Anand Gundakaram, MD, MRCPCH (UK) - Milford

When you visit a neurologist, they’ll assess your child’s needs, run some tests (think imaging or EEG), and diagnose. From there, they’ll create a customized treatment plan. Medication, lifestyle tweaks, or maybe even a referral to another specialist could be on the table.

There unfortunately isn’t one test for all neurodevelopmental conditions. Most likely you will go into a visit to test one or two medical conditions. If you are looking for a comprehensive autism evaluation, developmental pediatricians, psychologists, or neuropsychologists are the preferred specialists who can diagnose autism.

No, neurologists focus mainly on non-surgical interventions. If your child needs surgery, neurologists might point you in the direction of a pediatric neurosurgeon.

More research is needed to understand the link between sleep disturbance and autism, but there are a few possible reasons why autistic children have difficulty sleeping.2

• Co-occurring conditions. Coexisting medical conditions like ADHD, anxiety, or sleep apnea (when you stop breathing multiple times throughout the night), environmental allergies, and gastrointestinal upset (like constipation), can negatively impact sleep.
• Sensory sensitivities. Sensitivity to lights, sounds, and touch (think textures of blankets and clothing) can disrupt sleep.
• Medications. Often autistic children are prescribed medications to address various concerns like hyperactivity, anxiety, or aggression. Many of these medications may contribute to sleep problems. Adderall, Focalin, and Vyvanse are examples of stimulants prescribed to children on the spectrum to treat hyperactivity, impulsivity, and inattention, that can cause insomnia. Abilify and Risperdal (medications commonly prescribed for autistic children who have severe irritability, aggression, and/or self-injurious behaviors) may cause some children to become very sleepy.  However, each person responds differently to medications. (Pro tip: Keep channels of communication open with your doctor so that you can find the best medication to help your child that least affects sleep.)
• Neurobiological differences. Some research suggests autistic people may not produce the same levels of neurotransmitters (such as serotonin) or hormones (melatonin) important for sleep regulation, and may also experience disruption in circadian rhythms.3 In addition, low muscle tone can contribute to sleep-breathing disorders, such as sleep apnea, which also affects the quality of sleep and can lead to increased inattentive and hyperactive symptoms during the day. These behaviors, in turn, make it more challenging for the child to participate in therapies and activities. 

For more information, read our comprehensive sleep guide.

Like anyone else, when children on the spectrum don’t get adequate sleep, they may find it difficult to self-regulate during the day. But there’s another consequence – autistic kids who don’t get enough sleep can experience an increase in stimming, irritability, inattention, difficulty socializing, and keeping up in school.3 They may also face challenges with increased hyperactivity and lack of impulse control. In short, lack of sleep can intensify your child’s existing challenges.

The same goes for parents, too. It’s hard for you to keep your cool and be fully present when you aren’t well-rested.5 As you’ve already found out, good sleep is crucial for everyone in the home.

Speak with your doctor if you have concerns – especially if you notice your child snores or gasps in their sleep, grinds their teeth (bruxism), sleeps with their mouth open/drools, or is very sweaty during sleep, as these are potential signs of sleep apnea. It can be helpful to keep a log of concerns, including when the child falls asleep, how many times they wake up, when they wake for the day, and any unusual behaviors (e.g., an unusual number of sleep terrors, recurrent nightmares, sleepwalking, sleep talking, unusual hand movements, lip-smacking).

Research shows that pediatricians are sometimes unaware of the severity of sleep issues in autistic children, so please continue to advocate for your child if you have concerns.