Bridging the Gap: Primary Care Physician Self-Efficacy in Assessing and Treating Sleep Problems in Children with ASD

Background:  Children with autism spectrum disorder (ASD) are at increased risk for sleep disturbances compared to children with typical development (TD). Sleep disturbances in children with ASD have traditionally been treated by sleep specialists. However, given that sleep specialists are limited in number and that the reported prevalence of ASD has risen in recent years, an increasing number of children with ASD must receive treatment for sleep problems from primary care physicians (PCPs). Insofar as recent evidence suggests that PCPs feel generally less efficacious in treating children with ASD compared to children with TD, it stands to reason that PCPs might also feel ill equipped to treat sleep disturbances in children with ASD.

Objectives:  1) To examine differences in PCP self-efficacy in addressing and treating sleep disturbances in children with ASD compared to children with TD. 2)To examine whether low perceived knowledge among PCPs is associated with reduced comfort in treating sleep problems in children with ASD.

Methods:  General pediatricians (n = 52) and family physicians (n = 23) across Missouri completed an online questionnaire assessing: 1) knowledge and comfort in managing sleep concerns among individuals with ASD and TD, 2) factors affecting ability to address sleep concerns, 3) knowledge of specific sleep interventions, 4) educational topics useful for practice, and 5) preferences for sleep education. Comfort composite scores were determined using a scale from 1 [Not Comfortable] to 4 [Very Comfortable].

Results:  PCPs feel markedly less comfortable in treating sleep problems in children with ASD (M = 2.40; SD = 0.83) compared to TD children (M = 3.22; SD = 0.61), d = 1.10, with 95% confidence interval [0.82, 1.41]. A lack of perceived knowledge about treating and assessing sleep problems in children with ASD was associated with less comfort in treating sleep problems in this group (r= .76 [.67, .85]). A majority of PCPs want to increase their knowledge of disordered sleep (93%) and medical conditions in children with ASD (91%).

Conclusions:  Although PCPs want to address sleep disturbances in children with ASD, a lack of knowledge in this domain limits their comfort in effectively doing so. In a time of subspecialty shortage to diagnosis and treat ASD, it is imperative that PCPs bridge the gap between their desire to help and their expertise. This study supports increasing outreach efforts to PCPs to build capacity for community-based care.