A Brief Behavioral Sleep Intervention Improves Sleep Onset Delay and Sleep Efficiency in Adolescents with Autism Spectrum Disorders

Background: Sleep problems affect many individuals with autism spectrum disorders (ASD). Many studies of sleep problems in ASD have focused on young children, with less understood about the treatment of sleep problems in adolescents with ASD. Treatment of sleep problems with medications is not always successful and often has negative side effects. Behavioral treatment of sleep concerns for adolescents with ASD is an understudied area with many potential benefits regarding its use. In this study, we are assessing the impact of an education-based program on nighttime sleep and daytime functioning for adolescents with ASD.  

Objectives: Objectives of this study are to: 1) develop a manualized education program for adolescents with ASD and their parents and 2) assess the impact of this program on nighttime sleep and daytime functioning for adolescents with ASD. 

Methods: We delivered a brief sleep intervention to 20 adolescents, ages 11-18 years, and their parents. Adolescents had sleep onset delay and/or night wakings as measured by actigraphy. The program consisted of 2 education sessions with a psychologist, the adolescent, and his/her parent, followed by 2 follow-up phone calls. These sessions focus on previously researched components of successful sleep, including daytime habits, bedtime routines, sleep timing, and sleep environment as well as the addition of strategies related to relaxation and distraction. Actigraphy provided objective data concerning the adolescent’s pre- and post-program sleep. The parent and adolescent also completed pre- and post-program self-report measures. Final study results are presented here from actigraphy, parent and adolescent sleep measures, and satisfaction measures. The sleep measures include parent and adolescent report of the Adolescent Sleep Wake Scale (ASWS), Adolescent Sleep Hygiene Scale (ASHS), and Modified Epworth Sleepiness Scale (M-ESS).

Results: Of those enrolled, 63% were male and 22.2% were female. The average age was 14.77 years (SD=1.769), the average full scale cognitive score was 102.48 (SD=14.65), and the average ADOS-2 calibrated severity score was 7.33 (SD=2.176). Through actigraphy, significant improvement was observed in sleep latency (p=0.007) and sleep efficiency following treatment (p=0.030). In both parent and adolescent report of the ASWS, a significant improvement was seen with treatment in total score (p<0.001 and p=0.006) and all subscales. In both parent and adolescent report of the ASHS, a significant improvement was seen in total score (p<0.001) and 4 of 5 subscales. A significant improvement in total score was seen in adolescent report of the M-ESS (p=0.002), but not parent report. 50% of the sample was able to be contacted 3 months following completion of the study and gains were maintained for all contacted based on parent and/or adolescent report. Parents reported high satisfaction and were able to implement session recommendations at a high rate of understanding and comfort level. 

Conclusions: Through this brief format of behavioral sleep education, significant improvements were detected in reported overall sleep behaviors and objectives measures of sleep latency and efficiency. These findings offer promising results in improving sleep for adolescents with ASD through a brief intervention.