How does screen use affect the sleep quality of children with autism?

Overexposure to screens interferes with sleep quality for everyone. But in the case of children and adolescents with autism, this interference is exacerbated by two factors: firstly, the amount of time they spend in front of screens is greater than the general average, and secondly, sleep disorders are common in autistic individuals, often associated with sensory processing differences. In fact, 80% of children with autism do not get the expected quality and quantity of sleep for their age, experiencing difficulty falling asleep and frequent nighttime awakenings.

To reflect on the risks of excessive screen time and how it can affect sleep quality in people with autism spectrum disorder (ASD), the Catalan Autism Federation and Sant Joan de Déu Hospital in Barcelona organized a talk for families. The talk featured Aritz Aranbarri , a child clinical neuropsychologist from the ASD Unit of the Mental Health Area at Sant Joan de Déu Hospital in Barcelona and co-principal investigator of the iCase study, and Òscar Ramon Sans , a clinical neurophysiologist and Head of the Sleep Disorders Unit at Sant Joan de Déu Hospital in Barcelona . They also shared recommendations and tips for promoting good sleep hygiene.

The American Academy of Pediatrics establishes some basic recommendations on screen use in children:

• Avoid exposure to screens for children under 2 years of age.
• Between the ages of 2 and 5, use should be less than one hour, and between the ages of 5 and 12, less than two hours.
• Avoid using screens in the two hours before bedtime for all ages.
• Reduce screen time and exercise more to improve health and sleep quality.

Using screens before bed affects the quality of children's sleep, risking them not getting enough sleep (they need 10 hours of sleep at night) and experiencing poor sleep quality, with difficulty falling asleep, nightmares, and increased daytime sleepiness . In the long term, this can negatively impact academic performance and increase mood swings and anxiety.

80% of children with autism do not have the expected quality and quantity of sleep for their age, with difficulties falling asleep and frequent nighttime awakenings.

In the case of children with autism, sleep problems at an early age have been associated with an increase in repetitive and restrictive behaviors; but at the same time, rigidity and the tendency towards repetitive behaviors and greater sensory sensitivity affect sleep, and this feeds back into itself, creating a loop that is difficult to break.

Sleep in children with autism

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Recommendations for improving sleep quality

Improving the sleep quality of children with autism is a common concern for families. Establishing routines and sleep habits is essential to achieving this.

Routines and schedules in daily activity

• Establishing a schedule for all meals and activities helps regulate sleep.
• Avoid sleeping too little, too much, or without a schedule, as this disrupts nighttime sleep.
• Promote physical activity integrated into the naturalness of play in childhood and according to the developmental stage.
• Regulate peak activity hours.

Healthy diet

• Avoid excess calories, processed foods, and sugars.
• Increase vegetables and fish in your diet.

Sensory perception

• Understanding your child's sensory profile helps you control: light, the fabric of their pajamas, stimuli coming through the window, triggering noises…
• Make sure the room is a screen-free space: blue light interferes with the secretion of melatonin, with implications for sleep.
• Establish a schedule to stop using screens two hours before going to sleep.
• Replace screens with reading a book together.

Stable routines for the whole family

• Ensure activity and sunlight during daylight hours.
• Make sure the room is a "sanctuary" for sleep (warm light, warm colors, no noise or light, sensory needs...)
• Look for deactivating routines to reduce moments of activation before going to sleep.
• Having a visual schedule to structure the daily routine and show it to the child.
• Eliminate screen use two hours before going to sleep.
• Establish a two-hour gap between dinner and bedtime.
• Eliminate the television during dinner.

The role of the family in screen use

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