A Multi-Method Approach to Examining Correlates of Sleep Quality, Individual Well-Being, and Mother-Child Relationship Quality in Adolescents with Autism Spectrum Disorder

Background: Sleep problems are more prevalent among children with ASD--about 50-80% of children with ASD experience sleep problems--relative to their typically developing peers (Goldman et al., 2012). In children with ASD, poor sleep is chronic, often persisting into adolescence (Humphreys et al., 2013). Biological changes associated with adolescence, such as changing sleep architecture and circadian rhythms, can exacerbate sleep issues, as has been found among individuals without ASD (Colrain & Baker, 2011). Because of this, adolescents with ASD with poor sleep quality may experience more intense and/or more frequent sleep problems, which may compromise daytime functioning. Previous research examining sleep quality among children with ASD has relied on parent reports. Recent work has extended the measurement of sleep quality to include self-reports by adolescents with ASD; this approach has verified that adolescents with ASD experience greater sleep problems relative to their peers without ASD (Baker et al., 2013). The current study extends the literature by examining emotional, behavioral, and social correlates of objective sleep quality among adolescents with ASD. 

Objectives:  To examine associations between objective reports of sleep quality and well-being in adolescents with ASD, namely psychological well-being, adaptive functioning, and mother-child relationship quality. 

Methods:  Participants were 18 adolescents with ASD and their mothers. After confirming clinical reports of ASD using the ADOS-2 (Lord et al., 2000), adolescents used pre-programmed iPads to report on their psychological well-being. Mothers also completed measures reporting on their child’s developmental history, including ASD symptomology and adaptive functioning. Participants were then instructed in the use of a MicroMini Motionlogger actigraph, which collected objective sleep data for 7 consecutive nights. Adolescents were also provided with a Smartphone, which contained an “app” that kept logs of entered sleep/wake times over the 7 days. The app also recorded adolescents’ daily reports of closeness and discord in their daily interactions with their mothers. 

Results:  Spearman correlations were conducted to examine associations between sleep quality as measured by actigraphy and adolescent psychological well-being and adaptive functioning. More nocturnal wakefulness and disturbed sleep were associated with poorer adolescent well-being, including greater maladaptive behaviors and ASD severity, as well as more depressive symptoms and more loneliness with family members (Table 1). Correlations conducted between sleep quality and mother-child relationship quality found that adolescents who took longer to fall asleep reported feeling closer to their mothers but those adolescents with more night wakings felt less close to their mothers (Table 2). Together, these data suggest that disrupted sleep as measured by actigraphy is associated with adolescents’ well-being and ability to function adaptively in expected ways but associations between sleep quality and mother-adolescent closeness are more complex.

Conclusions:  

The current study showed the utility of using actigraphs and modern technology (e.g. Smartphones and iPads) for assessments conducted with adolescents with ASD. Although results are correlational and direction cannot be ascertained, they suggest a need for interventions to remediate sleep issues in adolescents with ASD.