PL is 13 year old boy. He has a diagnosis of autism and severe learning disability and attends special school. PL presents with significant sensory seeking behaviours and often becomes dysregulated throughout the day. PL can experience stress responses in school and in the home setting. PL experiences significant difficulty settling down to sleep at night. PL enjoys music and sensory based activities for example Theraputty. PL likes routine and repetition and responds very positively to consistency and structure. PL uses a photograph schedule at school.
After consultation with parents the following triggers were identified.
- PL presents as movement seeking and energetic especially in the evenings and prior to bedtime
- PL will not go to bed unless his dad lies beside him until he falls asleep
- PL finds it difficult to fall asleep when in bed
- PL’s dad co-sleeps with him.
Sleep diary information was gathered from PL’s parents and shows PL’s sleep patterns over a two-week period.
Baseline data collection findings over two-week sleep diary period:
- PL takes an average of 1.5 hours to fall asleep.
- PL slept an average of 10 hours and 15 mins per night.
- Introduce a photograph schedule within the home setting to provide structure and increase predictability for PL and to ensure consistency across settings
- Include a physical activity in the early evening, for example trampolining to provide an opportunity for PL to engage in regulating activities before his bedtime routine begins
- Introduce a photograph schedule for the sequence of bedtime routine to provide PL with increased structure at this particular time of the day
- Include having a bath in the bedtime routine 30 mins before getting into bed, to provide PL’s body to relax and regulate in temperature
- Provide PL with an opportunity to use his weighted blanket before going to bed to provide deep pressure
- Play calming music at bedtime before PL goes to sleep as he enjoys music and this can be used as an auditory signal that it is soon time to go to sleep
- Ensure PL’s bedroom has low lighting in the bedroom and a night light for during the night
- Attach a photograph of PL to his bed and place a photograph of his dad beside the camp bed where he will sleep. Place photos on the doors of other bedrooms to indicate where everyone sleeps
- When it is time to go to sleep PL’s Dad turns off the lights and lies down on the camp bed and says goodnight
- Consistency will be key. PL has demonstrated his ability to follow routines extremely well once those supporting him are consistent
- If PL gets up during the night, his dad will guide him back to bed and say “PL’s bed” while pointing to his bed. Lie back down in the camp bed and say good night to PL using the chosen “goodnight” phrase
- As PL demonstrates the ability to sleep in the single bed, his dad will start to move the camp bed towards the parents’ bedroom every night. Placing the photo of PL’s Dad in the new location of the camp bed prior to going to bed, and showing this to PL. Following the usual routine as noted above and go to bed
- When the camp bed has moved closer to PL’s parents’ bedroom, his Dad’s photo will be placed on the door of the parent’s bedroom. PL will be shown this and the usual night time routine will be followed.