Abstract
Sleep problems of varying kind and severity, including both insomnias and parasomnias, are a commonly reported clinical problem among children and adolescents with autism spectrum disorder (ASD) and, it is estimated that approximately 50–80% of children with ASD and their families are affected by such problems. Without effective treatment, these sleep problems are likely to persist and can result in adverse long-term effects for the child and other family members. Despite the higher prevalence of sleep problems in individuals with ASD, little is known about the interaction between the type of sleep problems and the impact they have on the individual and their families. The purpose of this study was to examine the types of sleep problems reported by parents of children with ASD and their secondary impact. Specifically, using data from a survey of families with a child with ASD we classified the types of sleep problems reported and examined correlations between these sleep problems and reported effects on the individual and their family. Data from 244 children with ASD were reported to experience various types of sleep problems, particularly insomnia and bedtime resistance. Further, the findings confirm the far reaching adverse effects of sleep problems on child and family wellbeing. The implications of these findings and future research directions are discussed.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Adams, H., Matson, J. L., Cervantes, P., & Goldin, R. (2014). The relationship between autism symptom severity and sleep problems: Should bi-directionality be considered? Research in Autism Spectrum Disorders, 8, 193–199. https://doi.org/10.1016/j.rasd.2013.11.008.
Boergers, J., Hart, C., Owens, J. A., Streisand, R., & Spirito, A. (2007). Child sleep disorders: Associations with parental sleep duration and daytime sleepiness. Journal of Family Psychology, 21, 88–94. https://doi.org/10.1037/0893-3200.21.1.88.
Carnett, A., Hansen, S., McLay, L., Neely, L., & Lang, R. (2020). Quantitative-analysis of behavioral interventions to treat sleep problems in children with autism. Developmental Neurorehabilitation, 23(5), 271–284. https://doi.org/10.1080/17518423.2019.1646340.
Christodulu, K. V., & Durand, V. M. (2004). Reducing bedtime disturbance and night waking using positive bedtime routines and sleep restriction. Focus on Autism and Other Developmental Disabilities, 19, 130–139. https://doi.org/10.1177/10883576040190030101.
Chu, J., & Richdale, A. L. (2009). Sleep quality and psychological wellbeing in mothers of children with developmental disabilities. Research in Developmental Disabilities, 30, 1512–1522. https://doi.org/10.1016/j.ridd.2009.07.007.
Cohen, S., Conduit, R., Lockley, S. W., Rajaratnam, S. M. W., & Cornish, K. M. (2014). The relationship between sleep and behavior in autism spectrum disorder (ASD): A review. Journal of Neurodevelopmental Disorders, 6, 1–10.
Cortesi, F., Giannotti, F., Ivanenko, A., & Johnson, K. (2010). Sleep in children with autistic spectrum disorder. Sleep Medicine, 11, 659–664. https://doi.org/10.1016/j.sleep.2010.01.010.
Couturier, J. L., Speechley, K. N., Steele, M., Norman, R., Stringer, B., & Nicolson, R. (2005). Parental perception of sleep problems in children of normal intelligence with pervasive developmental disorders: Prevalence, severity, and pattern. Journal of the American Academy of Child & Adolescent Psychiatry, 44, 815–822. https://doi.org/10.1097/01.chi.0000166377.22651.87.
Davis, N. O., & Carter, A. S. (2008). Parenting stress in mothers and fathers of toddlers with autism spectrum disorders: Associations with child characteristics. Journal of Autism and Developmental Disorders, 38, 1278–1291. https://doi.org/10.1007/s10803-007-0512-z.
DeLeon, I. G., Fisher, W. W., & Marhefka, J.-M. (2004). Decreasing self-injurious behavior associated with awakening in a child with autism and developmental delays. Behavioral Interventions, 19, 111–119. https://doi.org/10.1002/bin.154.
DeVincent, C. J., Gadow, K. D., Delosh, D., & Geller, L. (2007). Sleep disturbance and its relation to dsm-iv psychiatric symptoms in preschool-age children with pervasive developmental disorder and community controls. Journal of Child Neurology, 22, 161–169. https://doi.org/10.1177/0883073807300310.
Doo, S., & Wing, Y. K. (2006). Sleep problems of children with pervasive developmental disorders: Correlation with parental stress. Developmental Medicine and Child Neurology, 48, 650–655. https://doi.org/10.1111/j.1469-8749.2006.tb01334.x.
Foody, C., James, J. E., & Leader, G. (2015). Parenting stress, salivary biomarkers, and ambulatory blood pressure: A comparison between mothers and fathers of children with autism spectrum disorders. Journal of Autism and Developmental Disorders, 45, 1084–1095. https://doi.org/10.1007/s10803-014-2263-y.
Giallo, R., Wood, C. E., Jellett, R., & Porter, R. (2011). Fatigue, wellbeing and parental self-efficacy in mothers of children with an autism spectrum disorder. Autism, 17, 465–480. https://doi.org/10.1177/1362361311416830.
Goldman, S. E., Surdyka, K., Cuevas, R., Adkins, K., Wang, L., & Malow, B. A. (2009). Defining the sleep phenotype in children with autism. Developmental Neuropsychology, 34, 560–573. https://doi.org/10.1080/87565640903133509.
Goldman, S. E., McGrew, S., Johnson, K. P., Richdale, A. L., Clemons, T., & Malow, B. A. (2011). Sleep is associated with problem behaviors in children and adolescents with autism spectrum disorders. Research in Autism Spectrum Disorders, 5, 1223–1229. https://doi.org/10.1016/j.rasd.2011.01.010.
Hodge, D., Hoffman, C. D., Sweeney, D. P., & Riggs, M. L. (2013). Relationship between children's sleep and mental health in mothers of children with and without autism. Journal of Autism and Developmental Disorders, 43, 956. https://doi.org/10.1007/s10803-012-1639-0.
Hodge, D., Carollo, T. M., Lewin, M., Hoffman, C. D., & Sweeney, D. P. (2014). Sleep patterns in children with and without autism spectrum disorders: Developmental comparisons. Research in Developmental Disabilities, 35, 1631–1638. https://doi.org/10.1016/j.ridd.2014.03.037.
Hoffman, C. D., Sweeney, D. P., Gilliam, J. E., Apodaca, D. D., Lopez-Wagner, M. C., & Castillo, M. M. (2005). Sleep problems and symptomology in children with autism. Focus on Autism and Other Developmental Disabilities, 20, 194–200. https://doi.org/10.1177/10883576050200040101.
Hoffman, C. D., Sweeney, D. P., Gilliam, J. E., & Lopez-Wagner, M. C. (2006). Sleep problems in children with autism and in typically developing children. Focus on Autism and Other Developmental Disabilities, 21, 146–152. https://doi.org/10.1177/10883576060210030301.
Hoffman, C. D., Sweeney, D. P., Lopez-Wagner, M. C., Hodge, D., Nam, C. Y., & Botts, B. H. (2008). Children with autism: Sleep problems and mothers' stress. Focus on Autism and Other Developmental Disabilities, 23, 155–165. https://doi.org/10.1177/1088357608316271.
Hollway, J. A., & Aman, M. G. (2011). Sleep correlates of pervasive developmental disorders: A review of the literature. Research in Developmental Disabilities, 32, 1399–1421. https://doi.org/10.1016/j.ridd.2011.04.001.
Hollway, J. A., Aman, M. G., & Butter, E. (2013). Correlates and risk markers for sleep disturbance in participants of the autism treatment network. Journal of Autism and Developmental Disorders, 43, 2830–2843. https://doi.org/10.1007/s10803-013-1830-y.
Hundley, R. J., Shui, A., & Malow, B. A. (2016). Relationship between subtypes of restricted and repetitive behaviors and sleep disturbance in autism spectrum disorder. Journal of Autism and Developmental Disorders, 46, 3448–3457. https://doi.org/10.1007/s10803-016-2884-4.
IBM, C. R. (2017). IBM SPSS statistics for windows, version 25 (p. 0). IBM Corp: Armonk, NY.
Jin, C. S., Hanley, G. P., & Beaulieu, L. (2013). An individualized and comprehensive approach to treating sleep problems in young children. Journal of Applied Behavior Analysis, 46, 161. https://doi.org/10.1002/jaba.16.
Keenan, R. A., Wild, M. R., McArthur, I., & Espie, C. A. (2007). Children with developmental disabilities and sleep problems: Parental beliefs and treatment acceptability. Journal of Applied Research in Intellectual Disabilities, 20, 455–465. https://doi.org/10.1111/j.14683148.2007.00382.x.
Krakowiak, P., Goodlin-Jones, B., Hertz-Picciotto, I., Croen, L. A., & Hansen, R. L. (2008). Sleep problems in children with autism spectrum disorders, developmental delays, and typical development: A population-based study. Journal of Sleep Research, 17, 197–206. https://doi.org/10.1111/j.1365-2869.2008.00650.x.
Liu, X., Hubbard, J. A., Fabes, R. A., & Adam, J. B. (2006). Sleep disturbances and correlates of children with autism spectrum disorders. Child Psychiatry and Human Development, 37, 179–191. https://doi.org/10.1007/s10578-006-0028-3.
Lopez-Wagner, M. C., Hoffman, C. D., Sweeney, D. P., Hodge, D., & Gilliam, J. E. (2008). Sleep problems of parents of typically developing children and parents of children with autism. The Journal of Genetic Psychology, 169, 245–259. https://doi.org/10.3200/gntp.169.3.245260.
Malow, B., Marzec, M., McGrew, S., Wang, L., Henderson, L., & Stone, W. (2006). Characterizing sleep in children with autism spectrum disorders: A multi-dimensional approach. Sleep, 29, 1563–1571. https://doi.org/10.1093/sleep/29.12.1563.
Mazurek, M. O., & Petroski, G. F. (2015). Sleep problems in children with autism spectrum disorder: Examining the contributions of sensory over-responsivity and anxiety. Sleep Medicine, 16, 270–279. https://doi.org/10.1016/j.sleep.2014.11.006.
McLay, L., France, K., Blampied, N., & Hunter, J. (2017). Using functional behavioral assessment to treat sleep problems in two children with autism and vocal stereotypy. International Journal of Developmental Disabilities, 16, 254–270. https://doi.org/10.1080/20473869.2017.1376411.
McLay, L., Hansen, S. G., Carnett, A., France, K. G., & Blampied, N. M. (2020). Attributions, causal beliefs, and help-seeking behavior of parents of children with autism spectrum disorder and sleep problems. Autism. https://doi.org/10.1177/1362361320924216.
Meltzer, L. J. (2008). Brief report: Sleep in parents of children with autism spectrum disorders. Journal of Pediatric Psychology, 33, 380–386. https://doi.org/10.1093/jpepsy/jsn005.
Meltzer, L. J. (2011). Factors associated with depressive symptoms in parents of children with autism spectrum disorders. Research in Autism Spectrum Disorders, 5(1), 361–367. https://doi.org/10.1016/j.rasd.2010.05.001.
Meltzer, L. J., & Mindell, J. A. (2007). The relationship between child sleep disturbances and maternal sleep, mood, and parenting stress: A pilot study. Journal of Family Psychology, 21, 67–73. https://doi.org/10.1037/0893-3200.21.1.67.
Meltzer, L. J., & Montgomery-Downs, H. E. (2011). Sleep in the family. Pediatric Clinics, 58(3), 765–774.
Miano, S., Bruni, O., Elia, M., Trovato, A., Smerieri, A., Verrillo, E., & Ferri, R. (2007). Sleep in children with autistic spectrum disorder: A questionnaire and polysomnographic study. Sleep Medicine, 9, 64–70. https://doi.org/10.1016/j.sleep.2007.01.014.
Paavonen, E. J., Nieminen-von Wendt, T., Vanhala, R., Aronen, E. T., & Von Wendt, L. (2003). Effectiveness of melatonin in the treatment of sleep disturbances in children with asperger disorder. Journal of Child and Adolescent Psychopharmacology, 13, 83–95. https://doi.org/10.1089/104454603321666225.
Park, S., Cho, S.-C., Cho, I. H., Kim, B.-N., Kim, J.-W., Shin, M.-S., . . . Yoo, H. J. (2012). Sleep problems and their correlates and comorbid psychopathology of children with autism spectrum disorders. Research in Autism Spectrum Disorders, 6, 1068–1072. https://doi.org/10.1016/j.rasd.2012.02.004.
Peters-Scheffer, N., Didden, R., & Korzilius, H. (2012). Maternal stress predicted by characteristics of children with autism spectrum disorder and intellectual disability. Research in Autism Spectrum Disorders, 6, 696–706. https://doi.org/10.1016/j.rasd.2011.10.003.
Richdale, A. L. (2001). Sleep in children with autism and asperger syndrome. In G. Stores & L. Wiggs (Eds.), Sleep disturbance in children and adolescents with disorders of development: Its significance and management (pp. 181–191). London: MacKeith Press.
Richdale, A. L., & Schreck, K. A. (2009). Sleep problems in autism spectrum disorders: Prevalence, nature, & possible biopsychosocial aetiologies. Sleep Medicine Reviews, 13, 403–411. https://doi.org/10.1016/j.smrv.2009.02.003.
Robinson, A. M., & Richdale, A. L. (2004). Sleep problems in children with an intellectual disability: Parental perceptions of sleep problems, and views of treatment effectiveness. Child: Care, Health and Development, 30, 139–150. https://doi.org/10.1111/j.1365-2214.2004.00395.x.
Rzepecka, H., McKenzie, K., McClure, I., & Murphy, S. (2011). Sleep, anxiety and challenging behaviour in children with intellectual disability and/or autism spectrum disorder. Research in Developmental Disabilities, 32, 2758–2766. https://doi.org/10.1016/j.ridd.2011.05.034.
Schreck, K., Mulick, J. A., & Smith, A. F. (2004). Sleep problems as possible predictors of intensified symptoms of autism. Research in Developmental Disabilities, 25, 57–66. https://doi.org/10.1016/j.ridd.2003.04.007.
Schwichtenberg, A. J., Young, G. S., Hutman, T., Iosif, A. M., Sigman, M., Rogers, S. J., & Ozonoff, S. (2013). Behavior and sleep problems in children with a family history of autism. Autism Research, 6, 169–176. https://doi.org/10.1002/aur.1278.
Sikora, D. M., Johnson, K., Clemons, T., & Katz, T. (2012). The relationship between sleep problems and daytime behavior in children of different ages with autism spectrum disorders. Pediatrics, 130, 83–90. https://doi.org/10.1542/peds.2012-0900f.
Singh, K., & Zimmerman, A. W. (2015). Sleep in autism spectrum disorder and attention deficit hyperactivity disorder. Seminars in Pediatric Neurology, 22, 113–125. https://doi.org/10.1016/j.spen.2015.03.006.
Stores, G., & Wiggs, L. (1998). Clinical services for sleep disorders. Archives of Disease in Childhood, 79, 495–497. https://doi.org/10.1093/sleep/20.10.829.
Taylor, M. A., Schreck, K. A., & Mulick, J. A. (2012). Sleep disruption as a correlate to cognitive and adaptive behavior problems in autism spectrum disorders. Research in Developmental Disabilities, 33, 1408–1417. https://doi.org/10.1016/j.ridd.2012.03.013.
Tilford, J. M., Payakachat, N., Kuhlthau, K. A., Pyne, J. M., Kovacs, E., Bellando, J., . . . Frye, R. E. (2015). Treatment for sleep problems in children with autism and caregiver spillover effects. Journal of Autism and Developmental Disorders, 45, 3613–3623. https://doi.org/10.1007/s10803-015-2507-5.
Tudor, M. E., Hoffman, C. D., & Sweeney, D. P. (2012). Children with autism: Sleep problems and symptom severity. Focus on Autism and Other Developmental Disabilities, 27, 254–262. https://doi.org/10.1177/1088357612457989.
Wiggs, L., & Stores, G. (2001). Behavioural treatment for sleep problems in children with severe intellectual disabilities and daytime challenging behaviour: Effect on mothers and fathers. British Journal of Health Psychology, 6, 257–269. https://doi.org/10.1348/135910701169197.
Wiggs, L., & Stores, G. (2004). Sleep patterns and sleep disorders in children with autistic spectrum disorders: Insights using parent report and actigraphy. Developmental Medicine and Child Neurology, 46, 372–380. https://doi.org/10.1017/s0012162204000611.
Williams, P. G., Sears, L. L., & Allard, A. (2004). Sleep problems in children with autism. Journal of Sleep Research, 13, 265–268. https://doi.org/10.1111/j.1365-2869.2004.00405.x.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of Interest
The authors report no conflicts of interests and are solely responsible for the content and writing of this paper.
Ethical Approval
All procedures involving human participants were in accordance with the ethical standards of the institutional research ethics committee and in allignment with the 1964 Helsinski declaration and its later amendments.
Informed Consent
Informed consent was obtained from all individual participants included in the study.
Additional information
Publisher’s Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
About this article
Cite this article
Carnett, A., McLay, L., Hansen, S. et al. Sleep Problems in Children and Adolescents with Autism: Type, Severity and Impact. J Dev Phys Disabil 33, 977–991 (2021). https://doi.org/10.1007/s10882-020-09783-5
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10882-020-09783-5