Telehealth cognitive behavioral therapy for insomnia in children with autism spectrum disorder: A pilot examining feasibility, satisfaction, and preliminary findings

Abstract

Insomnia is common in children with autism. Cognitive behavioral treatment for childhood insomnia may improve sleep and functioning in children with autism and their parents, but delivery involving multiple office visits limits accessibility. This single-arm pilot study tested telehealth delivery of eight-session cognitive behavioral treatment for childhood insomnia in 17 children (6–12 years) with autism spectrum disorder and insomnia and their parent(s). Treatment integrity was assessed each session ( delivery, by therapist; receipt, participant understanding; and enactment, home practice). Treatment satisfaction was assessed after treatment. Children and parents wore actigraphs and completed electronic diaries for 2 weeks, children completed 5-min Holter Monitoring (assessed heart rate variability, physiological arousal indicator), and parents completed Aberrant Behavior Checklist before and after 1 month. Average integrity scores were high (98%, delivery; 93%, receipt; and 82%, enactment). Parents found cognitive behavioral treatment for childhood insomnia helpful, age-appropriate, and autism-friendly. Paired-samples t-tests (family-wise error controlled) indicated telehealth cognitive behavioral treatment for childhood insomnia improved child and parent sleep ( objective and subjective) and functioning (child—decreased irritability, lethargy, stereotypy, hyperactivity; parent—decreased fatigue). At 1 month, inappropriate speech also decreased, but hyperactivity was no longer decreased. Other gains were maintained. Most children demonstrated reduced arousal following treatment. This pilot shows telehealth cognitive behavioral treatment for childhood insomnia is feasible and may improve child and parent sleep, child behavior and arousal, and parent fatigue. A randomized controlled trial of telehealth cognitive behavioral treatment for childhood insomnia for children with autism is needed. Lay abstract Insomnia is common in children with autism. Cognitive behavioral treatment for childhood insomnia (CBT-CI) may improve sleep and functioning in children with autism and their parents, but typical delivery involving multiple office visits can make it difficult for some children to get this treatment. This pilot study tested telehealth delivery of CBT-CI using computers, which allowed children and their parents to get the treatment at home. This pilot shows therapists that parents and children were able to use telehealth CBT-CI to improve child and parent sleep, child behavior and arousal, and parent fatigue. Parents found telehealth CBT-CI helpful, age-appropriate, and autism-friendly. Telehealth CBT-CI holds promise for treating insomnia in school-aged children with autism and deserves further testing.

Telehealth and Autism Prior to and in the Age of COVID-19: A Systematic and Critical Review of the Last Decade

“…Four studies focused on implementing an intervention via telehealth directly with individuals with ASD. The VC platform was either OoVoo (Hepburn et al, 2016) or Zoom Video conferencing (Cihon et al, 2021;Ferguson et al, 2020;McCrae et al, 2020). Two studies utilized telehealth to administer cognitive behavioral therapy directing to children with ASD (Hepburn et al, 2016;McCrae et al, 2020).…”

“…The VC platform was either OoVoo (Hepburn et al, 2016) or Zoom Video conferencing (Cihon et al, 2021;Ferguson et al, 2020;McCrae et al, 2020). Two studies utilized telehealth to administer cognitive behavioral therapy directing to children with ASD (Hepburn et al, 2016;McCrae et al, 2020). The first study delivered a cognitive behavioral intervention (modified version of Face Your Fears: Group Therapy for Managing Anxiety in Children with High Functioning Autism) via VC for 10 sessions to small groups of childparent dyads to address co-occurring anxiety symptoms in ASD (Hepburn et al, 2016;Reaven et al, 2011).…”

“…Parents and youth indicated strong satisfaction with the telehealth delivery method, although technical glitches (e.g., lost connections) were commonly reported (Hepburn et al, 2016). The second study conducted cognitive behavior therapy for childhood insomnia for eight, 50 min sessions with children with ASD and insomnia (McCrae et al, 2020). Children with ASD saw improvements in challenging behaviors and sleep related measures (e.g., time awake from lights out until out of bed) and reported the intervention to be moderately to very helpful (McCrae et al, 2020).…”

“…The second study conducted cognitive behavior therapy for childhood insomnia for eight, 50 min sessions with children with ASD and insomnia (McCrae et al, 2020). Children with ASD saw improvements in challenging behaviors and sleep related measures (e.g., time awake from lights out until out of bed) and reported the intervention to be moderately to very helpful (McCrae et al, 2020). Treatment integrity for both studies was high (Hepburn et al, 2016;McCrae et al, 2020).…”

Autism and physical health across the lifespan

“…Given that sleep problems persist into adolescence and adulthood (Goldman et al, 2011) , it is important for autistic study how to adapt existing evidence-based practices to adolescents and adults given their unique challenges in communication styles, motivation, and other factors, as well as how to maximize dissemination to a wide range of providers. In this issue, McCrae and colleagues (2021) describe an innovative telehealth delivery of an established intervention for sleep, cognitive-behavioral therapy for insomnia (CBT-I). This study is timely given the COVID-19 pandemic, which presents challenges to in-person care.…”