Associations of Sleep Disturbance and Autism Symptomatology in Children and Adolescents with ASD

Background:  Between 50 and 80% of children and adolescents with Autism Spectrum Disorders (ASD) present with sleep disturbances, compared to just 9-50% of neurotypical and developmentally delayed (without ASD) children, suggesting a fundamental disruption of the sleep system in ASD. Clinicians and researchers often disregard these sleep abnormalities, despite their potential impact on the primary symptoms of ASD and on caregivers. The relationship between sleep difficulties and behavioral habits is likely bidirectional, as lack of sleep fuels daytime irritability, and behavioral problems interfere with a consistent sleep schedule. The resolution of sleep issues may allow for improved outcomes for the core symptoms of ASD.

Objectives:  This study aims to retrospectively assess the association of sleep disturbance in children with autistic symptomatology.

Methods:  Subjects were children and adolescents (N=52) seen in the Yale Developmental Disabilities Clinic. Children aged 3-14 years, with a confirmed diagnosis of autism (ADOS CSS≥4) were included. After excluding children outside the age range or without a confirmed autism diagnosis and those taking sleep medications other than melatonin, the final sample included 21 children; data collection and retrospective analyses of additional historical cases are ongoing. Parents completed a sleep history questionnaire which characterized sleep/wake time and sleep onset latency (SOL) as well as a 40-item Autism Screener Questionnaire, assessing symptoms of autism. T-tests were performed to evaluate the relationship of sleep disturbance and autism symptoms.

Results:  Children aged 3-14 years (N=21) with a diagnosis of autism were stratified into those with (N=16, 76%) and without (N=5) disordered sleep as defined by SOL≥30 minutes. Children with disordered sleep were significantly more likely to have unusual sensory fixations (p<.001).

Conclusions:  In this pilot study of sleep disturbance in a pediatric population with autism, disordered sleep as defined by a sleep onset latency of ≥30 minutes was observed in the majority of children with autism. Results are consistent with previously noted high rates of disordered sleep in autism. Our findings also suggest that disordered sleep is strongly associated with autistic symptomatology, specifically unusual sensory fixations. Future studies should assess sensory issues as a risk factor for sleep disturbance.