Focus on Sleep and Feeding Issues at ASNC Conference

The Autism Society of North Carolina held its annual conference March 11-12 in Charlotte. We will be sharing information from conference presentations in upcoming blog posts.

girolamiDr. Peter Girolami of the Kennedy Krieger Institute in Baltimore, MD, opened the first day of ASNC’s 2016 conference with a presentation titled “Sleep and Feeding Issues in Kids and Adults with Autism: Creating Successful Outcomes.” As many as 70 percent of individuals with Autism Spectrum Disorder have some sort of sleep or feeding problem, Dr. Girolami said.

 

Sleep issues

Some of the common sleep problems are bedtime tantrums, repeated awakening during the night, falling asleep late, reduced total sleep time per day, and daytime sleeping.

Not getting enough sleep can cause irritability, unintentional injuries due to clumsiness, lower test scores, risk of obesity, anxiety, and stress to the rest of the family, Dr. Girolami said.

Keep a log: The first step to solving sleep problems is assessing them and recording data about the issues with a diary or log. The information you should gather includes:

  • How long is it taking from time starting to go to bed to actually falling asleep?
  • Number, time, and length of night awakenings
  • What time do they awaken in the morning?
  • Total sleep time
  • Location of sleep – bed? Your bed?
  • Bedtime routine

In addition to a clear description of the individual’s sleeping problems, you should note any situations that predict when the problem behaviors will occur.

Try these strategies: Dr. Girolami offered some strategies that families can use at home to clear up sleep problems.

  • Establish a consistent schedule for bedtime. If your loved one is visual, try using a picture schedule.
  • Start the bedtime routine 30 minutes before you want the child to get into bed.
  • Add activity to the bedtime routine that is calming, such as putting away toys or reading.
  • Avoid energizing activities such as use of electronic toys.
  • Limit use of the bed to sleeping only. For example, don’t allow the child to lie in bed during the day using an iPad.
  • Limit naps late in the day, or any time. (Check your log – your child may be getting more sleep than you realize.)
  • Try a light snack before bedtime, but avoid liquids.
  • Say goodnight closer to actual bedtime or when the child typically falls asleep, to provide closure.
  • If the child takes a long time to fall asleep, move bedtime later, then over a period of days or weeks, move it back.
  • Make time to converse with your child earlier in the day. Try not to engage them right at bedtime.
  • If your child gets out of bed, guide him or her back to bed and then leave. Don’t interact, and avoid engaging. Stay neutral and minimize eye contact.

Dr. Girolami acknowledged that often other issues flare up when families are working on sleep issues, and he said that you might need to take a whole-child approach without overwhelming your child.

 

Feeding Issues

Children with autism often refuse more food than typical children and have limited foods they will eat. Reasons they may not eat include conditioned aversion (reflux), lack of experience, lack of appetite (grazers), and hypersensitivity, Dr. Girolami said.

Individuals with autism often engage in inappropriate mealtime behavior to escape eating, and this is then reinforced by parents, who give in because they are concerned about their health and just want them to eat something. Some areas that can be targeted for intervention include:

  • Rate of acceptance (how fast bites are accepted into the mouth)
  • Refusal behaviors, such as batting away food
  • New foods consumed
  • Increase in texture
  • Self-feeding
  • Negative vocalizations
  • Expelling food (spitting)
  • Coughs/gags (This also could be a sign of a physical problem, so it must be checked out. Thus, a multidisciplinary team is an asset for feeding issues, Dr. Girolami said.)
  • Vomiting
  • Duration of meals (longer than 20-30 minutes)
  • Amount of food consumed

As with sleep issues, feeding problems can get worse when you are trying to solve them. Progress may be variable, and if children get sick, they often regress temporarily. Parents must be determined and persistent, and may require assistance from professionals, Dr. Girolami said.

Try these strategies: Dr. Girolami discussed some strategies that might help.

  • Start with a very small bite of the food that you want the individual to consume. Once they have accepted it, allow them to leave. Next time, give a little more. Over time, gradually increase the number of bites.
  • Use a schedule and routine for eating time to take all of the mystery away.
  • Blend foods they like with others you want them to eat. Over time, add more and more of the non-preferred food, until they are willing to eat it separately.
  • Alternate bites of the food you are trying to get the individual to accept with a preferred food.
  • Start with a lower texture of a food, such as blended, and slowly work up to fork-mashed.
  • Help them grow accustomed to utensils by using them empty at first.
  • To work on self-feeding and independence, start by feeding them with your hand over your child’s on the utensil.
  • To work on chewing, model the motion – they may not realize how to move their mouths in a rotary fashion. Start with dissolvable foods such as crackers. You can also put the food into their mouths back by their molars, so they understand where to chew. Dr. Girolami recommended a NUK brush to help with this technique. Give lots of praise and encouragement.
  • Allow them to watch a video at the table. Turn it off to prompt them to take a bite; once they have taken one, turn it back on.

For a lot of individuals with autism, eating has become an anxiety-inducing exercise. They think about it and worry about it too much, Dr. Girolami said, so you might have to tackle one issue at a time. But for some, once they take that first bite, and realize they can do it, they progress rapidly.

Dr. Girolami serves as a program director and case manager for Kennedy Krieger Institute’s pediatric feeding disorders program in the Department of Behavioral Psychology.

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