Sleep Advice for Children with Additional Needs

• Following the same routine in the hours before bedtime.

• Having a consistent bedtime and waking at the same time every morning.

• Being free of all screens for at least one hour before bedtime (including TV, tablet, phones and computers).

• Avoiding heavy meals, caffeine and sugary snacks or drinks in the run up to bedtime.

Melatonin is a naturally produced hormone released by the brain to help us feel sleepy. It is manufactured just behind the optic nerve in the eye, hence why darkness and light are so important. We can help children increase their melatonin levels naturally by adopting the strategies enclosed.

• It is important to develop a good day time routine before tackling a night time routine, as well as having boundaries consistently in place. Having a regular morning waking time and set mealtimes is a good place to start.

• Your child may need visual aids to help them understand what is expected of them or what will be happening next. Objects of reference such as showing them their pyjamas or a night time comfort object can be used. Visual schedules, now and next boards, timers or verbal reminders can help with the transition between day and night time.

• Help your child to understand the difference between day and night routines, such as introducing calming activities before bed and using a quiet voice.

• Some children respond well to rewards / incentives.

Consider any physical or medical needs that might be impacting on your child's sleep. See your GP if you are concerned about a night time cough or pain/ discomfort, itchy skin or persistent snoring.

• Cortisol which is the fight or flight hormone can affect the readiness for sleep. Cortisol is produced in response to fear, anger, frustration, stress, anxiety or excitement. Cortisol makes us feel energetic and alert for many hours. It is useful to consider how we can reduce cortisol levels leading up to bedtime. Thinks about any triggers that could evoke these emotions. If your child is very excited in the bath, it may be useful to bath them at a different time of day. Any worries your child might have, are best discussed earlier in the day and not in the bedroom. It is best to avoid rough and tumble play before bed as this could overstimulate your child.
• Complete a sleep diary to identify any sleeping and waking patterns: ​​​​​​Download Our Sleep Diary

Before starting the bedtime routine, prepare for readiness for sleep in the living room by making it as dark as possible (dimming lighting, turning off television and drawing curtains)

In the Bedroom

• Use white noise (calming background noise) or other sounds to block out external noises.
• Tidy the bedroom and toys.
• Avoid sending children to their bedroom as a punishment.
• Use minimal lighting and blackout blinds. Avoid blue and white lighting, opt for red or orange bulbs.
• Make sure the room is a comfortable temperature

There are many sensory calming strategies that can help your child prepare for bed, here are some examples -

• Encourage movement activities throughout the day such as trampolining. Some activities to try before bed if your child finds pressure activities calming e.g. wrap your child in a towel and roll them back and forth gently.
• Massage to help your child fall asleep.
• Rocking on a peanut ball.
• Avoid rough and tumble play before bed.
• Avoid stimulating activities such as bath time if they find it exciting or upsetting.
• Consider how bedding and pyjamas impact on your child’s sensory needs.

A child who is feeling anxious can find it difficult to settle or sleep alone. A transitional object may help with this or a particular comfort item (e.g., a teddy bear wearing a parent's t-shirt). For more information about strategies that can help your child learn to sleep without an adult, such as gradual withdrawal.

Here are some ideas and strategies around supporting and managing anxiety in children with additional needs:

What is Anxiety

When we say someone is anxious, we usually mean they are frightened of or worried about something. Anxiety can look like many different things. This is especially true for children with additional needs or children with a developmental disability who may communicate their feelings using behaviour or mask their anxiety altogether. Anxiety is a normal response in many situations, and often goes away once the situation has passed. In fact, fear and anxiety are often a helpful response to danger. Human beings wouldn’t have lasted very long without it!

This stress response is a really helpful response when there is real, physical danger but when we use our minds to imagine bad things that might happen to us (worry), this also triggers the same stress response, with all the physical symptoms that go with it!

The Physical Signs of Anxiety

When we feel anxious, our body experiences physical symptoms like the ones in the diagram above. This can feel scary or confusing to a young person, and they may think that they are poorly or unwell. It can be helpful to talk through a diagram like this, or point to different parts of a doll, to help explain to children how anxiety affects our bodies.

The Science behind Anxiety

We experience symptoms like this when we worry because our brain tells our body to react as if we are being presented with physical threats. Our body releases adrenaline (stress hormones) which sets off a stress response in our body designed to help us ‘fight’, ‘run away’ or ‘hide’ from the danger. This stress response is also known as fight, flight or freeze. The unconscious part of our brain that controls our heart-rate, breathing and digestive processes takes over and prepares us to either FIGHT/FLIGHT or FREEZE. Most people experience the symptoms of FIGHT/FLIGHT when they are worried.

What Keeps Anxiety Going?

Eventually our bodies will get used to being ‘exposed’ to the thing that is making us worried, and our anxiety will come down. This anxiety curve is true for every situation that makes someone anxious that has no real threat – eventually our bodies will realise we are not in danger and that we are physically safe.

Anxiety in Children with Additional Needs

They may have additional or different things that make them anxious, such as sensory sensitivity to noise, touch or taste They may present their anxiety through challenging behaviour If they have difficulties with language, they may find it harder to express or articulate what is making them anxious or worried. It might be harder to tell when they are anxious or why.

One thing that might help with this is to keep a diary around what happened before, during, and after a situation that you feel might be making your child anxious. If you notice a pattern – this can be the first step to putting strategies in place to try to help reduce anxiety for your child.

The Circle of Security®

Sometimes children can pick up on our own anxieties. This could be children sensing that parents feel uneasy to leave them in a new place. Our own worry can be useful, if it drives us to make something safer for our children; however, at other times our worry may be holding our children back in order to reduce our anxiety. Sometimes as parents, you might need to make a conscious effort to allow your child to experience independence and you might have to prepare them and teach them skills to be able to manage this. The Circle of Security® diagram below shows how it can be helpful to be attuned to when children need to ‘go out’ on the top of the circle and explore away from their secure base. This may feel harder for parents of children with additional needs or a developmental difficulty as they may be more vulnerable or anxious about the world around them. However, it is still important that children get opportunities to do this.

Equally, something we know that helps children when they are feeling worried is being around someone who makes them feel safe and understood. This is someone who can ‘be with’ them through their emotions. ‘Being with’ a child’s emotions is about matching their emotions and is a balance of not rushing them to feel better but also not feeding into their worries. We can sometimes over/under estimate how a child copes and this can be even more likely if they have additional needs or a developmental difficulty. When children know that they have someone they can rely on, they can start to feel safe and work through difficult emotions. An example of this is when children may be feeling anxious and will want to come ‘back in’ to their secure base, as shown on the bottom of the circle.

Common Pitfalls for Adults

We can all fall into common traps when trying to support an anxious child or young person.

Overly minimising concerns: Sometimes it can be tempting to reassure children by downplaying their concerns, perhaps saying “there’s nothing to be scared of here!” or “[A fly] can’t hurt you!” Unfortunately it takes a little while for us to both learn and believe these things, and so comments that don’t allow time for processing the anxiety as an emotion, and don’t validate that feeling, often have little impact. Automatic Reassurance: When children are anxious, it’s natural to try and reassure them, because we want to make them feel safe. If we don’t provide children with any reassurance, it can make them feel alone and uncertain but sometimes we can reassure too quickly which doesn’t give children enough time to explain their feelings. When we reassure too quickly, children can feel that we haven’t understood the situation or care about how they feel which can make their anxieties grow. Avoidance: It is natural to want to protect children from situations which cause them distress and worry. However, this is tricky when the situations which cause your child to be anxious are part of everyday life. In the short-term, it can seem ‘not worth the battle’ but in the long-term, avoiding situations also means removing the opportunities for children to learn that things they are worried about might actually be ok.

Preventative Tools and Strategies

Here are some strategies that can you can use to support your child to manage their anxiety. Some of these can also be helpful to try and pre-empt anxiety about a certain situation

Routines and Visual Timetables: Day to day activities can be unpredictable, and the anticipation of what comes next can cause anxiety for children and young people with additional needs. By using clear visuals on a timetable strip, perhaps with ‘Now, Next, and Then’ steps, you can help your child feel more aware and prepared for what is expected of them.

Social stories can be helpful for children and young people who experience difficulty with social interaction and understanding complex social situations. Drawing out or writing out a social event can help bring clarity and context to what might happen. These can be really useful with things like medical appointments.

Drawing Feelings: For children who might find it tricky to articulate or explain their anxiety, supporting them to draw or write their feelings can be a helpful strategy for caregivers to understand what is going on for them before things escalate. This is a creative way for children to express their feelings and emotions in a way that is appropriate and adjusted for their developmental stage.

Sensory Need Strategies: Some (but not all) children with additional needs may have sensory needs in relation to their taste, smell, sight, hearing, touch, movement and balance. These needs exist on a spectrum of sensory seeking needs vs. sensory avoidant needs. Sensory seeking children might enjoy more input from things like fidget spinners, squeezy toys and swings. Sensory avoidant children might need a little protection for their senses, for example, ear defenders. Using the appropriate strategies for your child can help reduce sensory-related anxiety.

Helping Children to ‘Let Go’ of Worries

Anxiety can be a difficult thing to ‘move on’ from when it gets stuck in our heads. It can often lead to rumination which can mean that we aren’t fully living in the moment, or that it’s tricky to feel relaxed enough to do thinks like get to sleep. The below strategies might help children and young people to ‘let go’ of their worries and things they can’t control.

Feelings Like the Weather: When we are anxious, it can be really hard to remember a time that we didn’t feel worried or a time that we will feel better. It might be helpful to explain to children and young people that our emotions come and go, a bit like the weather. Although it may feel like it’s stormy right now, if we sit with our emotions it will pass. Some days might be stormier than others, but the weather is always changing and our emotions are a bit like that too.

Thought Balloons: Support your child to write or draw their anxious thoughts onto drawings of a balloon. Count down, and imagine letting the balloons go. Perhaps you could try letting real balloons go!

Control Wheels: Control wheels can be another helpful way to support children to remember what they can and can’t control about situations that may worry them. This example is around anxiety about school, but you could create your own depending on what is specifically worrying your child.

Calming Strategies

Finally, here are some calming, grounding, and relaxation strategies that might help your child or young person when they are feeling worried and anxious. As we discussed earlier, it’s still important to ‘be with’ your child in their anxiety. Particularly for children with additional needs or a developmental disability, repeated attempts to calm or redirect them from their anxiety can cause frustration, and the anxiety curve teaches us that anxiety will always eventually decrease. Use your instincts and wealth of knowledge about your child as a caregiver to find a balance, and to judge when is best to try these activities.

Exploring Feelings Exercise

Now it’s your turn! Help your child understand the feelings associated with anxiety by completing this activity together. You could use it when your child is feeling anxious to help them communicate how they feel, or just as a practice to learn more about anxiety and physical symptoms! Ask your child to ‘draw’ what they are feeling in their bodies.

Recommended Books

• The ‘What-to-do’ guides for children and young people to work through. These books are recommended for developmental ages of 6-12 years.
• What to Do When Your Brain Gets Stuck: A Kid's Guide to Overcoming OCD (What-to-Do Guides for Kids)
• What to Do When You Worry Too Much: A Kid's Guide to Overcoming Anxiety
• What to Do When Your Temper Flares: A Kid's Guide to Overcoming Problems with Anger (What-to-Do Guides for Kids)
• What to Do When You Dread Your Bed: A Kid's Guide to Overcoming Problems with Sleep (What-to-Do Guides for Kids)
• Starving the Anxiety Gremlin for Children Aged 5-9 (Gremlin and Thief CBT Workbooks) by Kate Collins-Donnelly
• Starving the Anxiety Gremlin – A Cognitive Behavioural Therapy Workbook on Anxiety Management for Young People by Kate Collins Donnelly.
• The Huge Bag of Worries by Virgina Ironside
• The Big Book of Calmers by Jenny Mosley and Ross Grogan
• Relax by Catherine O’Neil
• Building Bridges Through Sensory Integration: Therapy for Children with Autism and Other Pervasive Developmental Disorders by Ellen Yack, Paula Aquilla, Shirley Sutton.
• The Out-of-Sync Child by Carol Kranowitz

Useful Websites

The following websites may offer some useful resources and information regarding building resilience, learning disabilities, and mental health support.

https://www.nhs.uk/conditions/stress-anxiety-depression/anxiety-in-children/

https://youngminds.org.uk/find-help/for-parents/parents-guide-to-support-a-z/parents-guide-to-support-anxiety/

https://www.moodcafe.co.uk/media/19579/cyp_parents_1_2_web.pdf

Further Support

Helping Hands Psychology Team: If you require further support please use the contact details overleaf to contact the Helping Hands team in your designated Children’s Centre.

GP: If you are concerned about yourself or a member of the family you can access support from your local GP.

Charities: Charity organisations such as Mind Cymru, Samaritans and Young Minds may also be able to provide you with support. Local Support Groups: Groups are a great way to meet new people and to talk about shared experiences. Here are the links to some we are aware of in the local area:

https://www.facebook.com/SparrowsAln/

http://www.valleydaffodils.co.uk/

https://www.asdinfowales.co.uk/newport-autism-support-group/

http://www.buildingbridgesproject.org.uk/

https://hopegb.co.uk/

http://www.onelife.wales/About-us/

https://www.magicparents.co.uk/

Contact

if you need any help or support with using or accessing these resources, please do not hesitate to contact a member of the Helping Hands Psychology Team at your local children’s centre.

Serennu Children’s Centre 01633 748023

Nevill Hall Children’s Centre 01873 732713

Caerphilly Children’s Centre 02920 867447