Saturday, May 22, 2010
Franklin Hall B Level 4 (Philadelphia Marriott Downtown)
9:00 AM
Background: Precise measurement of sleep patterns in children with autism spectrum disorders (ASD) is critical to developing effective treatments for insomnia. Appropriate parent education related to the collection of sleep measures within treatment trials may contribute to the success of these trials.
Objectives: To compare the impact of parent education, aimed at teaching parents to accurately complete sleep diaries and properly use actigraphs, on outcome data in two sleep treatment trials. Actigraphy uses measurements of inactivity/activity as surrogate measures of sleep/wake patterns.
Methods: Families were participating in two ongoing studies of sleep in children ages 2-10 years. Study #1 involves the use of supplemental melatonin to improve sleep in ASD children. Study #2 involves the use of behavioral interventions to improve sleep in ASD children within two sites of the Autism Treatment Network. All children met DSM-IV criteria for an ASD with confirmation on the Autism Diagnostic Observation Schedule and the Autism Diagnostic Interview-Revised. In Study #1 (n = 13), parents were given actigraphy watches for their children to wear, and sleep-wake diary to complete, along with brief verbal instructions. In Study #2 (n = 11), research coordinators spent between 30 minutes and 1 hour individually with each parent (separately from their children) reviewing the actigraphy and diary procedures. Study #2 also incorporated scenarios for completing the data collection tools and a quiz to measure parent comprehension of the tools.
The proportion of scorable nights of data in Study #1 (minimal parent education on actigraphy/sleep diary procedures) was compared with Study #2 (intensive parent education on actigraphy/sleep diary procedures). Mann-Whitney non-parametric tests were performed to compare the two study groups on proportion of scorable nights and socioeconomic status (SES—defined by averaging the four-factor Hollingshead Index of Social Status for each parent). Spearman rank product correlation coefficients were also performed to examine the association of SES with the proportion of scorable nights within the two studies.
Results: Mean (± standard deviation) child age in Study #1 was 6.5 ± 2.3 and in Study #2 was 5.7 ± 2.6 (p = 0.46). Based on the first three weeks of actigraphy data, the proportion of scorable nights was higher: 0.86 +/- 0.25 in Study #2 compared to 0.71 +/- 0.25 in Study #1, although significance was not reached potentially due to the small sample size (p = 0.19). In Study #2, SES was highly correlated with the proportion of scorable nights (r = 0.95; p < 0.0001). In Study #1, SES was not correlated with the proportion of scorable nights (r = 0.27; p = 0.37). SES did not differ for parents enrolled in Study #1 and Study #2 (p = 0.26).
Conclusions: Socioeconomic status may influence data collection during trials in children with ASD, especially in the setting of intensive parent education. Although our findings require confirmation in larger samples, we are refining our actigraphy education to ensure that education provided is successful for families regardless of socioeconomic status. Our findings are generalizable to other ASD trials involving parental data collection.
Objectives: To compare the impact of parent education, aimed at teaching parents to accurately complete sleep diaries and properly use actigraphs, on outcome data in two sleep treatment trials. Actigraphy uses measurements of inactivity/activity as surrogate measures of sleep/wake patterns.
Methods: Families were participating in two ongoing studies of sleep in children ages 2-10 years. Study #1 involves the use of supplemental melatonin to improve sleep in ASD children. Study #2 involves the use of behavioral interventions to improve sleep in ASD children within two sites of the Autism Treatment Network. All children met DSM-IV criteria for an ASD with confirmation on the Autism Diagnostic Observation Schedule and the Autism Diagnostic Interview-Revised. In Study #1 (n = 13), parents were given actigraphy watches for their children to wear, and sleep-wake diary to complete, along with brief verbal instructions. In Study #2 (n = 11), research coordinators spent between 30 minutes and 1 hour individually with each parent (separately from their children) reviewing the actigraphy and diary procedures. Study #2 also incorporated scenarios for completing the data collection tools and a quiz to measure parent comprehension of the tools.
The proportion of scorable nights of data in Study #1 (minimal parent education on actigraphy/sleep diary procedures) was compared with Study #2 (intensive parent education on actigraphy/sleep diary procedures). Mann-Whitney non-parametric tests were performed to compare the two study groups on proportion of scorable nights and socioeconomic status (SES—defined by averaging the four-factor Hollingshead Index of Social Status for each parent). Spearman rank product correlation coefficients were also performed to examine the association of SES with the proportion of scorable nights within the two studies.
Results: Mean (± standard deviation) child age in Study #1 was 6.5 ± 2.3 and in Study #2 was 5.7 ± 2.6 (p = 0.46). Based on the first three weeks of actigraphy data, the proportion of scorable nights was higher: 0.86 +/- 0.25 in Study #2 compared to 0.71 +/- 0.25 in Study #1, although significance was not reached potentially due to the small sample size (p = 0.19). In Study #2, SES was highly correlated with the proportion of scorable nights (r = 0.95; p < 0.0001). In Study #1, SES was not correlated with the proportion of scorable nights (r = 0.27; p = 0.37). SES did not differ for parents enrolled in Study #1 and Study #2 (p = 0.26).
Conclusions: Socioeconomic status may influence data collection during trials in children with ASD, especially in the setting of intensive parent education. Although our findings require confirmation in larger samples, we are refining our actigraphy education to ensure that education provided is successful for families regardless of socioeconomic status. Our findings are generalizable to other ASD trials involving parental data collection.