Employment Status Is Related to Sleep Problems in Adults with Autism Spectrum Disorder

Background: Sleep problems are commonly reported for individuals with Autism Spectrum Disorder (ASD). While insomnia symptoms are the most frequently reported problems, there is emerging evidence that the timing of sleep is also atypical, with circadian rhythm sleep-wake disorders (CRSWDs) also reported for some individuals with ASD. Research also demonstrates a distinct sub-group of individuals who do not have sleep problems. However, there is very little research that has investigated factors that may be associated with the presence or absence of sleep problems in those with ASD. Comorbid diagnoses of psychopathology disorders (anxiety and depression) as well as employment outcomes may be associated with the presence of sleep problems in adults with ASD. Gaining an understanding of factors that are associated with and without sleep problems, will assist in the development of appropriate prevention and treatment techniques.

Objectives: The aim of this study was to explore factors that may be associated with the presence and absence of an ICSD-3 defined sleep problem in adults with ASD and no comorbid intellectual impairment.

Methods: 36 adults with ASD (47.2% male; M_age = 34.41 years, SD= 6.52) completed a 14-day sleep-wake diary and 14 day actigraphy assessment. All participants had an IQ > 80. Fifteen participants were medicated for a comorbid diagnosis of anxiety and/or depression. Participants also completed a questionnaire battery including the Pittsburgh Sleep Quality Index (PSQI), the State-Trait Anxiety Inventory (STAI), the Patient Health Questionnaire (PHQ-8; depression scale) and a demographic questionnaire.

Results: Based on 14-day sleep-wake diary and actigraphy assessment four adults with ASD met criteria for insomnia, 10 for a CRSWD and six met criteria for both. Demographic variables including FSIQ, age and gender did not differentiate the two groups of adults (Table 1). Consistent with the presence of sleep problems, PSQI scores were higher in the Sleep Problem group. The groups did not differ on their scores on the STAI (t = -0.998, p = .325) and PHQ-8 (t = .019, p = .985). Likewise, there were no differences in the proportion of individuals in each group who were medicated for comorbid diagnoses of anxiety and depression (χ² = .630, p = .427). The Sleep Problem group were more likely to be unemployed compared to adults with no sleep problem (χ² = 12.963, p < .001). In particular, all nine adults who were unemployed met criteria for a sleep problem.

Conclusions: Employment outcomes are frequently reported to be poor in adults with ASD. These poor outcomes have typically been associated with the social deficits those with ASD experience. The findings of this study demonstrate for the first time that sleep problems are associated with unemployment, however the direction of this relationship is unclear. It is possible that sleep problems, particularly CRSWDs that have developed during adolescence make attainment and maintenance of employment for those with ASD difficult, or that a lack of employment results in less restrictions required for optimal and appropriate sleep timing. Longitudinal studies would be beneficial to further explore this relationship.