Variables related to sleep problems in children with autism
Section snippets
Frequency and type of sleep problems in autism
Children with autism have a significantly higher frequency of parent reported sleep problems than typical controls (Allik et al., 2006, Couturier et al., 2005, Honomichl et al., 2002, Krakowiak et al., 2008, Richdale and Prior, 1995, Schreck and Mulick, 2000). More than half of parents of children with autism report a sleep disturbance in their children (Allik et al., 2006, Couturier et al., 2005, Hering et al., 1999, Honomichl et al., 2002, Krakowiak et al., 2008, Liu et al., 2006, Mayes and
Parent reported sleep problems in autism and associated variables
Several variables have been found to be related to sleep problems in children with autism, including medication use, age, IQ, autism severity, and comorbid psychiatric symptoms. However, studies have resulted in inconsistent findings. For example, Liu et al. (2006) found greater parent reported sleep problems in children with autism on psychoactive medication than in children not on medication. In another study (Krakowiak et al., 2008), psychoactive medication was associated with greater
Purpose
According to the National Institutes of Health (2005), “Little is known about characteristics or consequences of sleep disturbances in most childhood psychiatric disorders.” Researchers note that studies are needed to understand sleep problems in both children with high and low functioning autism (Allik et al., 2006, Couturier et al., 2005, Johnson, 1996) and that existing studies are limited in quantity and quality (Wiggs & Stores, 2004). Studies consistently show that children with autism
Sample
The study involves a retrospective analysis of existing clinical data on 477 children with autism, 1–15 years of age (M = 6.5, SD = 3.0) with Full Scale IQs of 9–146 (M = 85.4, SD = 27.8). Eighty-seven percent of the children are male, 94% are white, and 37% have a parent with a professional or managerial occupation. The children were consecutive referrals to our child psychiatry diagnostic clinic who were diagnosed with autism by a licensed PhD psychologist. Diagnoses were based on comprehensive tests
Medication
In the total sample of 477 children, 151 (32%) were on one or more psychoactive medication. The most common medications were a stimulant or atomoxetine (18%) and neuroleptic, most often risperidone (14%). Other medications used in more than 1% of the children were an SSRI (7%); medication for sleep, specifically melatonin, clonidine, or diphenhydramine (4%), and a mood stabilizer, including anticonvulsants and lithium (4%). Children taking versus not taking medication did not differ in IQ (t =
Discussion
Our study suggests that sleep disturbance is part of the autism symptom complex and increases with increasing autism severity. The strongest predictors of sleep disturbance in our sample of 477 children with autism were autism severity and symptoms common in autism (hyperactivity, mood variability, and aggression), which together explained one-third of the variance in sleep problems. Further, correlations were highly significant between sleep disturbance and parent ratings of oppositional
Acknowledgements
We wish to thank the Organization for Autism Research, Autism Speaks, and the Children's Miracle Network for their support of this study.
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