HJAR Mar/Apr 2025

AUTISM CARE 24 MAR / APR 2025 I  HEALTHCARE JOURNAL OF ARKANSAS to sleep. For children with autism, having a visual schedule of the tasks prior to getting into bed can help them to understand the expectations and routine. Reduce exposure to electronics and instead utilize a white noise machine, ceiling fan, or other type of noise to reduce environmental noise. If children wake during the night, caregivers can either ignore the behavior for a period of time or set behavioral boundaries dur- ing the night. This can include setting a spe- cific number of times caregivers will go into a child’s bedroom during the night to help with sleep rituals. Feeding Sleep difficulties also have a positive relationship with the number of problem- atic mealtime behaviors in children with autism. 2 These behaviors can include any- thing from crying or throwing food to more aggressive behavioral challenges related to the food served. While picky eating is com- monly seen throughout childhood, picky eating in children with autismmay be more children with autism who have more sleep difficulties tend to have caregivers who experience an increase in parental stress. Melatonin is often discussed in the treat- ment of children with autism spectrum dis- order. According to the numerous research articles completed, it is shown that a com- bination of abnormal production of melato- nin, the increased breakdown of melatonin in the body, and the abnormal receptor sites of melatonin may explain sleep difficulties in children with autism spectrum disorder. 3 Therefore, prior to the use of melatonin, it may be more beneficial to utilize mental and behavioral strategies to intervene. To intervene on behalf of sleep diffi- culties, caregivers will need to maintain a consistent bedtime schedule every day of the week for the child’s circadian rhythm to understand when it is time to wake and go to sleep. Additionally, maintaining a con- sistent routine prior to bed can help with this schedule as well. It is helpful to start the bedtime routine at least 15 to 30minutes prior to the time in which a child should go Caregivers of children with autism spec- trum disorder face a variety of challenges that come with caring for a child with com- plex behavioral and medical needs. Two of the most common medical concerns par- ents notice in early development are diffi- culties with sleep and eating. Understanding the intricacies and prevalence of sleep and feeding problems in children with autism spectrum disorder can help healthcare providers intervene and support caregiv- ers through managing these challenges. For more information on other medical condi- tions for children with autism, please refer to the article in this series. Sleep According to Galli, et al., 57% of the chil- dren in their sample met criteria for diagno- sis of insomnia. 1 Children with autism tend to experience higher nighttime awaken- ings requiring specific rituals to fall asleep. Research shows an increase in sleep diffi- culties can result in increased aggression and stereotypical behaviors. 2 Additionally, take to help minimize their impact. Many families need support and training to help manage these behaviors. Increased access to ABA and other ser- vices is also needed. As Kerry Magro, an award-winning professional speaker and self-advocate once said, “Autism doesn’t come with an instruction guide. It comes with a family who will never give up.” 9 As we navigate the changing world with new research findings, rapidly changing politi- cal climates, and worldwide environmental issues, we must remember these children and families and walk alongside them to educate others and show the way to sup- ports. We must help eliminate barriers, increase access to services, and allow fam- ilies to see that we hear them, stand with them, and that we will also never give up. n most commonly recommended evidence- based therapy is applied behavioral analy- sis (ABA). 4,5 This therapy works to change and replace unwanted behaviors by first understanding the function of the behav- ior and then through the use of a variety of behavioral strategies. ABAstrategies include applying positive reinforcement to increase desired behaviors and decrease undesired behaviors. ABA is also to used improve social skills, communication, and daily liv- ing skills, which may reduce challenging behaviors by increasing self-sufficiency. 4,3 Some families also seek out other versions of behavioral therapy, such as parent-child interaction therapy or, if the child can par- ticipate in talk therapy, cognitive behav- ioral therapy (CBT). 8 Many individuals with autism receive a variety of these therapies. While challenging behaviors are often upsetting for families, there are steps to noise cancelling headphones, going for a walk, or swinging are commonly used; how- ever, what works will depend on the individ- ual and what is comforting for them. Addi- tionally, it is recommended to limit attempts at conversation and trying to reason with the child in the moment. In dealing with significant behavioral challenges, seeking professional help from experts can be essential. Proactive treat- ment is needed for any persistent or reoc- curring behavior triggers. For example, if difficulty with speech leads to frustration and behavior challenges, a speech-language pathologist is needed. If overstimulation is a challenge, occupational therapy and sen- sory support may be the next step. If the problem is introducing new foods, a feeding therapist may be helpful. Many challeng- ing behaviors exhibited by children with autism will warrant behavior therapy. The From Sleepless Nights to Picky Eating: Supporting Children with Autism By RachelWingfield, PhD