21648
Associations Between Sleep and Behavioral Problems in Children with ASD
Children with autism spectrum disorder (ASD) are at high risk for sleep disturbance. These problems have a significant impact on daytime functioning; however, the relationships between sleep and behavioral dysregulation in children with ASD are not fully understood. This is an important consideration, given that children with ASD experience high rates of behavioral problems, including aggression, irritability, hyperactivity, and inattention. A large body of literature has demonstrated that sleep disturbance is associated with these types of behavior problems in typically developing children. Surprisingly, however, the relationship between specific types of sleep and behavioral problems in children with ASD has received relatively little empirical attention, as noted in a recent review.
Objectives:
The purpose of the current study was to examine the relationships between distinct types of sleep and behavioral problems in children with ASD. The specific behavior problems selected for examination were aggression, irritability/hostility, inattention, and hyperactivity, given their particular clinical relevance in the ASD population. The primary hypothesis was that sleep problems would be associated with daytime behavioral disturbance among children with ASD. The secondary research aim was to identify the specific types of sleep symptoms that were most closely related to each behavioral problem.
Methods:
Participants included 81 children and adolescents with ASD recruited through an interdisciplinary academic medical center. Participants ranged in age from 3 to 19 years (M = 10.3, SD = 3.8), and the majority of children in the study were male (86.4%). All participants had been previously evaluated and diagnosed by an interdisciplinary team, comprised of a physician and psychologist, using standardized diagnostic tools (i.e., ADOS or ADOS-2), cognitive and adaptive skill assessment, and clinical interview. Measures for the current study included selected subscales of the Children’s Sleep Habits Questionnaire, the Children’s Scale for Hostility and Aggression: Reactive/Proactive, and the Vanderbilt Attention Deficit/Hyperactivity Disorder Parent Rating Scale.
Results: In bivariate correlations, sleep problems were associated with all four types of behavior problems of interest, including physical aggression, irritability, inattention, and hyperactivity (p < .05 to p < .001; small to medium effect sizes). Backward stepwise linear regression models revealed that distinct sets of sleep problems predicted each behavior problem, with different combinations of variables accounting for between 22 and 32% of the variance in behavior problems across statistical models. Importantly, the night awakenings score was a significant predictor in three of four models (i.e., physical aggression, inattention, and hyperactivity).
Conclusions:
Sleep disturbance is associated with behavioral dysregulation among children with ASD. Of particular note, night awakenings appear to have the most consistently strong association with daytime behavior problems, even after controlling for the effects of age and sex. Future research is needed to develop more targeted treatments for these conditions and to identify patterns of change over time.