Maternal Depressive Symptoms and Child Sleep Quality in Young Children with ASD

Background:  Parents of children with ASD are at increased risk for poor psychological well-being (Montes & Haltermann, 2007).  Potential sources of maternal depressive symptoms include maternal and child factors especially disrupted child sleep (Hodge et al., 2013).  77.2%-80.9% (Mannion et al., 2013; Rzepecka et al., 2011) of children with ASD demonstrate comorbid sleep problems.  Limited studies have explored links between maternal well-being and child sleep quality.

Objectives:  To examine the associations between maternal depressive symptoms and (1) child sleep quality, (2) child adaptive behavior, (3) maternal sleep quality, (4) maternal global self-rated health among mothers of young children with ASD.

Methods:  Participants were 72 toddlers with ASD (24-39 months; 75% male) and their mothers (22-53 years; 54% Caucasian).  Maternal depressive symptoms were assessed using an adapted version of the Patient Health Questionnaire (PHQ-9; Kroenke & Spitzer, 2002).   Children’s sleep quality was assessed using the Children’s Sleep Habits Questionnaire (CSHQ; Owens et al., 2000), which consists of seven subscales:  (1) bedtime resistance, (2) sleep onset delay, (3) sleep duration, (4) sleep anxiety, (5) night wakings, (6) parasomnias, (7) sleep disordered breathing, and (8) daytime sleepiness.  Children’s adaptive behavior was measured using the Vineland Adaptive Behavior Scales (Sparrow et al., 2005).  Maternal sleep quality was assessed using a single item from the PHQ-9.  Maternal global self-rated health was evaluated using a single-item on a four-point scale (Surkan et al., 2009).     

Results:  Maternal reports of greater depressive symptoms were significantly linked to (1) shorter child sleep onset delay (r=-.203, p=.044), (2) poorer child sleep duration (r=.418, p<.001), (3) greater child sleep anxiety (r=.272, p=.011), (4) greater child night wakings (r=.372, p=.001), (5) greater child parasomnias (r=.387, p<.001), (6) greater child daytime sleepiness (r=.399, p<.001), (7) poorer child adaptive functioning (r=-.367, p=.001), (8) poorer maternal reports of sleep quality (r=.600, p<.001), and (9) poorer maternal reports of global self-rated health (r=-.383, p<.001).  A regression analysis was used to examine the variance in maternal depressive symptoms accounted for by child sleep quality, child adaptive functioning, maternal sleep quality, and maternal global self-rated health.  The four most strongly related child sleep quality subscales (i.e., sleep duration, night wakings, parasomnias, and daytime sleepiness) were selected for inclusion in the model predicting maternal depressive symptoms because of the limited sample size.  The overall model predicted 52% of the variance in maternal depressive symptoms, F(7,64)=9.95, p<.001. Within the model, only child daytime sleepiness (β=.20 indicated a small effect) was significantly related to maternal depressive symptoms after adjusting for the other variables in the equation.

Conclusions:  This study extends previous work examining the links between maternal well-being and child sleep quality among children with ASD (Hodge et al., 2013).  Bivariate analyses indicated significant links between maternal depressive symptoms and child sleep quality; multivariate analyses pointed to toddlers’ daytime sleepiness as an important contributor to maternal depressive symptoms.  By teasing apart specific child sleep factors that may be important for maternal mental health, targeted priorities for behavioral parent training to address sleep disturbances among children with ASD may be empirically-driven.