Abstract
Objectives
Sleep disturbances are a significant problem for individuals with autism spectrum disorder (ASD) across the lifespan; however, there is a paucity of research examining effective sleep interventions for adolescents with ASD. Although research has demonstrated individuals with ASD can be meaningfully engaged in their own intervention process, such engagement has not appeared in previous studies targeting sleep in adolescents with ASD.
Methods
This study investigated the feasibility of including pre-adolescents and adolescents (ages 9 to 14 years) with ASD as active intervention agents within comprehensive, individualized treatments for sleep problems. Participants had a range of intellectual functioning but all produced spoken language. Outcomes were evaluated using single-case designs.
Results
Data suggest intervention was effective in eliminating sleep disturbance for all participants. Improvements were maintained during 18- to 24-month follow-up. All three participants and their parents indicated a high degree of treatment satisfaction.
Conclusions
Findings illustrate the feasibility and potential benefit of including adolescents with ASD in the process of developing and implementing individualized behavioral interventions for sleep problems.
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References
Achenbach, T. (2001). Child behavior checklist for ages 6–18. Burlington: ASEBA.
Baker, E., Richdale, A., Short, M., & Gradisar, M. (2013). An investigation of sleep patterns in adolescents with high-functioning autism spectrum disorder compared with typically developing adolescents. Developmental Neurorehabilitation, 16, 155–165. https://doi.org/10.3109/17518423.2013.765518.
Beresford, B., Stuttard, L., Clarke, S., & Maddison, J. (2016). Parents’ experiences of psychoeducational sleep management interventions: a qualitative study of parents of children with neurodevelopmental disabilities. Clinical Practice in Pediatric Psychology, 4, 164–175. https://doi.org/10.1037/cpp0000144.
Blampied, N. M. (2013). Functional behavioral analysis of sleep in infants and children. In A. R. Wolfson & H. E. Montgomery-Downs (Eds.), The Oxford handbook of infant, child, and adolescent sleep and behavior (pp. 169–188). New York: Oxford University Press.
Callahan, K., Shukla-Mehta, S., Magee, S., & Wie, M. (2010). ABA versus TEACCH: The case for defining and validating comprehensive treatment models in autism. Journal of Autism and Developmental Disorders, 40, 74–88. https://doi.org/10.1007/s10803-009-0834-0.
Chevallier, C., Kohls, G., Troiani, V., Brodkin, E. S., & Schultz, R. T. (2012). The social motivation theory of autism. Trends in Cognitive Sciences, 16, 231–239. https://doi.org/10.1016/j.tics.2012.02.007.
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.
Cuomo, B. M., Vaz, S., Lee, E. A. L., Thompson, C., Rogerson, J. M., & Falkmer, T. (2017). Effectiveness of sleep-based interventions for children with autism spectrum disorder: a meta-synthesis. Pharmacotherapy: The Journal of Human Pharmacology and Drug Therapy, 37, 555–578. https://doi.org/10.1002/phar.1920.
Delemere, E., & Dounavi, K. (2018). Parent-implemented bedtime fading and positive routines for children with autism spectrum disorders. Journal of Autism and Developmental Disorders, 48, 1002–1019. https://doi.org/10.1007/s10803-017-3398-4.
Durand, V. M. (2002). Treating sleep terrors in children with autism. Journal of Positive Behavior Interventions, 4, 66–72.
Elrod, M. G., Nylund, C. M., Susi, A. L., Gorman, G. H., Hisle-Gorman, E., Rogers, D. J., & Erdie-Lalena, C. (2016). Prevalence of diagnosed sleep disorders and related diagnostic and surgical procedures in children with autism spectrum disorders. Journal of Developmental and Behavioral Pediatrics, 37, 377–384. https://doi.org/10.1097/DBP.0000000000000248.
Gilliam, J. E. (2013). Gilliam autism rating scale-third edition. Austin: Pro-Ed.
Goldman, S. E., Richdale, A. L., Clemons, T., & Malow, B. A. (2012). Parental sleep concerns in autism spectrum disorders: variations from childhood to adolescence. Journal of Autism and Developmental Disorders, 42, 531–538. https://doi.org/10.1007/s10803-011-1270-5.
Gray, C. A., & Garand, J. D. (1993). Social stories: improving response of students with autism with accurate social information. Focus on Autistic Behavior, 8, 1–10.
Hanley, G. P. (2005). Sleep assessment and treatment tool [Measurement Instrument]. Retrieved from https://practicalfunctionalassessment.files.wordpress.com/2015/06/satt.pdf. Accessed 26 May 2017
Herrmann, S. (2016). Counting sheep: sleep disorders in children with autism spectrum disorders. Journal of Pediatric Health Care, 30, 143–154. https://doi.org/10.1016/j.pedhc.2015.07.003.
Ho, B. P. V., Stephenson, J., & Carter, M. (2015). Cognitive-behavioral approach for children with autism spectrum disorder: a literature review. Journal of Intellectual and Developmental Disability, 40, 213–229. https://doi.org/10.3109/13668250.2015.1023181.
Hodge, D., Parnell, A. M. N., Hoffman, C. D., & Sweeney, D. P. (2012). Methods for assessing sleep in children with autism spectrum disorders: a review. Research in Autism Spectrum Disorders, 6, 1337–1344. https://doi.org/10.1016/j.rasd.2012.05.009.
Jacobson, N. S., & Truax, P. (1991). Clinical significance: a statistical approach to defining meaningful change in psychotherapy research. Journal of Consulting and Clinical Psychology, 59, 12–19. https://doi.org/10.1037//0022-006X.59.1.12.
Jan, J. E., Owens, J. A., Weiss, M. D., Johnson, K. P., Wasdell, M. B., Freeman, R. D., & Ipsiroglu, O. S. (2008). Sleep hygiene for children with neurodevelopmental disabilities. Pediatrics, 122, 1343–1350. https://doi.org/10.1542/peds.2007-3308.
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, 161–180. https://doi.org/10.1002/jaba.16.
Kazdin, A. E. (2001). Behavior modification in applied settings (6th ed.). Belmont: Wadsworth/Thompson Learning.
Kuhn, B. R., & Weidinger, D. (2000). Interventions for infant and toddler sleep disturbance: a review. Child and Family Behavior Therapy, 22, 33–50. https://doi.org/10.1300/J019v22n02_03.
Loring, W. A., Johnston, R., Gray, L., Goldman, S., & Malow, B. (2016). A brief behavioral intervention for insomnia in adolescents with autism spectrum disorders. Clinical Practice in Pediatric Psychology, 4, 112–124. https://doi.org/10.1037/cpp0000141.
Ma, H. (2009). The effectiveness of intervention on the behavior of individuals with autism: a meta-analysis using percentage of data points exceeding the median of baseline phase (PEM). Behavior Modification, 33, 339–359. https://doi.org/10.1177/0145445509333173.
Malow, B. A., Katz, T., Reynolds, A. M., Shui, A., Carno, M., Connolly, H. V., et al. (2016). Sleep difficulties and medications in children with autism spectrum disorders: a registry study. Pediatrics, 137, 98–104. https://doi.org/10.1542/peds.2015-2851H.
Matson, J. L., & Vollmer, T. R. (1995). User’s guide: Questions About Behavioral Function (QABF). Baton Rouge: Scientific Publishers.
McLay, L. K., France, K. G., Knight, J., Blampied, N. M., & Hastie, B. (2019). The effectiveness of function-based interventions to treat sleep problems, including unwanted co-sleeping, in children with autism. Behavioral Interventions, 34, 30–51. https://doi.org/10.1002/bin.1651.
Moore, P. S. (2004). The use of social stories in a psychology service for children with learning disabilities: a case study of a sleep problem. British Journal of Learning Disabilities, 32, 133–138. https://doi.org/10.1111/j.1468-3156.2004.00278.x.
Moore, M., Evans, V., Hanvey, G., & Johnson, C. (2017). Assessment of sleep in children with autism spectrum disorder. Children, 4, 72. https://doi.org/10.3390/children4080072.
Owens, J. A., Spirito, A., & McGuinn, M. (2000). The Children’s Sleep Habits Questionnaire (CSHQ): psychometric properties of a survey instrument for school-aged children. Sleep, 23, 1–9.
Parker, R. I., Vannest, K. J., & Davis, J. L. (2011). Effect size in single-case research: a review of nine nonoverlap techniques. Behavior Modification, 35, 303–322. https://doi.org/10.1177/0145445511399147.
Quist, H., Chaplin, E., & Hendey, O. (2015). Sleep intervention for adults with autism spectrum condition. Mental Health Practice, 18, 14–18. https://doi.org/10.7748/mhp.18.10.14.e937.
Reimers, T. M., Wacker, D. P., Cooper, L. J., & DeRaad, A. O. (1992). Clinical evaluation of the variables associated with treatment acceptability and their relation to compliance. Behavioral Disorders, 18, 67–76.
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.
Sanders, M. R., & Burke, K. (2014). The “hidden” technology of effective parent consultation: a guided participation model for promoting change in families. Journal of Child and Family Studies, 23, 1289–1297. https://doi.org/10.1007/s10826-013-9827-x.
Schlarb, A. A., Liddle, C. C., & Hautzinger, M. (2011). JuSt - a multimodal program for treatment of insomnia in adolescents: a pilot study. Nature and Science of Sleep, 3, 13–20. https://doi.org/10.2147/NSS.S14493.
Sparrow, S. S., Cicchetti, D. V., & Balla, D. A. (2005). Vineland Adaptive Behavior Scales: Second Edition (Vineland II), Survey Interview Form/Caregiver Rating Form. Livonia: Pearson Assessments.
Stewart, S. E., & Gordon, J. E. (2014). Parent-assisted cognitive-behavioural therapy for children's nighttime fear. Behaviour Change, 31, 243–257. https://doi.org/10.1017/bec.2014.19.
Tordjman, S., Anderson, G. M., Bellissant, E., Botbol, M., Charbuy, H., Camus, F., et al. (2012). Day and nighttime excretion of 6-sulphatoxymelatonin in adolescents and young adults with autistic disorder. Psychoneuroendocrinology, 37, 1990–1997. https://doi.org/10.1016/j.psyneuen.2012.04.013.
Vriend, J. L., Corkum, P. V., Moon, E. C., & Smith, I. M. (2011). Behavioral interventions for sleep problems in children with autism spectrum disorders: current findings and future directions. Journal of Pediatric Psychology, 36, 1017–1029. https://doi.org/10.1093/jpepsy/jsr044.
Weiskop, S., Matthews, J., & Richdale, A. (2001). Treatment of sleep problems in a 5-year old boy with autism using behavioral principles. Autism, 5, 209–221.
Funding
This study was partially supported by the Health Research Council of New Zealand (grant number 17/852).
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JvD: designed and executed the study, conducted data analyses, and wrote the paper. LM and KM contributed equally towards the collaboration of the design, execution, and writing of the study. NB: collaborated with the data analysis and writing of the study. RL: collaborated with the writing of the study. JH: assisted with clinical application of assessment and intervention to Peter.
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All procedures performed in studies involving human participants were in accordance with the ethical standards of the University of Canterbury Human Ethics Committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
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van Deurs, J.R., McLay, L.K., France, K.G. et al. Behavioral Sleep Intervention for Adolescents with Autism Spectrum Disorder: a Pilot Study. Adv Neurodev Disord 3, 397–410 (2019). https://doi.org/10.1007/s41252-019-00123-z
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DOI: https://doi.org/10.1007/s41252-019-00123-z