Sensory Processing and Insomnia

Background:  Chronic Insomnia is one of the most common co-occurring conditions in children with ASD. Multiple etiologies have been attributed to insomnia in ASD including sensory over-reactivity and resultant arousal regulation difficulties.  Thus, assessment of sensory reactivity and the development of individually-tailored protocols that address the potential sensory factors that may impact sleep behavior is critical. We have evidence from our recent RCT (Schaaf, et al, in press, J A D D) to show that an individually-tailored, sensory intervention significantly improved functional behaviors (p = .003, d = 1.2) and decreased problem behaviors including sleep problems (Schaaf, et al, 2013).  We apply these principles to the current study to refine the interdisciplinary, home-based intervention protocol for chronic insomnia in ASD.    

Objectives:  1) Understand the role of the sensory-sleep environment as a potential contributor to insomnia; 2) Refine strategies to assess sensory processing and its impact on sleep; 3)  Hone the process utilized to develop individually-tailored intervention strategies targeting the identified sensory contributors to insomnia; 4) Assess the outcome of sensory interventions on sensory domains measured by the sensory profile; and 6) identify the unique role of occupational therapy(OT) on the interdisciplinary team.

Methods: Forty dyads (child with ASD, ages 6-10 + caregiver) will be randomized to standard care (SC; 1 hour ATN sleep tool kit session) or SC plus Tailored Behavioral Intervention (TAB).  To develop the TAB, the team synthesizes all baseline data and identifies each child’s arousal profile based on insomnia, anxiety and sensory sensitivity severity. When sensory processing difficulties are determined to be a factor impacting sleep, the family, guided by a team member, will choose intervention strategies from the “Calming Module”.  These include 1) The Five Senses Awareness Exercise, 2) Gentle Rocking protocol, 3) Taking a Warm Bath; 4) Qigong Massage and/or 5) Yoga Poses.   The intervention is  tailored to the child and sensitive to the families goals, cultural, beliefs, and capabilities. The interventionist (Nurse or Occupational Therapist) delivers the TAB over four weeks with eight (1-2 hr. sessions).  An additional four weeks of phone support or visits are conducted by the team as necessary.  All measures are repeated for both groups at four and eight weeks post intervention. 

Results:  27 dyads have been enrolled thus far.  Our data show that the interdisciplinary team process through case conferencing is effective in identifying specific, home based intervention strategies that match the unique needs of each child and family.  We expect to have outcome data on the 40 dyads and details of the feasibility of implementing a RCT and refining a TAB and SC protocol.

Conclusions: The use of an interdisciplinary team and case conferencing is a valuable strategy to address the multi-factorial factors that may impact sleep in children with ASD and their families. We will present two exemplar cases (single with in case design) to describe the use of sensory interventions to improve sleep.