Re: Help with behaviour long

[Guest guest]

okay, i used this technique for my daughter when she was 2 or 3. it

worked very well, but took alot of time and patience. good luck.

mel

>

>

> Children who insist on parents' presence

> Graded withdrawal:

>

> 1. Lie next to child on bed for three nights

> 2. Lie on mattress next to bed for three nights

> 3. Move mattress closer to door every three nights

> 4. Sit on chair in bedroom at door with door open for three nights

> 5. Sit outside door whilst still visible to child for three nights

> 6. Sit outside door not visible to child for three nights

> 7. Sit outside room with door closed for three nights.

>

> Social stories could also be used to reassure your child that they

are safe when sleeping or in

> bed alone. Please see the 'Useful fact sheets' section for further

details.

>

> For night waking

> Scheduled awakening:

>

> 1. From sleep diary, see when child wakes up during the night

> 2. Set alarm clock for 30 minutes before this

> 3. Wake child and allow to fall back to sleep

> 4. If child doesn't fall back to sleep try waking 45 minutes before

on the next night and

> experiment until you find the best time.

>

> To ensure your child is sleepy at bed time

> Restricting sleep:

>

> 1. From sleep diary, see average hours of sleep per night

> 2. Calculate 90% of this and make this the new sleeping time (delay

bedtime and/or waking time);

> never restrict below five hours

> 3. If lying awake, occupy in another room until sleepy

> 4. Avoid naps in day/oversleeping at weekend

> 5. After a week, move settling/waking time by 15 minutes - continue

until desired pattern of sleep

> occurs.

> Children with autism respond well to routine and structure because

it allows them to feel safe and

> in control. Although sticking to routines can be frustrating during

the day, setting up a routine

> that fits in with your family's needs and helps your child feel

calm by the time they go to bed

> could be very helpful. To do this effectively you will need to look

carefully at the routine your

> family follows at the moment. Things to consider include:

>

> Is it possible for you to eat dinner at the same time each night?

> Do you do this already?

> Is this quite late in the evening or quite early?

> Is it possible for your child with autism to have a bath at the

same time each night?

> Is there anything about your child's routine that can only be done

in your home? This could be

> something like playing on a particular climbing frame or having

their own space for time out in

> the evenings.

> Essentially, an evening routine needs to be fairly simple, with

scope for flexibility. This means

> that if you go away, or your child goes away, the basic routine can

be preserved. You could try

> something like:

>

> 6.30pm: dinner

> 7.00pm: quiet time

> 7.15pm: drink and a piece of fruit

> 7.45pm: bath

> 8.25pm: clean teeth

> 8.30pm: bedtime/sleep

> 7.30am: waking up/getting up.

> Essentially, whatever routine you try to impose needs to be

something you feel comfortable

> implementing and that your family can agree on. It may take several

weeks for it to alter your

> child's sleep patterns. It can help to present this routine

visually, using a timetable for

> instance, so your child knows exactly what to expect, including

getting up in the morning. If the

> routine needs to be altered, it can then be explained visually. It

may be that your child's

> timetable needs to be more detailed so that they are told exactly

what to do when going to bed,

> for instance, draw the curtains, get in to bed, turn light off, lie

down, pull cover up.

>

> It may also be worth setting aside time to prepare for the next day

in the routine. This could

> include getting the school bag ready or making a list/timetable of

things that need to be done the

> next day.

>

> Making sleep more comfortable

> Sleep, as Donna describes it, sounds pretty uncomfortable.

If that is what your child is

> experiencing then it is not surprising if they get a bit agitated

near bedtime. But there are ways

> of working with your child's fears to help them.

>

> Some children are exceptionally sensitive to light so sleeping when

there is even a very dim light

> on could be very difficult for them. Putting up thick curtains

which will block out as much light

> as possible in your child's room.

>

> Similarly, some parents have found that their children can be woken

by very slight sounds at

> night. Aside from general advice about having a thick carpet in the

room and making sure the door

> shuts properly, other parents have tried a more specific approach.

One family found that after

> their child with autism had gone to bed, she could be woken by the

noise of their changing in the

> bedroom next door. To solve this they moved her bed to the other

side of the room and built

> shelves and cupboards along the wall the two rooms shared to act as

sound-proofing. Sometimes even

> a computer left on standby can be enough to disrupt sleep. Ear

plugs, or music playing on

> headphones, could also be used to block out noise for those

children who are comfortable with

> wearing these.

>

> Touch sensitivity is extremely common in autism: some children

experience certain types of touch

> as physical pain. Temple Grandin (a woman with autism) describes

being unable to sleep if one of

> her legs touches the other so she always has to wear pyjama

trousers, even in the hottest weather.

> Labels on bed clothes and different materials can also be

uncomfortable. Some children respond

> well to a weighted blanket, which is made from thick blanket

material like a quilt with the

> pockets filled with beans instead of hollowfibre. The pressure of

the blanket can be re-assuring

> and it works on much the same principle as the 'squeeze machine'

which Temple Grandin invented to

> help her learn to cope with touch. Please see the 'Useful contacts'

section for details of where

> you can buy weighted blankets.

>

> It is also worth considering if smells in the room, or coming from

other parts of the house, may

> effect people with heightened senses.

>

> The layout of the room may also need to be adjusted. Although it

may be comforting for some

> children to have lots of their belongings around them, it may serve

to be quite distracting for

> others. Even the colours of the room or pictures on the wall may be

disturbing. See the NAS

> infromation sheet Creating an autism-friendly environment for

further details:

> www.autism.org.uk/a-z

>

> Explaining sleep

> As mentioned before, children can often have difficulty

understanding the need for sleep. A social

> story (developed by Carol Gray) could be used to explain this.

Please see the NAS Social Stories

> and Comic Strip Conversations information sheet for further

details. Visual supports, such as flow

> charts, could also be used to explain sleep; as can children's

books that provide the biological

> explanation for sleep.

>

> Sleep diaries can be useful for a number of reasons.

>

> They can help to establish any unusual patterns of sleep. In the

example attached (Appendix 2), Jo

> actually sleeps for seven hours a day but takes a nap after

returning from school, which then

> disturbs his sleep at night. If over a period of time this became a

consistent pattern his parents

> could think about ways of keeping him stimulated after coming home

from school. In time he might

> begin to sleep more at night and less during the day. It is also

clear that his most disturbed

> night follows the time away which he spends with his Gran. This

suggests that consistency and

> routine are very important to Jo.

> If you do decide to try any routines or behavioural modifications

to help your child to sleep then

> the sleep diary will allow you to see if what you are doing is

working consistently, sporadically

> or not at all.

> You can show a sleep diary to professionals involved in your

child's life, such as teachers, GPs

> or social workers, to give them a clearer idea of the impact your

child's sleep patterns are

> having on the child, you and your family. People may assume you are

exaggerating if you tell them

> you only get an average of two hours sleep a night but if you can

show them charts with times

> specified they may take more notice.

> Certain benefit applications, for example the Disability Living

Allowance (DLA) form, ask you to

> specify how much your child sleeps and how often you have to get up

in the night to help them. You

> can send in a copy of the sleep diary to support your application.

> For more able children with autism a sleep diary can act as a

visual reminder of their disruptive

> sleep patterns. They can then be used to establish incentives for

staying in bed and trying to

> sleep, eg a gold star for every night when the child doesn't get

out of bed, plus a small reward

> if the child doesn't get out of bed for three nights in a row.

> A sleep diary does not have to follow the format of the example

given. Appendix 2 is a sleep diary

> form which you can modify for your own personal use. If you haven't

time to fill in details of

> your child's routines, having a twenty-four hour format and using

shading to indicate when the

> child is asleep can be a good way of showing exactly how much sleep

you and your child are

> getting.

>

> What causes sleep disorders?

>

> Settling and waking problems

> The answer to this is likely to be different for every person.

Unfortunately it seems that

> virtually all children with autism are likely to suffer from

disturbed sleep patterns at some

> point or another. Sleep problems can be divided into two main

groups: settling problems, where the

> child has difficulty going to sleep at the appropriate time, and

waking problems, where the child

> wakes repeatedly during the night. Both of these will be dealt with

on this page.

>

> We don't know why children with autism are so vulnerable to

disturbed sleep, but Donna ,

> who has written extensively about living with an autistic spectrum

disorder, describes her fear of

> falling asleep in her autobiography:

>

> " Sleep was not a secure place. Sleep was a place where darkness ate

you alive. Sleep was a place

> without colour or light. In the darkness you could not see your

reflection. You couldnt get lost

> in sleep. Sleep just came and stole you beyond your control.

Anything that robbed me of total

> control was no friend of mine. "

>

> From Somebody somewhere by Donna

>

> " I was afraid to sleep, always had been. I would sleep with my eyes

open and I did this for years.

> I guess I did not appear to be terribly normal. Haunting or haunted

would have been better

> adjectives. I was afraid of the dark, though I loved the early dawn

and dusk. "

>

> From Nobody nowhere by Donna

>

> These descriptions are subjective and do not necessarily describe

the experience for everyone.

> They do suggest that Donna had more problems with settling than

waking. We don't know which

> problems children with autism are most likely to suffer from

although we are aware of children who

> have problems with both.

>

> In Donna's case her fear of the unknown prevented her sleeping and

this may well be true for some

> children with autism. For most children with autism this is

unlikely to be the only explanation.

> Many children will have disturbed sleep as a result of a number

root causes.

>

> Waking problems may in some cases be a continuation of settling

problems - like the child who

> wakes up to go to the toilet but then finds it difficult to fall

asleep again. In very young

> children, waking problems are an indication that they still haven't

developed mature sleep

> patterns. As babies they woke up to feed every couple of hours and

this pattern hasn't yet been

> eradicated. In the older child with autism, there may be an

indication that they suffer from sleep

> disturbances. This could mean anxiety - making it difficult for

them to fall into a deep sleep -

> or acute nightmares.

>

> Although many experts would suggest approaches to waking problems

such as bed-time fading - where

> you look in on your child when he/she wakes but for shorter periods

each time so that they learn

> not to rely on this behaviour for attention - we would suggest that

attention is unlikely to be

> the motivation of children with autism. Instead, coping with waking

problems may require

> consistent reassurance on your part and a creative approach to your

child's needs.

>

> Alternative explanations include:

>

> Social sense

> Children with autism may have difficulty understanding why and when

they need to sleep. Problems

> with social cueing - that is learning why and in what order things

should happen are common in

> autism and this may mean your child does not make the connection

between their family going to bed

> and their own need to sleep.

>

> Some children may find the transition from sleeping in parents

rooms to their own room by

> themselves. This can be related to difficulty with change but also

the need for reassurance around

> bedtime and sleeping.

>

> Melatonin

> This is a hormone secreted by the pineal gland which has been shown

to regulate sleep patterns in

> animals. There have been studies conducted which have shown that

taking melatonin supplements can

> help to ward off jet-lag after long journeys. It is also thought

that in children with autism,

> their patterns of melatonin secretion may be irregular so it is not

that they don't produce, it

> but that they don't produce it at the right times of day.

>

> Melatonin supplements must be prescribed in the UK. For further

information you should consult

> with your GP. Some foods are rich in melatonin such as oats, rice,

sweetcorn, tomatoes, plums,

> bananas and brazil nuts but current research is not clear whether a

melatonin-rich diet could be

> effective in helping children to sleep.

>

> Too much information

> Children with autism can have significant problems with

hypersensitivity to touch, visual stimuli

> or sound. This can be both distracting and distressing and make the

process of falling asleep very

> difficult.

>

> Allergy and food sensitivities

> Children with autism are perhaps more likely than their peers to be

sensitive to foodstuffs like

> sugar, caffeine and additives which can keep people awake. If your

child frequently has sweet or

> caffeine-rich drinks and foodstuffs near bed time then it is worth

checking whether this could be

> disturbing their sleep.

>

> What can we do?

>

> Natural remedies

> Many of the natural remedies available from health food stores are

supposed to treat insomnia and

> other sleep disorders. These may have similar effects to

conventional medicines but carry less

> risk of side-effects than conventional sedatives. You could also

try contacting a homoeopath. You

> can find details of a local qualified homeopath by telephoning the

Society of Homoeopaths on 0845

> 450 6611.

>

> Removing stimulants from the diet

> If you are already keeping a sleep diary then monitoring this

should not be a problem. If you are

> not then it is advisable that you at least start keeping note of

when your child sleeps so that

> you can monitor any improvements.

>

> Changing your child's bedtime routine can be stressful and if they

are used to having certain

> drinks or snacks near bedtime, suddenly switching to something

different may be

> counter-productive. However, you could change to decaffeinated

drinks, replace ordinary chocolate

> with sugar-free chocolate bought in health food stores, use carob

powder to replace cocoa and

> chocolate, switch to sugar-free drinks or replace sugar in drinks

with sweetener or fruit sugar,

> which may help some children.

>

> Alternatively, you could try gently phasing certain foods out over

a period of days or weeks so

> that your child is consuming less and less sugar and caffeine

overall without having anything

> suddenly taken away from them; for example, you could offer them

one biscuit instead of two, put

> just half a spoonful of sugar in their tea and mix decaffeinated

and caffeinated drinks together.

> This also has the advantage of reducing your child's taste for

sweet foods, which can help improve

> oral hygiene.

>

> Some people advocate making radical changes to the child's diet

like completely eliminating sugar

> and caffeine. We would suggest that this is only worth doing if you

have already tried a more

> moderate approach. We would also suggest that you should visit a

dietician before introducing any

> major changes in order to ensure that you continue to offer your

child a balanced diet.

>

> Using relaxation techniques

> We all have difficulty sleeping if we are feeling wound up when we

go to bed. Settling down when a

> lot has been happening or when we are feeling emotional can be very

difficult. Children with

> autism may not be able to articulate their need to unwind and

relax. Additionally, they may feel

> more anxious and confused around bedtime.

>

> Relaxation techniques can be introduced in low-key, non-intrusive

ways in many areas of family

> life. Some possible techniques follow.

>

> Adding a few drops of lavender oil to your child's bath; this has

been shown to have a soothing

> effect.

> Giving your child a massage. Direct skin contact can be

uncomfortable for some children with

> autism but some types of massage, such as shiatsu, can be conducted

through clothing. A gentle

> foot, hand or scalp massage in the right environment might help

your child to calm down before

> going to bed. Please see the 'Useful reading' section for details

of books on this subject.

> Introducing an hour's quiet time before the child's bedtime could

serve two purposes. Doing a

> quiet activity, perhaps with help from you or a sibling, could help

them unwind and it also

> provides a valuable social cue. If everyone in the house is quiet

and relaxed then the message the

> child receives is consistent, not mixed as it is if the house is

still lively and noisy even

> though the child is expected to sleep. Clearly, introducing a quiet

period in the day may be

> easier said than done but you could start with small things, such

as suggesting the TV/computer is

> turned off for an hour. It may take a while to get into this

pattern but it could have a huge

> impact when you do. It is even worth marking this quiet time on a

daily timetable so the child

> knows what to expect and becomes familiar with this routine.

> Many experts have said that teaching formal relaxation techniques

to people with autism can be

> counter-productive as they may find them more distressing than

relaxing. Some people advocate

> using exercise as a way of winding down and this does have some

merits. Physically exhausting your

> children is a good way of ensuring that they sleep! Many children

with autism enjoy rough and

> tumble play and although this may seem to be the opposite of the

points made above regarding quiet

> time at the end of the day, it might be more effective for some

children. You will know best

> whether your child falls into this group.

> Some parents have found formal relaxation aids such as music and

exercises (for example yoga;

> please see the 'Useful reading' section) very useful. These aids

are widely available and you can

> judge for yourselves what your child is most likely to respond to.

Some parents have reported

> having lighting, such as a lava lamp, in the bedroom can be

helpful.

> It may be worth providing the child with a set time to talk about

their day or their worries as

> part of the evening routine. It may even help to have a 'worry

book' or diary next to the bed so

> the child can write down or draw any concerns. They are then dealt

with before bedtime.

> Alternatively, the child could have a worry box, so that worries

can be written down and shut away

> in it.

>

>

>

> kind regards shell

> http://groups.msn.com/AutismAndAspergersInTheFamily

>

>

>

>

>

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