Module 5

Relaxation

In order to fall asleep, we need to achieve a state of behavioural, emotional, and cognitive calm – essentially this means assuming our typical sleep position, having a calm emotional state, and a quiet mind. Children often have active minds and/or worries. As a result, they may struggle to fall asleep. There are many strategies that can be used to promote relaxation, which are the focus of this module.

This module covers:
  • Deep breathing
  • Progressive muscle relaxation
  • Grounding
  • Imagery
  • Worry time
  • Self-encouragement
  • Safety symbols
  • Supports to facilitate these strategies
  • Relaxation Strategies

    Deep breathing

    Deep breathing, also known as “belly” or diaphragmatic breathing, is a breathing technique which engages the stomach, abdominal muscles and diaphragm (the thin muscle that separates your abdomen from your chest) to efficiently move air in and out of our body. Research shows that, when done correctly, deep breathing can lead to feelings of relaxation. 

    If you are trying to teach your child to use deep breathing techniques, these are some of the steps that you could follow:

    • Find a comfortable position (e.g., sitting or lying down).
    • Breathe in through your nose, like you’re sniffing a flower.
    • Imagine your stomach is a balloon, feel your stomach/balloon fill up with air and puff up (note – it might help your child to place their hand or a preferred tangible item such as a small toy on their stomach to see and feel the physical sensation).
    • Now slowly breathe out through your mouth, like you’re blowing out a candle.
    • Let all the air out of your stomach and feel it slowly go down.
    • Keep slowly breathing in and out, until you feel relaxed.
    • Breathe in 1, 2, 3
    • Out 1, 2, 3, 4

    An example of a script that can be used to support your child to learn deep breathing, is provided below.

    Progressive muscle relaxation

    When people feel anxious and/or stressed, their muscles often tense up. When our muscles tense too much, they can be left with an uncomfortable feeling (e.g., headache, neck pain, difficulty breathing). This uncomfortable feeling can cause stress to increase, which again causes more tension in the muscles, which can make it difficult to fall asleep.

    Progressive Muscle Relaxation (i.e., PMR) is a technique (often paired with deep breathing) aimed at relaxing our muscles and reducing stress. It requires children to systematically tighten and relax different muscle areas of their body, while focussing on the feeling. When practicing using PMR, with each muscle area, the child should remain tense for 5 seconds, before relaxing the muscles for 10-15 seconds. Then they can move on to another muscle area. For example, clenching their hands and then relaxing them, pulling their shoulders to their ears, and then relaxing them, and so forth.

    Some Autistic children may experience differences in interoception, i.e., they may be over- or under-responsive to internal sensations such as the tension and relaxation of muscles. These children may have difficulty with this strategy. For example, they may become distressed and/or have difficulty understanding the process. In such cases, an alternative strategy may be preferred (e.g., imagery or self-encouragement).

    An example of a script that can be used to support your child to learn PMR is provided below.

    Grounding

    Grounding practices can help children integrate their senses and self-regulate. The 54321-grounding technique draws upon five senses (i.e., sight, touch, sound, smell and taste) and can be used in the lead up to bed or while in bed. The steps for this are outlined below.

    Steps to share with your child for 54321 grounding:

    1. Notice and name five things you can see.
    2. Notice and name four things you can touch.
    3. Notice and name three things you can hear.
    4. Notice and name two things you can smell.
    5. Notice and name one thing you can taste.

    A visual resource to support your child to learn grounding is below.

    Imagery

    Imagery involves the use of visualisation techniques to help your child to get their mind off arousing and/or anxious thoughts. This process typically involves closing their eyes and imagining the sights and sounds of a place that they find relaxing. For example, a beach on a tropical island. The more detailed the visualisation, the more there is to focus on. For example, the warmth of the sun, the blue sky, the sound of the waves, the feel of the sand between your toes and so forth.

    Some children may have difficulty creating detailed visual images in their mind. These children may benefit from having visual or physical prompts (e.g., certain lights and sounds) to direct them to the decided visualisation, or to be used as a source of focus while trying to relax. The focus of the imagery can be determined by your child.  

    Worry time

    It is not uncommon for children to seek reassurance from their caregivers at night in regard to their worries. They may yell out to their caregivers, ask them questions and/or get them to check for monsters under the bed. When these are frequent and repeated, they can delay falling asleep. It can be helpful to set a time during the day to discuss the child’s worries with them instead of at night. A “worry box” can be used as part of this technique so that any worries that come into the child’s mind outside of worry time, can be written down (or drawn) and put in a box and then discussed at the allocated time during the day. This allows for the child’s concerns to be validated, but not at a time that will disrupt sleep.

    Self-encouragement

    Self-encouragement is a strategy targeted at reframing negative and/or anxious thoughts that may be keeping the child’s mind occupied at night. For example, reframing “I can’t fall asleep” to “I always eventually fall asleep”. If the child is finding it difficult to actively reframe their thoughts on their own (i.e. they require help and prompting), ‘coping cards’ could be created to facilitate this. These cards provide the child with questions to test their thoughts. For example, “is this thought based on facts or feelings?”, “what are some things I am looking forward to tomorrow?” or “what have I done in the past that has helped me fall asleep?”. In addition, these cards can direct the child to other relaxation strategies outlined in this module. The types of questions used will depend on the child’s level of understanding and metacognition (i.e., ability to think about thoughts).

    Safety symbols

    Safety symbols are items/objects used to symbolise safety and provide reassurance for your child. Examples include:

    • Monster Spray – if a child has a specific fear keeping them awake such as that of monsters, a small bottle of ‘Monster Spray’ (or the like) could be made and used, to reduce that fear. All you need is a spray bottle, a homemade label, and a safe, simple liquid (e.g., lavender water). When the child feels fearful, they can use their spray in their room to keep the ‘monsters’ away.
    • A dream catcher – if the child is experiencing bad dreams, a dream catcher could help to assure the child their bad dreams will be ‘caught’.
    • A toy which will protect them – giving a special toy the role of protection, so that as long as the child has this toy, they will be safe.

    Supports to Facilitate Relaxation Strategies

    These strategies can look different across individuals, so it is important to consider your child’s unique experience and what modifications might need to be made to suit them. It is also important for children to practice these strategies (during the day and night) to experience their calming effects. Visual, sensory and physical supports can enhance the learning process, and so it is recommended you use these alongside the strategies. Examples include:

    • An animated video or toy model might help in externalising the process so the child can match their breathing or movements. For example, a soft toy that breathes in and out.
    • A visual schedule outlining the steps of the strategy or listing options of strategies they can use at night (see Visual Supports – Module 4).
    • Tangible items such as a breathing necklace (if supervised), bubbles, stress balls, or other items tailored to your child’s sensory needs.
    • A relaxation ‘toolbox’ with varying cards, schedules and/or tangible items to provide your child options for relaxation. Examples: Relaxation toolbox and Deep breathing & relaxation story.

    Even then, not all strategies will necessarily align with your child’s individual needs and preferences. If you find your child is having difficulty with a particular aspect of a strategy (e.g., lying still, tensing their muscles, diaphragmatic breathing) or the strategy overall, consider breaking it down into smaller steps or trying an alternative approach.