*3.4.1. Purpose of the technique*

Sleep and rest disturbances are important self-care challenges that are commonly faced by many children with ASD, with 44–83% of individuals reporting some form of sleep disturbances [45]. Humphreys and associates found that children between the ages of 18 months and 11 years with ASD slept 17–43 min less each night than their typically developing matched peers, with decreased sleep patterns found to be most pronounced in children between the ages of 30 and 42 months [46]. Additionally, Malow and associates found that children with ASD who slept poorly showed an average decrease in rapid eye movement sleep, possibly providing a partial explanation for their finding that disordered sleep in children with ASD exacerbates behavioral problems during the day [47].

As sleep is important for overall wellbeing, occupational therapists may work with individuals to establish healthy sleep routines in their clients, commonly including children with ASD and their families. They often assist such children in obtaining adequate sleep by experimenting with different sleep routines, using cognitive and behavioral interventions, and/or implementing sensory-based interventions [48]. Weighted blankets are an example of a sensory-based intervention commonly used in helping children with autism spectrum disorders attain adequate sleep participation. The underlying theory behind their use is that weighted blankets provide deep pressure touch without movement restrictions. This deep pressure, in turn, releases endorphins and serotonin to relax and calm the individual and help the individual to modulate sensory input [49, 50]. These relaxing sensations, it is hypothesized, allow the individual to be better able to fall asleep and stay asleep.

### *3.4.2. Overview of the technique*

Typically, weighted blankets are applied to children during sleep-time activities (nighttime and naps). The weight of the blankets used anecdotally is 10% of the child's body weight. The blankets size is large enough to cover the child's body, not including face and/feet. The intention is that the blanket will remain on top of the child throughout the duration of sleep.
