Sleep Problems in Children with Autism Spectrum Disorder: Examining the Role of Anxiety and Sensory over-Responsivity
Sleep problems are common among children with autism spectrum disorder (ASD), and can have significant detrimental effects on daytime functioning. Hyperarousal is often associated with insomnia in the general population and may also underlie sleep difficulties for children with ASD, particularly given their increased risk for arousal-related symptoms. Emerging evidence from previous studies suggests that specific arousal-related symptoms, sensory problems and anxiety, may be related to the development and maintenance of sleep problems in children with ASD. However, research has yet to explore the associations between these symptoms.
The goal of the current study was to examine the bivariate and multivariate relationships among anxiety, sensory over-responsivity, and specific sleep problems in a large well-characterized sample of children and adolescents with ASD.
Participants included 1348 children and adolescents (ages 2-18) enrolled in the Autism Speaks Autism Treatment Network (AS ATN) registry database. Primary measures included the Children’s Sleep Habits Questionnaire (CSHQ), Child Behavior Checklist (CBCL), and Short Sensory Profile (SSP).
In bivariate correlations and multivariate path analyses, anxiety was associated with each type of sleep problem examined (i.e., bedtime resistance, sleep onset delay, sleep duration, sleep anxiety, and night awakenings; ranging from p < .01 to p < .001; small to medium effect sizes). Sensory over-responsivity (SOR) was correlated with all sleep problems in bivariate analyses (ranging from p < .01 to p < .001; small effect sizes). In the multivariate path model for older children (ages 6-18), SOR was significantly associated with all sleep problems except night awakenings. In contrast, in the path model for younger children (ages 2-5), SOR was significantly associated with sleep onset delay, night awakenings, and sleep duration, but not bedtime resistance or sleep anxiety.
The purpose of this study was to examine the relationships among three common co-occurring problems for children with ASD: sleep problems, sensory problems, and anxiety. Despite evidence to suggest that these three conditions may be highly related, this was the first study to examine their interrelations in children with ASD. Consistent with our predictions, the results indicate that children with ASD who have anxiety and SOR may be particularly predisposed to sleep problems. These data provide support for the idea that sleep problems in many children with ASD may be due to arousal dysregulation, and that hyperarousal may represent a shared underlying mechanism. Future research using physiological measures of arousal and objective measures of sleep are needed. Longitudinal studies would also be helpful to identify patterns of sleep, anxiety, and sensory problems over time.
This research was supported by Autism Speaks and cooperative agreement UA3 MC 11054 through the U.S. Department of Health and Human Services, Health Resources and Services Administration, Maternal and Child Health Research Program, to the Massachusetts General Hospital. The work was conducted through the Autism Speaks Autism Treatment Network. The views expressed in this publication do not necessarily reflect the views of Autism Speaks, Inc. The authors acknowledge the members of the AS ATN for use of the data.