The Importance of Evaluating Sleep as an Occupation

One of the most common and most overlooked issues in pediatric OT cases is sleep. It is a critical occupation that can affect a child’s performance, behavior, attention, sensitivity, and much more. The following studies provide evidence for why sleep should be evaluated when a child comes in for occupational therapy.

Pediatric Sleep Difficulties: How OTs Address Sleep as an Occupation

Sleep is still a widely unstudied occupation. There is some evidence that references how critical sleep is, especially for pediatric patients. However, therapists reported that they feel sleep interventions and assessments, if done at all, aren’t thoroughly researched or effective.

Those therapists that do address sleep will typically offer sensory strategies, environmental recommendations, medication, or routine modifications. However, many therapists claim to not feel as though they can adequately address sleep issues. This survey suggests that sleep is not being appropriately addressed, and should not be overlooked as a critical determinant in a child’s performance in occupations throughout the day.¹

Experience of Sleep for Families of Young Adults With Autism Spectrum Disorder

Families living with ASD youth tend to have their entire routines revolve around the individual, and bedtime can be especially difficult. Usually, sleep difficulties don’t resolve even into the early years of adulthood. The families interviewed in this study showed emotional themes of difficulty and hopelessness when it came to managing sleep with their YA-ASD.² Each YA-ASD studied showed difficulty in falling and staying asleep, as well as disruptive nighttime behavior which led to the overall exhaustion of the family.³

This study cites the study published by the American Academy of Neurology which recommends “(1) addressing coexisting medical conditions, (2) implementing behavioral strategies, (3) using melatonin, and (4) exploring complementary alternative medicine.”⁴ These strategies are the typical recommendations for sleep problems when it comes to typically developing children, but may not be as effective for YA-ASD.⁵

Although this study shows the necessity for further study of effective sleep interventions for YA-ASD, it also shows the importance of not overlooking sleep when providing occupational therapy, especially for ASD individuals and their families.

Relationship Between Sensory Processing and Sleep in Typically Developing Children

Sensory processing challenges can affect a multitude of a child’s daily occupations such as participation in activities, socialization, play, and tasks of daily living; additionally, sensory processing affects sleep.⁶ Children who presented with sensory processing challenges had more difficulty falling and staying asleep, poor sleep hygiene, drowsiness, and difficulty with sleep preparation.

The study implicates that there is “significant associations exist between children’s sensory processing abilities and their functional participation in sleep occupations and therefore provide a preliminary reference point from which to assess children referred to occupational therapy for sleep problems.”⁷

• References

  1. Piller, Aimee, PhD, OTR/L, BCP, et al. “Pediatric Sleep Difficulties: How OTs Address Sleep as an Occupation,” The American Journal of Occupational Therapy, 75, no. 2 (2021), doi: 10.5014/ajot.2021.75S2-PO94

  2. Halliwell, Nicole, et al. “Experience of Sleep for Families of Young Adults With Autism Spectrum Disorder,” The American Journal of Occupational Therapy, 75, no. 5 (2021): p. 4, doi: https://doi.org/10.5014/ajot.2021.043364

  3. Halliwell, “Experience of Sleep,” p. 5.

  4. Buckley, Ashura Williams et al. “Practice guideline: Treatment for insomnia and disrupted sleep behavior in children and adolescents with autism spectrum disorder: Report of the Guideline Development, Dissemination, and Implementation Subcommittee of the American Academy of Neurology.” Neurology vol. 94, 9 (2020): 392-404. doi:10.1212/WNL.0000000000009033

  5. Halliwell, “Experience of Sleep,” p. 6.

  6. Foitzik, Kristie and Ted Brown. “Relationship Between Sensory Processing and Sleep in Typically Developing Children,” The American Journal of Occupational Therapy, 72, no. 1 (2018): p. 2, 7201195040p1–7201195040p9. doi: https://doi.org/10.5014/ajot.2018.027524

  7. Foitzik and Brown, “Relationship Between Sensory Processing and Sleep,” p. 7.