Elsevier

Research in Autism Spectrum Disorders

Volume 3, Issue 4, October–December 2009, Pages 931-941
Research in Autism Spectrum Disorders

Variables related to sleep problems in children with autism

https://doi.org/10.1016/j.rasd.2009.04.002Get rights and content

Abstract

Our study of 477 children with autism (1–15 years, IQs 9–146) showed that parent reported sleep problems are found in most children with autism and are not significantly related to age, IQ, gender, race, parent occupation, neuropsychological functioning, and learning ability. However, sleep problems increased with severity of autistic symptoms and with severity of parent reported symptoms known to be associated with autism (i.e., oppositional behavior, aggression, explosiveness, attention deficit, impulsivity, hyperactivity, anxiety, depression, and mood variability). This suggests that sleep disturbance is part of the autism symptom complex and increases with increasing autism severity. The strongest predictors of sleep disturbance were parent ratings of autism severity, hyperactivity, mood variability, and aggression. The most frequent sleep problems were difficulty falling asleep and restlessness during sleep. Daytime sleepiness was not significantly correlated with sleeping less than normal, but was associated with sleeping more than normal. Children who were sleepier during the day were also sleepier at night. Medical practitioners and clinicians should be aware of the risk of sleep disturbance in children with autism and should routinely screen for this. Empirically proven interventions (e.g., behavior therapy and melatonin) are available to improve sleep 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.

References (62)

  • K.B. van der Heijden et al.

    Effect of melatonin on sleep, behavior, and cognition in ADHD and chronic sleep-onset insomnia

    Journal of the American Academy of Child and Adolescent Psychiatry

    (2007)
  • M.D. Weiss et al.

    Sleep hygiene and melatonin treatment for children and adolescents with ADHD and initial insomnia

    Journal of the American Academy of Child and Adolescent Psychiatry

    (2006)
  • H. Allik et al.

    Sleep patterns of school-age children with Asperger syndrome or high-functioning autism

    Journal of Autism and Developmental Disorders

    (2006)
  • American Psychiatric Association

    Diagnostic and statistical manual of mental disorders

    (2000)
  • K.E. Beery

    The Beery-Buktenica Developmental Test of Visual-Motor Integration (VMI)

    (1997)
  • Calhoun, S. L., Mayes, S. D., Vgontzas, A. N., Tsaoussglou, M., Shifflett, L. J., & Bixler, E. O. (in press). No...
  • C.J. DeVincent et al.

    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

    (2007)
  • J. Garstang et al.

    Randomized controlled trial of melatonin for children with autistic spectrum disorders and sleep problems

    Child: Care, Health, and Development

    (2006)
  • M. Gordon

    The Gordon Diagnostic System

    (1983)
  • M. Gupta et al.

    Add-on melatonin improves sleep behavior in children with epilepsy: Randomized, double-blind, placebo-controlled trial

    Journal of Child Neurology

    (2005)
  • E. Hering et al.

    Sleep patterns in autistic children

    Journal of Autism and Developmental Disorders

    (1999)
  • R.D. Honomichl et al.

    Sleep patterns of children with pervasive developmental disorders

    Journal of Autism and Developmental Disorders

    (2002)
  • P. Howlin

    Outcome on high-functioning adults with autism with and without early language delays: Implications for the differentiation between autism and Asperger syndrome

    Journal of Autism and Developmental disorders

    (2003)
  • C.R. Johnson

    Sleep problems in children with mental retardation and autism

    Child and Adolescent Psychiatric Clinics of North America

    (1996)
  • P. Krakowiak et al.

    Sleep problems in children with autism spectrum disorders, developmental delays, and typical development: A population-based study

    Journal of Sleep Research

    (2008)
  • M.K. LeBourgeois et al.

    Snoring, sleep quality, and sleepiness across attention-deficit/hyperactivity disorder subtypes

    Sleep

    (2004)
  • M. Lecendreux et al.

    Sleep and alertness in children with ADHD

    Journal of Child Psychiatry

    (2000)
  • S.D. Lindgren et al.

    Assessing child behavior problems in a medical setting: Development of the Pediatric Behavior Scale

  • X. Liu et al.

    Sleep disturbances and correlates of children with autism spectrum disorders

    Child Psychiatry and Human Development

    (2006)
  • B.A. Malow et al.

    Characterizing sleep in children with autism spectrum disorders: A multidimensional approach

    Sleep

    (2006)
  • J. Manjiviona et al.

    Comparison of Asperger syndrome and high-functioning autistic children on a test of motor impairment

    Journal of Autism and Developmental Disorders

    (1995)
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