleep also helps to regulate our emotional responses to sensory stimuli, making us less likely to feel overwhelmed or reactive.

On the other hand, when we are sleep-deprived, our brains are less able to filter and process sensory input, making us more sensitive to stimuli. This can lead to increased feelings of overwhelm and irritability in response to sensory input. Additionally, sleep deprivation can also exacerbate symptoms of anxiety and depression, which can further worsen the experience of sensory sensitivities.

Many Autistic people have heightened sensory sensitivities, so the negative impact of sleep deprivation can be even more pronounced for us. Supporting our sleep can be an important part of managing our sensory sensitivities.

Executive Functioning

When Autism and sleep issues co-occur, this can amplify executive functioning difficulties. Executive functioning includes the ability to plan, organize, and break down complex tasks into smaller tasks. Executive function is controlled by the prefrontal cortex, an area of the brain that is particularly sensitive to lack of sleep.

When we don't get enough sleep, the prefrontal cortex doesn't function as well, leading to difficulties with planning, decision-making, impulse control, and more. This can make it even harder for Autistic people to manage our emotions and executive functioning challenges. This can make daily tasks such as work or school more challenging.

Conclusion

There is a significant overlap between Autism and sleep. Many Autistic people struggle with insomnia, REM sleep disruption, restless leg syndrome, and more. Because of this, sleep screening and treatment should be a part of holistic Autistic care.

If you're Autistic and struggle with getting good sleep at night, I recommend checking out my article on ADHD, Autism, and Sleep. In this guide, not only will you get more information about sleep and neurodivergence, but you will also get loads of resources and strategies to help you get better sleep at night. Read more here.

You can also download the Neurodivergent Sleep Guide, with several workbook pages to help you better understand your sleep.

Buckley, A. W., Rodriguez, A. J., Jennison, K., Buckley, J., Thurm, A., Sato, S., & Swedo, S. (2010). Rapid eye movement sleep percentage in children with autism compared with children with developmental delay and typical development. Archives of pediatrics & adolescent medicine, 164(11), 1032-1037. https://doi.org/10.1001/archpediatrics.2010.202

Furfaro, Hannah (2020). Sleep problems in autism, explained. Spectrum News. https://www.spectrumnews.org/news/sleep-problems-autism-explained/

Neumeyer, A. M., Anixt, J., Chan, J., Perrin, J. M., Murray, D., Coury, D. L., Bennett, A., Farmer, J., & Parker, R. A. (2019). Identifying Associations Among Co-Occurring Medical Conditions in Children With Autism Spectrum Disorders. Academic pediatrics, 19(3), 300-306. https://doi.org/10.1016/j.acap.2018.06.014

Reynolds, A. M., Soke, G. N., Sabourin, K. R., Hepburn, S., Katz, T., Wiggins, L. D., Schieve, L. A., & Levy, S. E. (2019). Sleep Problems in 2- to 5-Year-Olds With Autism Spectrum Disorder and Other Developmental Delays. Pediatrics, 143(3), e20180492. https://doi.org/10.1542/peds.2018-0492
This post was proofread by , my go-to for proofreading and catching all the details I naturally miss! is entirely free to use. Click here to give it a try.
My Favorite Sleep Helpers:

If you google autism and sleep, most of the advice you get is on how to help your Autistic child get sleep. Don't get me wrong, this is great, and my kids certainly have their fair share of sleep struggles! But what strikes me is the lack of resources for Autistic adults struggling with sleep! Autistic sleep problems don't magically go away when we become adults. Many Autistic adults continue to experience insomnia, circadian rhythm disorders, sleep apnea, restless legs syndrome, and more!

So even though sleep issues and autism co-occur at high rates, it is often overlooked in adults. As an Autistic person myself, I understand-both personally and professionally-how difficult this can be for someone. Let's look at the data:

If you want to do more of a deep dive into neurodivergence and sleep issues, you can see my deep dive article on it over here, including tips for improving sleep and working with sleep vulnerabilities.

Autism and Sleep Rundown

Sleep problems are one of the most common co-occurring conditions for Autistics. Here is a rundown of the infographic details: ⁠

50-80% of Autistic children experience sleep disorders (compared to 9-50% of neurotypical children) ( Reynolds et al., 2019 ).

Autistics are more likely to have a circadian rhythm sleep-wake disorder (CRSWDs). Many Autistics have a mutation within the CLOCK gene, which impacts circadian rhythm. Despite this growing body of literature, Autism is rarely considered when a person is diagnosed with CRSWD.

Autistic people are more likely to have a mutation in genes regulating melatonin resulting in a "flat melatonin curve." Thus our bodies often do not feel tired or send the same level of tired cues at night, and we may feel sleepier during portions of the day/upon waking ( Furfaro, 2020).

On average, it takes autistics 11 minutes longer to fall asleep.

Autistic people are more likely to experience insomnia which includes everything from difficulty falling asleep to night waking and early morning rising ( Furfaro, 2020 ).

Autistics are more likely to experience parasomnias, including sleep paralysis (waking but not being able to move), sleepwalking, and night terrors/sleep terrors⁠.

On average, Autistic people spend roughly 15% of their time asleep in REM (while neurotypicals, on average, get 25%). REM sleep is where we consolidate learning and memory and is important for a host of physical and mental health things⁠ ( Buckley et al., 2010 ; Neumeyer et al., 2019 ).

Repetitive behaviors & hyperactivity increase w/ poor sleep (which can make sleep more difficult).

Implications of Poor Sleep

Sleep is foundational for our physical and mental health. Our brains work hard when we sleep! They are storing our new learning and memories in long-term storage; they are detoxing our brains and releasing new neurotransmitters we need to feel refreshed.

Sleep and Neurotransmitters

During sleep, our brains release certain chemicals called neurotransmitters. These chemicals help regulate our mood, help us learn, grow and regulate our sleep-wake cycle. For example, when we're sleeping, our brains release

✦ Serotonin, which helps regulate our mood and makes us feel good.

✦ Acetylcholine, which is important for memory consolidation, learning, and attention

✦ Melatonin, which regulates the sleep-wake cycle and helps us feel sleepy

✦ Growth hormone, which helps the body grow and repair

When we don't get enough sleep, our brains don't get the chance to release these chemicals. And that can lead to a whole host of problems! When we're sleep-deprived, we're more likely to feel grumpy, anxious, and irritable. Plus, it's harder for us to focus and learn new things.

On the other hand, lack of sleep can lead to an increase in the levels of cortisol throughout the day, which is a stress hormone that can contribute to feelings of anxiety and difficulty relaxing. It also disrupts our circadian rhythm.

On the flip side, when we have enough good-quality sleep, it helps to maintain a balance in these hormones, which can improve our mood and overall mental well-being.

The Detoxing Benefits of Sleep

During sleep, the brain not only releases new chemicals, but it also cleans up from the day. It detoxifies certain chemicals, similar to how a cleaning cycle runs during the night while you sleep. If you ever wake up feeling refreshed and ready to start the day, it's likely because your brain was working to clear away certain chemicals and hormones while you slept. This process helps keep the brain and body functioning properly.

One of the main things it's cleaning up is a chemical called adenosine. Adenosine is like a sleepy chemical that builds up in your brain throughout the day. But while you sleep, your brain works to clear it out, so you wake up feeling more alert and less groggy.

Another thing your brain is cleaning up while you sleep is a chemical called glutamate. Glutamate helps with learning and remembering things. But when you're awake, your brain uses a lot of it. So, at night, your brain works to clear away any extra glutamate you don't need so that you're ready to learn and remember new things again in the morning.

Implications of Autism and Sleep

Beyond the typical health risks associated with sleep deprivation, sleep deprivation causes additional struggles for Autistic people, such as increased sensory sensitivities and executive functioning struggles.

Sensory Sensitivities

Sleep and sleep deprivation can have a significant impact on sensory sensitivities. When we are well-rested, our brains are better able to process and filter sensory input, allowing us to better tolerate and manage our sensitivities. Adequate sleep also helps to regulate our emotional responses to sensory stimuli, making us less likely to feel overwhelmed or reactive.

On the other hand, when we are sleep-deprived, our brains are less able to filter and process sensory input, making us more sensitive to stimuli. This can lead to increased feelings of overwhelm and irritability in response to sensory input. Additionally, sleep deprivation can also exacerbate symptoms of anxiety and depression, which can further worsen the experience of sensory sensitivities.

Many Autistic people have heightened sensory sensitivities, so the negative impact of sleep deprivation can be even more pronounced for us. Supporting our sleep can be an important part of managing our sensory sensitivities.

Executive Functioning

When Autism and sleep issues co-occur, this can amplify executive functioning difficulties. Executive functioning includes the ability to plan, organize, and break down complex tasks into smaller tasks. Executive function is controlled by the prefrontal cortex, an area of the brain that is particularly sensitive to lack of sleep.

When we don't get enough sleep, the prefrontal cortex doesn't function as well, leading to difficulties with planning, decision-making, impulse control, and more. This can make it even harder for Autistic people to manage our emotions and executive functioning challenges. This can make daily tasks such as work or school more challenging.

Conclusion

There is a significant overlap between Autism and sleep. Many Autistic people struggle with insomnia, REM sleep disruption, restless leg syndrome, and more. Because of this, sleep screening and treatment should be a part of holistic Autistic care.

If you're Autistic and struggle with getting good sleep at night, I recommend checking out my article on ADHD, Autism, and Sleep. In this guide, not only will you get more information about sleep and neurodivergence, but you will also get loads of resources and strategies to help you get better sleep at night. Read more here.

You can also download the Neurodivergent Sleep Guide, with several workbook pages to help you better understand your sleep.

Buckley, A. W., Rodriguez, A. J., Jennison, K., Buckley, J., Thurm, A., Sato, S., & Swedo, S. (2010). Rapid eye movement sleep percentage in children with autism compared with children with developmental delay and typical development. Archives of pediatrics & adolescent medicine, 164(11), 1032-1037. https://doi.org/10.1001/archpediatrics.2010.202

Furfaro, Hannah (2020). Sleep problems in autism, explained. Spectrum News. https://www.spectrumnews.org/news/sleep-problems-autism-explained/

Neumeyer, A. M., Anixt, J., Chan, J., Perrin, J. M., Murray, D., Coury, D. L., Bennett, A., Farmer, J., & Parker, R. A. (2019). Identifying Associations Among Co-Occurring Medical Conditions in Children With Autism Spectrum Disorders. Academic pediatrics, 19(3), 300-306. https://doi.org/10.1016/j.acap.2018.06.014

Reynolds, A. M., Soke, G. N., Sabourin, K. R., Hepburn, S., Katz, T., Wiggins, L. D., Schieve, L. A., & Levy, S. E. (2019). Sleep Problems in 2- to 5-Year-Olds With Autism Spectrum Disorder and Other Developmental Delays. Pediatrics, 143(3), e20180492. https://doi.org/10.1542/peds.2018-0492
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My Favorite Sleep Helpers:

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Autism and Sleep Issues: Understand the overlap (Infographic) - Insights of a Neurodivergent Clinician

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If you google autism and sleep, most of the advice you get is on how to help your Autistic child get sleep. Don't get me wrong, this is great, and my kids certainly have their fair share of sleep struggles! But what strikes me is the lack of resources for Autistic adults struggling with sleep!

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What you can do about anxiety - self managing anxiety for autistic people

Jump to: Visit our anxiety and autism hub Use our Molehill Mountain app Self soothing Thinking about your environment Taking time to relax to manage your energy levels Keep a diary Give mindfulness a go

Visit our anxiety and autism hub

We have a dedicated anxiety and autism hub, which is full of helpful research-backed information for positive coping strategies for anxiety for autistic people.

Use our Molehill Mountain app

Molehill Mountain is an app specially designed to help autistic people understand their anxiety. You can use Molehill Mountain to explore the causes and symptoms of your anxiety.

The app lets you track your worries and the situations that trigger your anxiety, get evidence-based daily tips to understand more about anxiety, and learn techniques to try.

Self soothing

There may be self-soothing methods that can help manage feelings of anxiety. For example, stimming, rocking, or creating calming sensory environments may help you relax if you are anxious.

Creating a sensory box is a good option for self-soothing. Fill a box with sensory toys and other items that bring you joy. The next time you feel dysregulated, you can access an assortment of items that might help you feel better.

Some autistic people find engaging in their specific interests can help them relax by focusing on something they enjoy rather than their stressors. Be mindful to keep a healthy balance between your interests and other responsibilities.

Thinking about your environment

If you have sensory issues that can make certain public environments stressful, there may be items you can use to minimise that stress. For example, carrying noise-cancelling headphones, sunglasses, or wearing comfortable clothes.

Too many public spaces are overwhelming for neurodivergent people who have hypersensitive sensory issues. Find out about our 2030 Goal of making public spaces more accessible for neurodivergent people.

Taking time to relax to manage your energy levels

If you find social situations or some public spaces exhausting and anxiety-inducing, taking time to relax and do something you enjoy afterwards can help you manage your energy levels

Keep a diary

Some people find that keeping a diary helps them understand and manage their anxiety better. Writing about situations and how they make them feel helps identify the causes and symptoms of their anxiety. Finding a daily routine can make the world a more predictable place and reduce anxiety.

Give mindfulness a go

Practising mindfulness can help you feel more present, feel more relaxed, and alleviate feelings of anxiety.

Often, when we talk about mindfulness our first thought is mindfulness meditation, such as focusing on your breathing or paying attention to various parts of your body and their physical sensations. In fact, mindfulness is about focusing on the present, whatever you are doing.

Mindfulness isn't always suitable for everyone. If it leaves you feeling more stressed and anxious than before you started, it might not be for you.

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Anxiety and autism | What is autism? | Autistica | Autistica

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Anxiety disorders are common in autistic people. Learn about anxiety and autism, and what we're doing to improve autistic people's mental health.

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National strategy for autistic children, young people and adults: 2021 to 2026

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National strategy for autistic children, young people and adults: 2021 to 2026

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National strategy for autistic children, young people and adults: 2021 to 2026

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The government's national strategy for improving the lives of autistic people and their families and carers in England, and implementation plan for 2021 to 2022.

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National strategy for autistic children, young people and adults: 2021 to 2026

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The government's national strategy for improving the lives of autistic people and their families and carers in England, and implementation plan for 2021 to 2022.

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Fight Flight Freeze – Anxiety Explained For Teens

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A definition of autism with an overview of communication, behaviours and interests, and sensory processing differences needed for an autism diagnosis.

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What are the mental health impacts of school anxiety and emotional based school avoidance (EBSA)?

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Body Scan Mindfulness Meditation (Mindfulness Based Cognitive Therapy) 15 minutes

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Our dedicated sleep service is here to help.

Alongside our Sleep Tips booklet and relevant guides, we also offer one-to-one support. This involves completing an application form for your child and two weeks' worth of sleep diaries which we'll send out to you as long as you come under our criteria for support.

If you need one-to-one support and are a parent/carer or a professional referring a family with their consent to having sleep support, please click the button below to contact the sleep service.

If you have a question or query about our services please email us at [email protected].

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Sleep tips Our Sleep Tips booklet introduces and explains different techniques for you to try that may improve your child's sleep. It covers ten main topics including bedtime routines, daytime napping, comfort objects and moving bedtime backwards or forwards. It gives lots of illustrated hints and tips for putting the...

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Guidance on the special educational needs and disability (SEND) system for children and young people aged 0 to 25, from 1 September 2014.

Applies to England

Documents

Details

This statutory code contains:

details of legal requirements that you must follow without exception

statutory guidance that you must follow by law unless there's a good reason not to

It explains the duties of local authorities, health bodies, schools and colleges to provide for those with special educational needs under part 3 of the Children and Families Act 2014.

The code, which applies to England, is for:

headteachers and principals

governing bodies

school and college staff

special educational needs (SEN) co-ordinators

early years providers

other education settings

local authorities

health and social services staff

Other SEND guides are also available.

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Guidance on the special educational needs and disability (SEND) system for children and young people aged 0 to 25, from 1 September 2014.

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Where can I find more videos from the Autism Education Trust?

To hear more autistic voices, visit the  brand-new YouTube channel  hosted by our Autistic Young Experts Panel.

The channel has been created for the Panel's autistic and non-autistic peers and aims to increase awareness of autism by sharing  first-hand, lived experiences.

The videos have already proven to be  entertaining, informative, and poignant in parts, and the group hopes they'll help to create a  more accepting and inclusive society.

By teaching their peers about autism and promoting the positive message that autism is a different, not deficient, way of experiencing the world, the group's videos will equip potential teachers with the skills and understanding to offer effective support.

Panel member Annabel explains:

"Hopefully, someone will come across the videos and understand autism a bit better. As an autistic person, I have a presentation of autism that ought to be included in societal perceptions too".

Watch, like and subscribe here: The Autistic Young Experts YouTube Channel

Sign up for our value-packed newsletter to get education support, practical resources and autism news exclusively for the AET community.

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Self-Regulation Skills: Why They Are Fundamental

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Self regulation consists of a set of skills and/or techniques that can help us stay in control of our emotions and behaviors. According to McClelland & Tominey (2014), self regulation includes "conscious control of thoughts, feelings, and behaviors". When we see children "bouncing off the walls" or having a meltdown/tantrum, their bodies are showing signs of being dysregulated. It could be due to being overtired, overstimulated, frustrated, stressed, or a variety of other factors. When children are very young, their ability to self regulate is limited. They begin to learn how to self regulate emotions through first co-regulating with adults in their environment. One aspect of co-regulation is modeling and prompting skills that will help a child gain control when they are becoming dysregulated. This could be something as simple as modeling deep breaths (not telling the child to take deep breaths). These strategies need to be taught when the child's body and mind are in a calm regulated state. For example, have activities to practice deep breaths when calm so that it is "easier" to access that skill during dysregulation.

How To Teach Young Children With Autism To Self Regulate Emotions

#1 The adults in the child's environment need to stay calm . If we, as adults, are not able to self regulate and model that, we aren't going to be able to teach the child to do so. Staying calm as an adult is also important during the co-regulation phase. You always hear that children can feel someone's "vibe". This is so true when it comes to co-regulation and self regulation of emotions! A child can tell when we are stressed, upset, and frustrated. So, the best thing we can do, is check inwith ourselves first, to make sure we are modeling deep breathing and other self regulatory strategies. An escalated adult cannot calm an escalated child down.

#2 As an adult, you should be modeling, prompting, and reinforcing the self regulatory strategies. This was touched on in tip #1. In practice, it may look like: modeling deep breaths next to the child, without asking or requiring them to participate. Their breathing may eventually sync up with yours if you keep doing it. This is an example of co-regulation. Cuddles and hugs when children are sad, upset, or overwhelmed are also forms of co-regulation. Remember, that preschool children will need different levels of co-regulation as they move toward their own self regulation of emotions.

#3 Directly teaching emotions can be especially helpful. Identifying emotions can be a difficult skill for children with autism. Start teaching basic emotions by using flashcards with line drawings or clipart pictures of emotions. Teach your child or student how to receptively identify, expressively label, and sort the basic emotions. Sometimes it is best to start with: happy, sad, and mad. Then, you can move on to making faces in the mirror together depicting those emotions. Some other fun activities include drawing faces with the emotions on paper or on a small white board, as well as making the faces using playdough. Once your student or child understands basic emotions, be sure to start pointing them out in real situations. For example, if a child is crying at the grocery store, you might say "they feel sad". Understanding emotions can be a helpful piece in learning how to self regulate emotions.

#4 Simplify language during times of dysregulation. When a child's body and mind are stressed and dysregulated, it is harder for them to access their "thinking" skills. It is very important to simplify the language we use when talking to children when they are experiencing dysregulation. Reduce the number of directions given and be sure to speak in a calmer, quieter tone. This helps with the co-regulation aspect we talked about in previous tips.

#5 Use visual supports . Visual supports are one of the best strategies that you can use to help children move from co-regulation to self regulation of emotions. An example of this may be using a visual support to teach and encourage deep breathing. You practice this deep breathing together during a calm, regulated state, so that they will be able to access that skill more automatically during a period of dysregulation. For example, "smell the flower....blow out the candle" (see below). The same goes for teaching a calming sequence. Practice a calming sequence several times each day, while in a regulated calm state. Then, it will be easier for the child to access that skill when they are becoming dysregulated.

If you are interested in how to teach children with autism to self regulate emotions, check out the following resources:

This free resource is a starter set for helping children learn to identify their emotions and start to use strategies for self-regulation.

The Preschool Self Regulation Activities resource is jam-packed with visual supports, and activities to teach self regulation in little learners! It was created for the early childhood level, but can also be used at the early elementary level with students who are just learning about emotions and working on self regulation. There are also ideas for sensory activities for autism to help calm children's bodies.

Teaching emotions using playdough can be fun! These spring playdough mats combine social-emotional learning with communication skills. This hands-on activity for preschoolers with autism and other social and communication disorders addresses the identification and labeling of basic emotions. Kids love this hands-on activity where they get to make the eyes, noses, and mouths for the spring characters!

For a resource to teach emotions using flashcards, file folders, and other activities, click here.

If you need Boom Card™ activities to teach emotions, check out the Identifying Animated Emotions boom deck, and the Emotions Match boom deck.

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Self Regulation Of Emotions In Autism: 5 Ways To Help!

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What Is Emotional Self Regulation? Self regulation consists of a set of skills and/or techniques that can help us stay in control of our emotions and behaviors. According to McClelland & Tominey (2014), self regulation includes "conscious control of thoughts, feelings, and behaviors". When we see children "bouncing off the walls" or having a meltdown/tantrum,...

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Understanding social cognition and autism 

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Understanding social cognition and autism 

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Understanding Social Cognition in Autism | Diverse Intelligences

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Obtaining healthy sleep is important for both physical and mental health, improving productivity and overall quality of life. Everyone, from children to older adults, can benefit from better sleep, and sleep hygiene can play a key part in achieving that goal.

Research has demonstrated that forming good habits is a central part of health National Library of Medicine, Biotech Information The National Center for Biotechnology Information advances science and health by providing access to biomedical and genomic information. View Source . Crafting sustainable and beneficial routines makes healthy behaviors feel almost automatic, creating an ongoing process of positive reinforcement. On the flip side, bad habits can become engrained even as they cause negative consequences.

Thankfully, humans have an impressive ability NIH News in Health The NIH, a part of the U.S. Department of Health and Human Services, is the nation's medical research agency - making important discoveries that improve health and save lives. View Source to make our habits serve our long-term interests. Building an environment and set of routines that promote our goals can really pay off.

Sleep hygiene encompasses both environment and habits, and it can pave the way for higher-quality sleep and better overall health.

Improving sleep hygiene has little cost and virtually no risk, making it an important part of a public health strategy National Library of Medicine, Biotech Information The National Center for Biotechnology Information advances science and health by providing access to biomedical and genomic information. View Source to counteract the serious problems of insufficient sleep and insomnia in America.

What Are Signs of Poor Sleep Hygiene?

Having a hard time falling asleep, experiencing frequent sleep disturbances, and suffering daytime sleepiness are the most telling signs of poor sleep hygiene. An overall lack of consistency in sleep quantity or quality can also be a symptom of poor sleep hygiene.

Good sleep hygiene is all about putting yourself in the best position to sleep well each and every night.

Optimizing your sleep schedule, pre-bed routine, and daily routines is part of harnessing habits to make quality sleep feel more automatic. At the same time, creating a pleasant bedroom environment can be an invitation to relax and doze off.

A handful of tips can help in each of these areas, they aren't rigid requirements. You can adapt them to fit your circumstances and create your own sleep hygiene checklist to help get the best sleep possible.

Set Your Sleep Schedule

Having a set schedule normalizes sleep as an essential part of your day and gets your brain and body accustomed to getting the full amount of sleep that you need.

Have a Fixed Wake-Up Time: Regardless of whether it's a weekday or weekend, try to wake up at the same time since a fluctuating schedule keeps you from getting into a rhythm of consistent sleep.

Prioritize Sleep: It might be tempting to skip sleep in order to work, study, socialize, or exercise, but it's vital to treat sleep as a priority. Calculate a target bedtime based on your fixed wake-up time and do your best to be ready for bed around that time each night.

Make Gradual Adjustments: If you want to shift your sleep times, don't try to do it all in one fell swoop because that can throw your schedule out of whack. Instead, make small, step-by-step adjustments of up to an hour or two so that you can get adjusted and settle into a new schedule.

Don't Overdo It With Naps: Naps can be a handy way to regain energy during the day, but they can throw off sleep at night. To avoid this, try to keep naps relatively short and limited to the early afternoon.

Follow a Nightly Routine

How you prepare for bed can determine how easily you'll be able to fall asleep. A pre-sleep playbook including some of these tips can put you at ease and make it easier to fall asleep when you want to.

Keep Your Routine Consistent: Following the same steps each night, including things like putting on your pajamas and brushing your teeth, can reinforce in your mind that it's bedtime.

Budget 30 Minutes For Winding Down: Take advantage of whatever puts you in a state of calm such as soft music, light stretching, reading, and/or relaxation exercises.

Dim Your Lights: Try to keep away from bright lights because they can hinder the production of melatonin, a hormone that the body creates to facilitate sleep.

Unplug From Electronics: Build in a 30-60 minute pre-bed buffer time that is device-free. Cell phones, tablets, and laptops cause mental stimulation that is hard to shut off and also generate blue light that may decrease melatonin production.

Test Methods of Relaxation: Instead of making falling asleep your goal, it's often easier to focus on relaxation. Meditation, mindfulness, paced breathing, and other relaxation techniques can put you in the right mindset for bed.

Don't Toss and Turn: It helps to have a healthy mental connection between being in bed and actually being asleep. For that reason, if after 20 minutes you haven't gotten to sleep, get up and stretch, read, or do something else calming in low light before trying to fall asleep again.

Cultivate Healthy Daily Habits

It's not just bedtime habits that play a part in getting good sleep. Incorporating positive routines during the day can support your circadian rhythm and limit sleep disruptions.

Get Daylight Exposure: Light, especially sunlight, is one of the key drivers of circadian rhythms that can encourage quality sleep.

Be Physically Active: Regular exercise can make it easier to sleep at night and also delivers a host of other health benefits.

numerous sleeping problems National Library of Medicine, Biotech Information The National Center for Biotechnology Information advances science and health by providing access to biomedical and genomic information. Don't Smoke: Nicotine stimulates the body in ways that disrupt sleep, which helps explain why smoking is correlated with View Source .

Reduce Alcohol Consumption: Alcohol may make it easier to fall asleep, but the effect wears off, disrupting sleep later in the night. As a result, it's best to moderate alcohol consumption and avoid it later in the evening.

Cut Down on Caffeine in the Afternoon and Evening: Because it's a stimulant, caffeine can keep you wired even when you want to rest, so try to avoid it later in the day. Also be aware if you're consuming lots of caffeine to try to make up for lack of sleep.

Don't Dine Late: Eating dinner late, especially if it's a big, heavy, or spicy meal, can mean you're still digesting when it's time for bed. In general, any food or snacks before bed should be on the lighter side.

Restrict In-Bed Activity: To build a link in your mind between sleep and being in bed, it's best to only use your bed for sleep with sex being the one exception.

Optimize Your Bedroom

A central component of sleep hygiene beyond just habits is your sleep environment. To fall asleep more easily, you want your bedroom to emanate tranquility.

While what makes a bedroom inviting can vary from one person to the next, these tips may help make it calm and free of disruptions:

Have a Comfortable Mattress and Pillow: Your sleeping surface is critical to comfort and pain-free sleep, so choose the best mattress and best pillow for your needs wisely.

Use Excellent Bedding: The sheets and blankets are the first thing you touch when you get into bed, so it's beneficial to make sure they match your needs and preferences.

Set a Cool Yet Comfortable Temperature: Fine-tune your bedroom temperature to suit your preferences, but err on the cooler side (around 65 degrees fahrenheit).

Block Out Light: Use heavy curtains or an eye mask to prevent light from interrupting your sleep.

Drown Out Noise: Ear plugs can stop noise from keeping you awake, and if you don't find them comfortable, you can try a white noise machine or even a fan to drown out bothersome sounds.

lavender National Library of Medicine, Biotech Information The National Center for Biotechnology Information advances science and health by providing access to biomedical and genomic information. Try Calming Scents: Light smells, such as View Source , may induce a calmer state of mind and help cultivate a positive space for sleep.

The basic concept of sleep hygiene - that your environment and habits can be optimized for better sleep - applies to just about everyone, but what ideal sleep hygiene looks like can vary based on the person.

For that reason, it's worth testing out different adjustments to find out what helps your sleep the most. You don't have to change everything at once; small steps can move you toward better sleep hygiene.

It's also important to know that improving sleep hygiene won't always resolve sleeping problems. People who have serious insomnia or sleep disorders like obstructive sleep apnea may benefit from better sleep hygiene, but other treatments are usually necessary as well.

In other words, even though it may be beneficial, sleep hygiene alone isn't a panacea. If you have long-lasting or severe sleeping problems or daytime sleepiness, it's best to talk with a doctor who can recommend the most appropriate course of treatment.

Learn more about our Editorial Team

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Mastering Sleep Hygiene: Your Path to Quality Sleep | Sleep Foundation

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Looking for ways to sleep better? Improving sleep hygiene can make your habits, routines, & environment more conducive to consistent and restorative sleep.

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Huge thanks to our corporate partner, Furniture Village, who has helped us to launch a brand new National Sleep Helpline to ensure that everyone has access to high quality, evidence-based advice regardless of age, ethnicity, background or income.
"We've always believed that sleep is equally as important as diet and exercise yet we know the UK is really struggling to sleep, particularly with the ongoing effects of the pandemic" says Charlie Harrison, Furniture Village Commercial Director. "From my work as a doctor, I know how great the need for a National Sleep Helpline is. It will make a huge difference to so many people." Dr Ranj, Furniture Village Sleep and Wellness Advisor
Working together to improve the nation's sleep.

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National Sleep Helpline - The Sleep Charity

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Who do I talk to if I can't sleep? The National Sleep Helpline can help with your sleep problems, 7pm-9pm, Sunday to Thursday, 03303 530 541.

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Molehill Mountain is an app to help autistic people understand and self-manage anxiety.

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Children and young people Bladder and bowel health Issues affecting the bladder and bowel are very common in children and young people. Here you can find specialist advice to help. varied issues The problems can include difficulties with toilet training, wetting and/or soiling.

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Double Empathy: Why Autistic People Are Often Misunderstood

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Autism affects how someone makes sense of the world around them. About 1–2% of people are autistic. You might have an autistic classmate or family member, or maybe you are autistic. Autistic people might communicate differently than people who are not autistic. This means that it can be difficult fo…

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The double empathy theory challenges the idea that social difficulties are specific to autism and suggests that problems arise from a mismatch in perspective between autistic and non-autistic people.

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Designed to help parents and carers whose child has received a diagnosis of autism to develop their understanding of autism, sessions will cover a range of subjects, including discussing a diagnosis of autism, communication skills, sensory processing differences, and self-esteem. Parents will learn valuable strategies for supporting their children with daily life. The overall aim is to empower parents to help their children achieve their full potential.