Behavioural Treatments for Sleep Problems in Children with Autism Spectrum Disorder: a Review of the Recent Literature

Pattison, Emily; Papadopoulos, Nicole; Marks, Deborah; McGillivray, Jane; Rinehart, Nicole

doi:10.1007/s11920-020-01172-1

Cited by 25 publications

(14 citation statements)

References 43 publications

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“…Despite evidence for the broad‐reaching effects of sleep disturbance in ASD summarized in this meta‐analysis, sleep problems remain under‐acknowledged in standard clinical care for autistic individuals, with one report indicating that 71% of autistic children report sleep problems, yet only 30% received a formal sleep‐related diagnosis (Malow et al, 2016). Clinical practice guidelines for treating sleep problems in ASD that include both pharmacological and behavioral treatments are in their inception (Buckley et al, 2020), and development of effective behavioral sleep interventions is ongoing (Pattison et al, 2020). Given that sleep problems were consistently and significantly associated with worse psychological and behavioral outcomes, prioritizing sleep as a principal target for intervention holds promise for improving myriad aspects of daytime functioning and wellbeing (Loring et al, 2018; Malow et al, 2014).…”

Section: Discussionmentioning

confidence: 99%

Associations between sleep problems and domains relevant to daytime functioning and clinical symptomatology in autism: A meta‐analysis

et al. 2022

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Autistic individuals experience significantly higher rates of sleep problems compared to the general population, which negatively impacts various aspects of daytime functioning. The strength of associations across domains of functioning has not yet been summarized across studies. The present meta-analysis examined the strength of associations between sleep problems and various domains of daytime functioning in autistic individuals. Searches were conducted in EMBASE, PubMed, Web of Science, and Google Scholar through May 2020. Inclusion criteria were: an index of sleep disturbance in individuals diagnosed with autism spectrum disorder (ASD); data collected prior to any sleep-related intervention; statistical data indicating relations between sleep problems and outcomes relevant to behavior, cognition, and physical or mental health. Exclusion criteria were: statistics characterizing the relationship between sleep disturbance and outcome variables that partialled out covariates; studies examining correlations between different measures of sleep disturbance. Participants totaled 15,074 from 49 published articles and 51 samples, yielding 209 effect sizes. Sleep problems were significantly associated with more clinical symptomatology and worse daytime functioning. Subgroup analyses demonstrated that sleep problems were most strongly associated with internalizing and externalizing symptoms and executive functioning, followed by core autism symptoms, family factors, and adaptive functioning. Findings highlight the far-reaching consequences of sleep problems on daytime functioning for autistic individuals and support the continued prioritization of sleep as a target for intervention through integrated care models to improve wellbeing. Lay SummaryAutistic individuals experience higher rates of sleep problems, such as difficulty falling asleep and staying asleep, compared to the general population. We quantitatively summarized the literature about how sleep problems are related to different aspects of daytime functioning to identify areas that may be most affected by sleep. Sleep problems were related to all areas assessed, with the strongest associations for mood and anxiety symptoms. We recommend prioritizing sleep health in autistic individuals to improve wellbeing and quality of life.

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Section: Discussionmentioning

confidence: 99%

Associations between sleep problems and domains relevant to daytime functioning and clinical symptomatology in autism: A meta‐analysis

et al. 2022

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“…These connections all illustrate the severity of sleep problems in ASD. There is growing evidence that ASD is associated with arousal dysregulation and sensory hyper-reactivity, and calming strategies may be helpful in improving sleep ( 29 ).…”

Section: Discussionmentioning

confidence: 99%

Analysis of sleep problem in children aged 1–3 years with autism spectrum disorder in Zhejiang province, China

Yao

Wang

et al. 2022

Front. Psychiatry

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BackgroundHigh prevalence of sleep problems have been founded in children with Autism Spectrum Disorder (ASD), with rates ranging from 50 to 80%. We aimed to study the sleep status and the occurrence of sleep problems in children with autism spectrum disorder (ASD) aged 1–3 years, and to provide reference for guiding early comprehensive intervention for ASD children from the perspective of sleep.MethodsFrom January 1 to December 31, 2021, 74 ASD children who met the diagnostic criteria of “Diagnostic and Statistical Manual of Mental Disorders-5 (DSM-V)” served as case group while 84 typically-developing children of the same sex and age served as control group. An original Children's Sleep Habit Questionnaire was adopted to compare the sleep status of children in the two groups and to conduct statistical analysis on related factors.ResultsThe incidence of sleep problems in the case group (78.4%) was significantly higher than that in the control group (34.5%) (P < 0.001). Compared with the children in the control group, children in the case group had later bedtime (P < 0.05) and less sleep duration (P < 0.05), and required longer time to fall asleep (P < 0.001) The incidence of sleep problems in children who could fall asleep autonomously in the case group was significantly lower than that in children who needed parental help (P < 0.05). In the case group, the longer the screen exposure time, the higher the incidence of sleep problems (P < 0.05).ConclusionsThe incidence of sleep problems in ASD children aged 1–3 years is also high, mainly manifested in late bedtime, difficulty falling asleep, frequent night awakenings and less sleep duration. Both sleep patterns and screen exposure can impact their sleep. In the early comprehensive intervention of ASD children, it is necessary to pay full heed to their sleep status and take timely intervention measures in order to improve the quality of life for the ASD children and their families.

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“…The sleep context also poses unique challenges for the treatment of sleep-related stereotypy, including that parents must act (where possible) as primary interventionists within their own home (Hanley et al, 2014;Jin et al, 2013). It is important, therefore, that sleep problems are assessed and addressed in collaboration with parents (Jin et al, 2013;Moes & Frea, 2002;Pattison et al, 2020), and that treatment includes parent education, training, and up-skilling, to help parents to manage sleeprelated behaviors within their own home (Boyd et al, 2012;Haywood & Hill, 2012;Lanovaz et al, 2016;Specht et al, 2017).…”

Section: Discussionmentioning

confidence: 99%

Parent Perceptions of Sleep-Related Stereotypy Within Sleep Problems in Children on the Autism Spectrum: Implications for Behavioral Treatment

Hunter

McLay

France

et al. 2022

Adv Neurodev Disord

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Objectives Sleep problems in children on the autism spectrum may be affected by core diagnostic characteristics, including stereotypy (restricted and repetitive behaviors). Little is known about the nature of sleep-related stereotypy and its role within sleep disturbance. This study aimed to improve our understanding of the types of sleep-related stereotypy, its potential role within sleep difficulties, and how parents manage night-time stereotypy, in children on the autism spectrum. Methods This qualitative study used thematic analysis to analyze clinical assessment reports obtained from 21 parents of children on the autism spectrum referred for behavioral sleep intervention. Five themes, including the types of stereotypy, timing within sleep problems, stereotypy as sleep-interfering, stereotypy as sleep-conducive, and parent-responses, were identified. A clinical case study illustrates the potential role of vocal stereotypy within night wakings, through functional assessment and treatment of sleep problems in a child on the autism spectrum. Results Stereotypy included vocal and motor behaviors and repetitive manipulation of objects. Parents perceived stereotypy as both problematic and as beneficial to sleep, which may differentially affect behavioral treatment. Parent responses to stereotypy were varied and included co-sleeping. The case study highlights the complexity of the sleep and stereotypy relationship and the difficulty in treating automatically maintained behavior in the sleep context. Conclusion The function that stereotypy serves in relation to sleep disturbance is unclear and may differ across and within children. It is important we seek to better understand the specific ways that stereotypy may affect sleep, and vice versa, to improve clinical management of sleep problems in children on the autism spectrum.

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Behavioural Treatments for Sleep Problems in Children with Autism Spectrum Disorder: a Review of the Recent Literature

Cited by 25 publications

References 43 publications

Associations between sleep problems and domains relevant to daytime functioning and clinical symptomatology in autism: A meta‐analysis

Associations between sleep problems and domains relevant to daytime functioning and clinical symptomatology in autism: A meta‐analysis

Analysis of sleep problem in children aged 1–3 years with autism spectrum disorder in Zhejiang province, China

Parent Perceptions of Sleep-Related Stereotypy Within Sleep Problems in Children on the Autism Spectrum: Implications for Behavioral Treatment

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