Sleep, Anxiety and Depression in High-Functioning Adolescents with Autism Spectrum Disorder (HFASD)

Background: Anxiety is commonly related to insomnia in typically developing (TD) populations.  At puberty sleep patterns change in TD adolescents with a rise in sleeping difficulties compared with middle childhood. Poor sleep, particularly insomnia, is common and often chronic in children with ASD and can be associated with behavioural difficulties, ADHD, anxiety and depression.  However, little is known about sleep problems and their associations in adolescents with ASD and whether they differ from TD adolescents. 

Objectives: Our aim was to explore the relationships between sleep patterns, psychopathology and satisfaction with life in high-functioning adolescents with autism spectrum disorder and age- and gender-matched TD adolescents 

Methods: HFASD adolescents completed 7-day sleep diaries, actigraphy and questionnaires including sleep-related anxiety (Sleep Anticipatory Anxiety Questionnaire); severity of core symptoms of anxiety (Anxiety subscale of the DASS-21); depressive symptoms (Centre for Epidemiological Depression Scale); perception of quality and satisfaction with life (Satisfaction with Life Scale; SLS); and the Chronic Sleep Reduction Questionnaire (CSRQ).  TD adolescents were drawn from an existing data base and matched with HFASD adolescents on both age and sex. 

Results: 27 adolescents with HFASD (22 male, 5 female), age 15.50 years (SD = 1.27) and 27 TD adolescents, age 15.54 years (SD = 1.14) were included in the study.  Sleep problems were reported by 46.2% (n = 26) of HFASD adolescents and 14.1% (n = 27) of TD adolescents (p = .01) and these were primarily symptoms of insomnia. HFASD adolescents had longer sleep latency (p = .01), poorer sleep efficiency (p < .05), and more symptoms of insomnia (p < .05) than TD adolescents. The groups did not differ on the SLS or the CSRQ, but HFASD adolescents had significantly higher levels of sleep-related anxiety and general anxiety (both p < .05), and depression (p < .05) than TD adolescents.  Sleep-related anxiety was significantly associated with several sleep parameters in the HFASD group, but there were no significant correlations in the TD group.  Many problematic aspects of sleep were significantly associated with both general anxiety and depression in the HFASD group, but few significant associations were found for the TD group. Additionally, sleep-related anxiety, general anxiety, and depression were significantly associated with the CSRQ (all p < .001) for the HFASD group but only general anxiety was associated with this measure (p < .01) for TD adolescents.   

Conclusions: Similar to reports for children, adolescents with HFASD self-report more sleep problems, primarily insomnia, and higher levels of anxiety and depression than TD adolescents. A range of insomnia symptoms are associated with sleep-related anxiety, general anxiety and depression in HFASD adolescents, with few such associations found for TD adolescents. Symptoms of chronic sleep reduction are also strongly associated with psychopathology in HFASD adolescents. These relationships have implications for the assessment and treatment of both sleep problems and psychopathology in HFASD.