The Impact of Demographics and Sleep Hygiene on Sleep in Children Aged 2-5 Years with and without Autism Spectrum Disorder (ASD)

Background: Poor sleep in children is often related to bedtime associations and routines, behavioural issues surrounding sleep, or night time fears. Socio-cultural factors including culture, education and family income, and sleep hygiene factors, including the sleep environment, bedding and night wear, screen time, and meals can also affect children’s sleep, but their impact is less commonly explored, particularly in young children.

Objectives: To investigate relationships between family demographics, environmental factors and caregiver-reported sleep difficulties in children aged 2- to 5-years with and without ASD. 

Methods: Participants were the primary caregivers (N = 96) of 101 children (63 boys, 34 girls), mean age 47.5 months (SD= 12.9 months), including 28 children with ASD and 2 children with developmental delay. Caregivers completed a survey including a demographic questionnaire, an environment and sleep questionnaire, and the Children’s Sleep Habits Questionnaire (CSHQ). Group comparisons (children with a sleep problem, children with no sleep problem; typically developing (TD) children, children with ASD), chi-square, and correlations were conducted as appropriate.  Regression models were also conducted to examine predictors of CSHQ total score and daily total sleep. 

Results: 55.4% of the children had a sleep problem (79% of the children with ASD; 46.5% of TD children), and the average CSHQ total score was higher in these children than in children without a reported sleep problem (p < .001). CSHQ scores did not differ with age or diagnosis. Younger children slept more than older children (p < .001), and children with ASD and a sleep problem slept less than other children (p < .05).  Total CSHQ score was related to family income, and primary caregiver employment and education. CSHQ score and total sleep were each related to a range of sleep hygiene variables including temperature, screen time, bed covers and night wear. Hierarchical multiple regressions with CSHQ total score and total daily sleep as dependent variables were conducted.  The final models were significant; screen time, temperature and bedcovers together significantly accounted for 28% of the variance in CSHQ total score, while age, ASD diagnosis, screen time and sleep environment significantly accounted for 44% of the variance in hours slept.  

Conclusions: These results indicate the importance of demographic and sleep hygiene factors on sleep problems in toddlers and pre-school children, regardless of whether the child has an ASD.  While ASD impacted negatively on total sleep in this age range, children with and without ASD had similar sleep problem scores.  The results support that attention to screen time (television and computers/tablets), the bedroom environment and bedding are important for good sleep.  It was surprising that even at this young age screen time impacted on children’s sleep. In particular, tablet (e.g., ipads) use by children with ASD is popular, with an increasing number of apps available for young children. Tablet use may be a new factor contributing to poor sleep in young children with ASD especially as the children with ASD in this study spent twice as much time as the TD children on computers/tablets.