The Relationship Between Sleep Problems and Daytime Behavior in Children of Different Ages With Autism Spectrum Disorders

Pediatrics (Impact Factor: 5.47). 11/2012; 130(Supplement):S83-S90. DOI: 10.1542/peds.2012-0900F


The purpose of the current study was to evaluate the relationships among sleep problems and daytime behaviors in a large, well-defined cohort of children with autism spectrum disorder (ASD).

Out of a registry population of 3452 children with ASDs, a subset of 1193 children aged 4 to 10 years of age from 14 centers across the country was used to evaluate the relationship between varying levels of sleep problems and daytime behavior. Measures included Children's Sleep Habits Questionnaire, Vineland Adaptive Behavior Scales, Survey Interview Form, Second Edition, and Child Behavior Checklist. Multiple analysis of covariance was used to assess the association between sleep and behavior.

Results suggest that sleep problems, as identified by parent report by use of the Children's Sleep Habits Questionnaire, have a negative relationship with daytime behavior. More specifically, children with ASDs and sleep problems had more internalizing and externalizing behavior problems, as measured by the Child Behavior Checklist, and poorer adaptive skill development, as measured by the Vineland Adaptive Behavior Scales, than children with ASDs and no sleep problems. Children with moderate to severe sleep problems had greater behavior difficulties, but not necessarily poorer adaptive functioning, than children with mild to moderate sleep problems. Both preschool- and school-aged children demonstrated a negative relationship between behavior and sleep, whereas the relationship between sleep and adaptive functioning was much more variable.

These results suggest that, although sleep has a negative relationship with internalizing and externalizing behavior, it may have a different relationship with the acquisition of adaptive skills.

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    • "Large-scale studies (n>1000) published in the past 5 years report sleep problems in 32 to 71.5 % of children and adolescents with ASD (Goldman et al. 2011; Hollway et al. 2013; Sikora et al. 2012). Variable prevalence might be due to different criteria (i.e., different cut-off scores) and assessment methods for sleep problems (hetero-evaluation scales, auto-questionnaires, actimetry, polysomnography, etc.). "
    08/2015; DOI:10.1007/s40489-015-0057-6
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    • "Children with ASD who also had comorbid sleep problems were more likely to have withdrawal problems, somatizing problems, internalizing problems, and overall total behavior problems than children with ASD who did not have sleep problems. This is supported by Sikora et al. (2012) who found that children with ASD and sleep problems had more internalizing and externalizing behavior problems than those with ASD and no sleep problems. "
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    ABSTRACT: The purpose of this literature review is to provide an overview of the research on sleep problems in autism spectrum disorder. Topics explored are the prevalence of sleep problems, the importance of studying sleep problems, as well as the objective and subjective measures used to measure sleep. Research on the relationships between sleep problems and parental stress and psychological distress, developmental regression, language and communication, adaptive behavior, autism severity, challenging behavior, comorbid psychopathology, attention deficit/hyperactivity disorder, gastrointestinal symptoms, epilepsy, and sensory issues is also discussed. Age-related variations in sleep problems are also examined. Finally, recommendations for treatment are given as well as areas where future research is needed.
    06/2013; 1(2):101-109. DOI:10.1007/s40489-013-0009-y
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    ABSTRACT: Autism spectrum disorders (ASD), once thought rare, are now commonly encountered in clinical practice. Academic pediatricians may be expected to teach medical students and pediatric residents about ASD, but most likely received limited exposure to ASD during their training. In recent years, research that informs the clinical guidance provided to pediatricians regarding surveillance, screening, and ongoing management of children with ASD has accelerated. By 24 months of age, children with ASD exhibit delays across multiple domains of development, yet the diagnosis is frequently made much later. Careful developmental surveillance lowers the age of identification of children with ASD. Several screening tools appropriate for use in primary care settings can aid in early identification. Improved surveillance and screening is of benefit because early intensive behavioral intervention has the potential to improve the developmental trajectory of children with ASD. Providing appropriate medical care for children with ASD improves both child and family outcomes. Recent research regarding sleep disturbances, gastrointestinal problems, and epilepsy in children with ASD has led to clinical pathways to evaluate and address these issues within the context of primary care. By being aware of and disseminating these research findings, academic pediatricians can help future and current clinicians improve the care of children with ASD.
    Academic pediatrics 09/2013; 13(5):390-9. DOI:10.1016/j.acap.2013.04.003 · 2.01 Impact Factor
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