The relation among sleep, routines, and externalizing behavior in children with an autism spectrum disorder

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Abstract

The present study examined relations among sleep, routines, and externalizing behavior (based on parent report) in 115 children ages 6 to 12 years in two groups: 58 children with an autism spectrum disorder (age M = 9.0, SD = 2.09) and 57 non-ASD children (age M = 8.25, SD = 1.98). Within the ASD group, sleep hygiene and sleep quality were related to both routines and externalizing behaviors. In the combined sample, a significant interaction was found between diagnostic status and general routines in predicting externalizing behaviors. Specifically, lower levels of routines were related to higher levels of externalizing behaviors for both groups, whereas higher levels of routines were related to lower levels of externalizing behaviors for the non-ASD group. Further research among these constructs may focus on children with an ASD who experience less consistent routines or significant sleep disturbance.

Section snippets

Routines, sleep, and externalizing behavioral problems

Routines are defined as “observable, repetitive behaviors which directly involve the child and at least one adult acting in an interactive or supervisory role, and which occur with predictable regularity in the daily or weekly life of the child” (Sytsma, Kelley, & Wymer, 2001, p. 243). Furthermore, “routines may occur at a regular time, in the presence of a regular adult, in a regular place, in a regular sequence, or a combination of these” (p. 243). Routines are important to study in children

Present study and hypotheses

The present study seeks to examine the complexity of the relations among routines (general and bedtime), sleep (hygiene and quality), and externalizing behaviors within children with an ASD. No known study has examined these linked factors within this population. However, Henderson and Jordan (2010) evaluated the relation among these variables via parent-completed questionnaires within a community sample. In their study, a significant positive relation was supported between both bedtime and

Participants

Primary caregivers of 115 children (58 children with an ASD and 57 non-ASD children) participated in the study. Children were between 6 and 12 years of age at the time parents completed the measures (ASD M = 9.0, SD = 2.09; non-ASD M = 8.25, SD = 1.98; total sample M = 8.63, SD = 2.06). In the ASD group, children were predominantly male (86.2%), whereas gender was more evenly represented in the non-ASD group (52.6% male). For both groups, participants were predominantly White (82.6% for the combined

Results

Zero-order correlations were performed with demographic variables to explore possible relations among demographic variables and the two main outcome variables, sleep quality and externalizing behavior. The correlations were performed twice, once for the ASD group and a second time for the combined sample. No demographic variables were found to relate to outcome variables within the ASD group only. Therefore, no controls were used in testing relations among variables within the ASD group. Within

Discussion

The findings of the present study yielded mixed support for the hypotheses. Within the ASD group, sleep hygiene and sleep quality were significantly positively correlated and both sleep hygiene and sleep quality were significantly negatively correlated with externalizing behaviors, as predicted in the first hypothesis. Likewise, consistency of bedtime routines was positively related to sleep hygiene and sleep quality within the ASD group, providing support for the second hypothesis. Finally, as

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