Some children find it difficult to settle by themselves, which can be a problem for the whole family. This document contains some suggestions on how the parent/ carer can help the child achieve this.

1. Establish a routine

It is essential to have a consistent bedtime routine, which should enable the child to wind down. This routine should last between 15 – 30 minutes (see information doc. 2001, Good Sleep Hygiene). The child is more likely to comply if they know that they are expected to settle at the end of the routine.

2. Graduated Extinction

This is can be used when the child either cries or throws a tantrum if left alone. A time interval can be set for the child to be left, which would be increased each week (or each day if the parent’s feel happy to do this). After the set time period, the parent/ carer would go back in put the child back to bed if necessary, tell them it is time to sleep, and then leave the room before any further interaction can occur. The child would then be left again for the set amount of time, and then if they are still crying they would go back in again, and so on. Below is an example of the time periods that can be set:

• 1st night: check after 3 minutes
• 2nd night: check after 5 minutes
• 3rd night: check after 7 minutes
• 4th night: check after 9 minutes
• 5th night: check after 11 minutes

There is nothing particularly special about the length of time, but it must be one that the parents feel comfortable with, as it can be very difficult to leave a child crying, and the length of time can seem longer than it is. It is important to realise that the first few nights can mean several hours of crying, but things should start to improve after a few nights. For this reason, it must be started at a time when the family can cope with sleepless nights to begin with, e.g. at the weekend or during the school holidays (siblings will also need to be considered).

The idea of this method is that the child will learn to fall asleep by themselves, without any props, so this means not introducing anything when the parent/ carer goes back in such as music, drink, picking the child up etc, that would mean the child relying on something else to get to sleep. Some studies have shown that the child will learn to settle themselves by rearranging pillows, cuddling a toy, sorting out bed covers etc.

3. Extinction

The parent/ carer could try going to the child when they first hear them cry out, check that there is nothing bothering them (e.g. check their nappy and that they are not ill), but not pick them up, soothe or have a conversation. They should then be left alone again, and any further crying ignored. If this method is used it is important to be consistent, or the settling difficulties may be worsened.

4. Modified Extinction

This is where the child is left alone for a period of twenty minutes (again this time can be adjusted to suit the parents) if they are crying or calling out, then the parent/ carer would check on the child without picking up or interacting with him/ her. If the parent is satisfied that the child is well, they should leave the room and enter again in another twenty minutes if the child is still not settling. This pattern of time intervals should be repeated as many times as necessary until the situation improves.

5. Positive Reinforcement

This can usually be used with children with a verbal age of three or above. The idea of positive reinforcement is to reward the desired behaviour in order to increase it. For example, if the child has a night without crying or calling out for the parent/ carer etc, then this can be rewarded in the form of anything that the child will find rewarding such as a start chart or stickers. Whether it works depends on the child’s developmental age and it is unlikely to work if the child never has a night where they stay in their room. In other words, the goals should be achievable. Verbal praise can sometimes be enough to reward the behaviour, e.g. "Well done for staying in your bed all night by yourself", but at the same time, if the child doesn’t manage to achieve the goal, try not to draw too much attention to it.

6. Association

The parent/ carer could try introducing a particular toy, scent or piece of music at nighttime and at naptimes, so that the child will begin to associate this with sleeping.

7. Put the child to bed awake

If the child falls asleep on the sofa, of in another bedroom etc, and then is transferred to their own bed asleep, they may not expect to wake up in this new environment alone, and this can make some children anxious, causing problems with night waking. To break this habit, you can start to put the child to sleep awake in their own bed, possibly in conjunction with one or more of the other methods discussed, or by itself.

8. Increasing the distance between parent and child

If the parent/ carer finds it difficult to leave the child when they are crying, then they could try by initially sitting beside the child’s bed at night time, but avoiding any interaction with the child, and remain there until the child is asleep. The idea would be to gradually increase the distance between the parent/ carer and the child each night (or every few nights) by moving the chair further away, until the parent is able to leave the room (there might then need to be a few more steps, e.g. after the parent is just outside the room, the next step might be to be upstairs but another room, then on the stairs, then downstairs). This seems to be one of the preferred methods, as it is sometimes easier to stick to, and the gradual changes are sometimes easier on children with autism, although it can sometimes take longer before the child is sleeping on his own.

9. Reduce anxiety

As well as some of the techniques listed above, there are also methods to reduce anxiety. It will depend on what the nature of the problem is as to how it is dealt with. The child must feel relaxed and content in the bedroom to begin with, and must start the night on a positive note. Sometimes separation anxiety can be a problem, in which case the above method (increasing the distance) may be suitable, but also it is important to remember that most children grow out of this as long as good sleep habits are reinforced during this time. How long it takes to improve may depend on the developmental age.

10. Fading

This is where you change the time of the bedtime (often to the time that the child normally falls asleep if settling is normally an issue) and then you can put the child to bed alone (again can be used with some of the other methods above) so that they fall asleep more easily than they would if put down alone at the earlier time. This would be done until the child falls asleep fairly easily by themselves and then the bedtime can be moved back by five minutes each day until back to the original time.