Psychological Correlates of Sleep Problems In Children with High-Functioning Autism Spectrum Disorder and Typically Developing Children

Background: Sleep problems are common in children with neurodevelopmental disorders such as autism. It is believed that multiple biological, psychological, and environmental factors may be associated with an increased risk for sleep disturbance in children with autism spectrum disorder (ASD). Children with ASD also have a wide range of co-morbid psychiatric disorders, including ADHD, anxiety, and depression and these may be associated with sleep problems; however these relationships have not been well explored. 

Objectives:  The present study examined the psychological correlates (ADHD, anxiety, and depression) of sleep problems in children with high functioning ASD (HFASD) as compared to typically developing (TD) children, using both the children and their caregivers as informants.

Methods:  Thirty-three children aged 8-12 years (HFASD, 18; TD, 15) and their primary caregivers completed questionnaires that investigated the child’s sleep and psychological wellbeing. Caregivers completed demographics, including questions about the presence of common sleep problems; the Family Inventory of Sleep Habits (FISH); the Children’s Sleep Habits Questionnaire (CSHQ); and the Child Behavior Checklist (CBCL). Children completed the Sleep Self Report Questionnaire (SSRQ), the Screen for Childhood Anxiety Related Emotional Disorders (SCARED) and the Children’s Depression Inventory-short form (CDI)

Results:  TD children slept significantly longer than the HFASD children. Caregiver reports of child sleep problems and psychopathology were significantly higher in children with HFASD, compared to TD controls, but the groups did not differ on the FISH. On child report the HFASD group had significantly higher SSRQ scores but the two groups did not differ on self-reported anxiety or depression. Sleep problems were associated with some measures of psychopathology on both parent and child report measures. Significant relationships were observed between specific types of sleeping difficulties and different dimensions of psychopathology for both groups of children.  In particular SCARED total score and some SCARED subscales were associated with both CSHQ and SSRQ scores in both groups. The CDI was associated with the SSRQ for the TD children while the CBCL-Affective score was associated with the SSRQ for the HFASD group. There were some associations between CHSQ subscales and CBCL-ADHD score for the TD but not the HFASD group.  While medication was not associated with the presence of sleep problems or psychopathology, when the 8 children who were on medication in the HFASD group were removed the pattern of sleep and psychopathology measures changed for the remaining 10 children

Conclusions:  Using both caregiver and child self-report, this study illustrates that significant, yet complex relationships exist between sleep disturbance and psychological wellbeing in children with and without HFASD. However, further research is required in order to gain a greater insight into the aetiology of sleep problems in HFASD, and the degree to which child development, daytime behaviour, and psychopathology is impacted. Clinical intervention research is also recommended in order to ascertain the effect that pharmacological and behavioural sleep interventions may have on children’s co-morbid psychopathology. It is possible that interventions designed to reduce children’s problematic sleep may result in overall improvements in their mood, anxiety, and ADHD symptomatology.