The Validity of Actigraphy As a Diagnostic Tool for Sleep Disturbances in Children with Autism Spectrum Disorders

Background: Children with autism spectrum disorders (ASD) experience sleep disturbances at a disproportionate rate compared to their typically developing peers. Due to the inherent difficulties in performing polysomnography (PSG) with children in this population, actigraphy is often used to collect data about sleep habits and disturbances. As this data is frequently used diagnostically, it is crucial to determine its validity to ensure that children with ASD are receiving appropriate sleep diagnoses and interventions. 

Objectives: This study aims to characterize the degree to which actigraphy is an accurate measurement of sleep habits and a valid tool in diagnosing sleep disturbances in children with ASD. Additionally, this study explores the feasibility of using in-home ambulatory PSG as an alternative diagnostic tool for this population of children, and will report on the detailed sleep architecture of children with ASD. 

Methods: 19 adolescents aged 9-18 years have been recruited and have completed study requirements. Currently, data have been analyzed for 11 typically developing (TD) children and 8 children with a previous diagnosis of ASD, confirmed by the Autism Diagnostic Observation Schedule and the Autism Diagnostic Interview-Revised. Data regarding typical sleep habits were collected via actigraphy and sleep diaries during one week leading up to a home-based PSG recording. Recruitment and data analysis are ongoing.

Results: Preliminary analyses indicate discrepancies between actigraphy and PSG reports of sleep efficiency, exclusively for the children with ASD. In these children, actigraphy significantly underestimated sleep efficiency compared to PSG recordings (p<.05). In-home PSG recording has been successful in all ASD participants run thus far.

Conclusions: Based upon preliminary analyses, actigraphy does not appear to be a valid measurement of all sleep parameters. This is problematic, particularly in the ASD population, for which actigraphy is frequently used due to aversion to PSG. However, we have found great success with ambulatory in-home PSG, incorporating desensitization protocol when necessary. Taking the discrepancy findings alongside the successful PSG recordings, this study has strong clinical implications for the support of in-home PSG recordings in assessing sleep disturbances in children with ASD.