Can cognitive behavioral therapy ease autism-related sleep problems?

For little understood reasons, difficulty falling asleep and staying asleep are particularly common among kids – and possibly adults – on the autism spectrum. Sleep problems, in turn, can worsen behavioral challenges and interfere with learning.

Cognitive behavioral therapy for sleep problems

Psychologist Christina McCrae, director of the University of Missouri Sleep Research Lab, is collaborating with psychologist Micah Mazurek, of the university’s Thompson Center for Autism and Neurodevelopmental Disorders, to evaluate the effectiveness of cognitive behavioral therapy for improving sleep in children, ages 6 to 12, who have autism and sleep problems. The Thompson Center is one of 13 sites in the Autism Speaks Autism Treatment Network.

Cognitive behavioral therapy focuses on practical ways to change problematic behaviors and beliefs. When it comes to improving sleep, the approach typically involves keeping a sleep diary to identify thoughts and behaviors that interfere with sleep and then working with a therapist to develop more-helpful attitudes and behaviors.

For example, a child who is scared of the dark might have scary thoughts such as “something is going to get me.” By helping the child logically challenge such a fear, CBT can help the child adopt a replacement statement such as “my room is a safe place.”

The child might also benefit from learning a relaxation technique. For some children, slow, deep breathing can help. For others, it can help to imagine a calm and relaxing place, Dr. Mazurek explains.

CBT for autism

“In treating insomnia and other behavioral sleep issues among adults and children in general, I’ve found that there’s no substitute for cognitive behavioral therapy,” Dr. McCrae says. “Yet it’s still unclear how to best use such therapy for children with autism who struggle with communication.” The University of Missouri research team aims to find out with their new study.

Last fall, the research team saw strong early results from an eight-session pilot study with children and parents coming into the Thompson Center for counseling. “We found that sleep improved so steeply over the first four sessions that the kids topped out in their improvement at that point,” Dr. McCrae says. At the same time, some families confided that traveling to the clinic from outlying areas presented problems. The researchers are planning a second study with eight sessions conducted using web-based videoconferencing. 

Dr. McCrae encourages all parents and health professionals to routinely screen for and address sleep problems in children who have autism. In particular, she urges parents to consider sleeping habits when evaluating possible reasons for behavioral issues at home or in school.

Related resources

Editor’s note: The above information is not meant to diagnose or treat and should not take the place of personal consultation, as appropriate, with a qualified healthcare professional and/or behavioral therapist.