Sleep Disturbance and Aggression in Children with Autism Spectrum Disorder : An Autism Speaks Autism Treatment Network Analysis

Background: Autism Spectrum Disorders are defined by impairments in behavior, communication, and social skills that initially appear in childhood. Children and Youth with Autism Spectrum Disorders (CYASD) frequently experience sleep disturbances, with bedtime resistance being especially problematic. Recent studies show that children with autism and sleep disturbances have worse adaptive skill development and greater behavior difficulties than children with autism without sleep difficulties. In addition, children with autism with more severe core symptoms were more likely to have increased sleep problems.

Objectives:  1) Examine the prevalence of sleep problems and aggression in CYASD. 2) Examine relationship link between sleep disturbances and behavior problems in CYASD.

Methods: Data was analyzed from 100 CYASD diagnosed with autism during the calendar year 2012-2013. All patients analyzed received diagnosis and care at an Autism Speaks Autism Treatment Network Center of Excellence, affiliated with an academic medical center. Demographic information and specific variables were analyzed including mood lability, sleep quality, aggression, communication skills and IQ. Behavioral and mood items were measured via parent/legal guardian reporting.

Results: Sleep disturbances were reported in 56% of patients; of these, 64.3% experienced symptoms of aggression, and 98.2% experienced mood lability. Of the 44% of patients who did not experience sleep disturbances, only 31.8% of patients had aggression and 90.9% experienced mood lability. The mean difference in IQ between those with and without sleep disturbances was only 4.3 points.

Conclusions: CYASD have a high prevalence of sleep disturbance, yet the behavioral manifestations of sleep disturbance are not well elucidated. This study supports previous findings of mood lability in CYASD and further delineates marked aggression in this subset of CYASD. Currently, sleep disturbances are an underrecognized co-occurring condition in CYASD.  Care for CYASD is multifaceted and complex including social, emotional, behavioral and medical treatments. Findings from this study support the need for increased awareness and assessment of sleep concerns in CYASD to maximize understanding of behaviors and inform treatment planning.   Larger studies looking at the correlation between sleep and aggressive behaviors will be an important next step.