A Brief Behavioral Sleep Intervention Improves Sleep and Irritability in Adolescents with Autism Spectrum Disorders

Background: Sleep problems affect many individuals with autism spectrum disorders (ASD). The majority of studies of sleep problems in ASD have focused on young children, with less understood about the treatment of sleep problems in adolescents with ASD. Treatment of sleep problems with medications is not always successful and often has negative side effects. Behavioral treatment of sleep concerns for adolescents with ASD is an understudied area with many potential benefits regarding its use. In this study, we are assessing the impact of a brief individual education-based program on nighttime sleep and daytime functioning for adolescents with ASD.  

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

Methods: The program consists of 2 individual education sessions with a psychologist, the adolescent, and the adolescent’s parent, followed by 2 follow-up phone calls. These sessions focus on components of successful sleep that we documented to improve sleep in 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 to utilize at sleep onset and during night wakings. The adolescent participant wears an actigraphy device to provide objective data concerning their pre- and post-program sleep. The parent and adolescent also complete pre- and post-program self-report measures to assess various aspects of sleep and daytime behavior.

Preliminary results from 11 completers of this program ages 13-18 years are presented here with a focus on 2 measures. One is the Adolescent Sleep Wake Scale (ASWS) used as a parent report measure of sleep along 5 behavioral dimensions: going to bed, falling asleep, maintaining sleep, reinitiating sleep, and returning to wakefulness (morning awakening). The other is the Aberrant Behavior Checklist (ABC), focusing specifically on its Irritability subscale, as this has been a frequently used outcome measure of daytime behavior in previous ASD research.

Results: The average age of the completers was 15.18 years old (SD=1.99). In our parent report of the ASWS, a statistically significant improvement in total score was seen with treatment (p=.003; Wilcoxon Signed Rank Test). Improvement on the ASWS was correlated with improvement on the ABC (r = 0.81; p < 0.0001; Spearman correlation coefficient).

Conclusions: Through this brief format of behavioral sleep education, statistically significant improvements were detected in reported overall sleep behaviors. Overall parent-reported improvements in sleep also strongly correlated with improvements of parent-reported irritability. Our work offers promising initial results in improving sleep and subsequent daytime behavior for adolescents with ASD.