Weighted Blankets and Sleep in Autistic Children—A Randomized Controlled Trial

Abstract

WHAT'S KNOWN ON THIS SUBJECT: Children with autism sleep poorly compared with their peers. Sensory integration, including use of weighted blankets, is proposed as a means to reduce arousal and stress. There is, however, no evidence that weighted blankets can improve sleep for these children. WHAT THIS STUDY ADDS:This is the first robust study to evaluate the impact of weighted blankets and show that they do not improve sleep parameters in children with autism spectrum disorder. abstract OBJECTIVE: To assess the effectiveness of a weighted-blanket intervention in treating severe sleep problems in children with autism spectrum disorder (ASD).METHODS: This phase III trial was a randomized, placebo-controlled crossover design. Participants were aged between 5 years and 16 years 10 months, with a confirmed ASD diagnosis and severe sleep problems, refractory to community-based interventions. The interventions were either a commercially available weighted blanket or otherwise identical usual weight blanket (control), introduced at bedtime; each was used for a 2-week period before crossover to the other blanket. Primary outcome was total sleep time (TST) recorded by actigraphy over each 2-week period. Secondary outcomes included actigraphically recorded sleeponset latency, sleep efficiency, assessments of child behavior, family functioning, and adverse events. Sleep was also measured by using parent-report diaries.RESULTS: Seventy-three children were randomized and analysis conducted on 67 children who completed the study. Using objective measures, the weighted blanket, compared with the control blanket, did not increase TST as measured by actigraphy and adjusted for baseline TST. There were no group differences in any other objective or subjective measure of sleep, including behavioral outcomes. On subjective preference measures, parents and children favored the weighted blanket. CONCLUSIONS:The use of a weighted blanket did not help children with ASD sleep for a longer period of time, fall asleep significantly faster, or wake less often. However, the weighted blanket was favored by children and parents, and blankets were well tolerated over this period. Pediatrics 2014;134:298-306

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.…”

“…Two RCTs and four before‐and‐after studies evaluated other types of non‐pharmacological intervention (Tables and ) …”

Sleep in children with neurodevelopmental difficulties

“…We know there is a high heritability for polymorphisms in the melatonin synthesis pathway (N‐acetyl serotonin and acetylserotonin O‐methyltransferase), which may influence the sleep cycles in these children . There is good evidence that weighted blankets do not improve sleep onset or total sleep time in children with ASD …”

Sleep in Neurodevelopmental Disorders

“…Several studies have substantiated parent-reported sleep problem reports using more objective measures of actigraphy and PSG (Goldman, Richdale, et al, 2012; Malow et al, 2006; Wiggs & Stores, 2004). However, several studies also note parent reports of sleep problems are higher than those specified using behavioral criteria (Goodlin-Jones et al, 2009; Gringras et al, 2014; Schreck & Mulick, 2000). For example, in a study of young children with ASD, other (non-ASD) developmental disabilities (DD), and no known diagnosis, Goodlin-Jones and colleagues reported elevated sleep problems via parent report in both the DD and ASD groups but only found elevated behaviorally defined sleep problems (e.g., frequent night awakenings) in the DD group (Goodlin-Jones, Tang, Liu, & Anders, 2009).…”