Behavioral parent training to address sleep disturbances in young children with autism spectrum disorder: a pilot trial

Abstract

Objectives A large percentage of children with autism spectrum disorders (ASD) have bedtime and sleep disturbances. However, the treatment of these disturbances has been understudied. The purpose of our study was to develop a manualized behavioral parent training (BPT) program for parents of young children with ASD and sleep disturbances and to test the feasibility, fidelity, and initial efficacy of the treatment in a small randomized controlled trial (RCT). Participants and methods Parents of a sample of 40 young children diagnosed with ASD with an average age of 3.5 years were enrolled in our study. Participants were randomized to either the BPT program group or a comparison group who were given nonsleep-related parent education. Each was individually administered a 5-session program delivered over the 8-week study. Outcome measures of feasibility, fidelity, and efficacy were collected at weeks 4 and 8 after the baseline time point. Children’s sleep was assessed by parent report and objectively by actigraphy. Results Of the 20 participants in each group, data were available for 15 participants randomized to BPT and 18 participants randomized to the comparison condition. Results supported the feasibility of the manualized parent training program and the comparison program. Treatment fidelity was high for both groups. The BPT program group significantly improved more than the comparison group based on the primary sleep outcome of parent report. There were no objective changes in sleep detected by actigraphy. Conclusions Our study is one of few RCTs of a BPT program to specifically target sleep disturbances in a well-characterized sample of young children with ASD and to demonstrate the feasibility of the approach. Initial efficacy favored the BPT program over the comparison group and suggested that this manualized parent training approach is worthy of further examination of the efficacy within a larger RCT.

Non‐pharmacological interventions for non‐respiratory sleep disturbance in children with neurodisabilities: a systematic review

“…All RCTs were assessed as having high risk of bias for most items on the Cochrane Risk of Bias tool because of issues with randomization and incomplete outcome data. We were unable to find a registered protocol for 10 RCTs, and in all RCTs blinded outcome assessment was either not undertaken or it was unclear whether blinding had occurred . However, we do note that the type of interventions and outcomes under investigation make robust, blinded outcome assessment challenging.…”

“…For the RCTs that were comparing parent‐directed interventions in terms of mode of delivery or intensity of support, the evaluation question is different and is concerned with comparing the effectiveness of alternative (in the case of this review, more and less resource intensive) ways of providing an intervention . In three of these trials, no significant differences in outcomes, as assessed by CHSQ scores and/or SOL, were reported.…”

“…In three of these trials, no significant differences in outcomes, as assessed by CHSQ scores and/or SOL, were reported. The remaining trial did not use these outcome measures. Again, we reiterate the caution with which these findings should be treated given the reported issues with study quality, the lack of any replication, and the absence of a rubric by which the clinical significance of observed effects can be judged.…”

Sleep in Neurodevelopmental Disorders

“…Similarly, Schreck and Mulick (2000) found that parents of children with ASD reported comparable amounts of sleep in their children when compared to controls but endorsed higher rates of sleep problems. Additionally, behaviorally focused treatments have been effective in reducing parent reports of sleep problems but these changes did not always coincide with actigraphically-measured changes in sleep behavior (Johnson et al, 2013). …”

Use of Sleep Evaluations and Treatments in Children with Down Syndrome

“…In typically developing children, behavioral sleep intervention has demonstrated efficacy and effectiveness in treating BSD 24,25 . In addition, a number of preliminary small sample studies have demonstrated that behavioral interventions are promising among children with intellectual and developmental disabilities (IDD) 26–28 . To date, however, there is a lack of empirical support for use of behavioral insomnia treatment among children with DS 29–31 .…”