Can a Brief Behavioral Intervention Improve Sleep Hygiene in Adolescents and Young Adults with Autism Spectrum Disorders?

Background: Sleep problems affect many individuals with autism spectrum disorders (ASD). Many studies of sleep problems in ASD have focused on young children, with less understood about the treatment of sleep problems in adolescents/young adults with ASD. Treatment of sleep problems with medications is not always successful and often has adverse effects. Behavioral treatment of sleep concerns for adolescents/young adults with ASD is an understudied area with many potential benefits. In this study, we employ an education-based program and are assessing the impact of the program on nighttime sleep and daytime functioning for adolescents/young adults ages 11-21 with ASD.  

Objectives: Objectives of this study are to: 1) develop a manualized education program for adolescents/young adults with ASD and their parents and 2) assess the impact of this program on nighttime sleep and daytime functioning for adolescents/young adults with ASD.

Methods: The program consists of 2 individual education sessions with a psychologist, the adolescent/young adult, and their parent, followed by 2 follow-up phone calls. These sessions focus on components of successful sleep previously researched with children with ASD ages 2-10. This includes daytime habits, bedtime routines, sleep timing, and sleep environment. This program also includes the addition of strategies related to relaxation, distraction, and mindfulness-based breathing for the adolescent/young adult to utilize at sleep onset and during night wakings. The adolescent/young adult participant wears an actigraphy device to provide objective data concerning their pre- and post-program sleep. The parent and adolescent/young adult also complete pre- and post-program self-report measures to assess various aspects of sleep and daytime behavior.

Preliminary results from our first six completers of this program are presented here, focused on the three measures. One is the Adolescent Sleep Hygiene Scale (ASHS), focusing specifically on its cognitive subscale, as challenges were exhibited in this area for the majority of participants at baseline. Subscale examples include “I use my bed for things other than sleep,” “I check my clock several times during the night,” and “I go to bed and think about things I need to do.” Another is a parent absorption interview administered during follow-up phone calls to assess parental understanding, implementation, and comfort level of concepts covered in the sessions. The final measure is an evaluation form parents complete at the end of the program regarding their satisfaction with the sessions.  

Results: In our parent report of the ASHS cognitive subscale, 5 out of 6 of the participants reported improvement in the majority of the items. In our adolescent/young adult report of this subscale, 4 out of 6 of the participants reported improvement in the majority or all of the items. For all participants, Parent Absorption Interview scores were 3-5 on a 5-point scale for all questions (higher numbers indicating more understanding, implementation, and comfort) and evaluation scores were 3-4 on a 4-point scale for all questions (higher numbers indicating more satisfaction).

Conclusions: The behavioral sleep education program shows promising results in improving sleep hygiene for adolescents/young adults with ASD, with high levels of parent implementation and satisfaction.