Pilot Testing of a Sleep Training Program for Children with Autism Spectrum Disorders

Background: Core features of autism include deficits in social interaction and communication as well as repetitive and restrictive patterns of behavior. In addition to these core diagnostic features, children with autism frequently present with a host of associated behavioral issues.  Sleep problems are estimated to occur in 30-86% of this group of children disruptive sleep patterns and habits appear to occur at a higher rate among children with autism than typically developing children based on both parental reports and other objective measures of sleep.  Sleep problems further seem to occur at high rates in children with high functioning autism and Asperger Disorder suggesting that sleep disruption may not be fully attributed to intellectual disability. Hence, there is an immediate need to develop and test efficacious interventions to address sleep disturbances in this population.

Objectives: This is a pilot study to evaluate the efficacy of a manualized behavioral parent training program for the amelioration of sleep disturbances in young children with autism.  This work will be used to examine the feasibility, acceptability and efficacy of five, individually delivered sessions targeting a number if sleep problems.  Outcome measures include parental report measures as well as actigraphy. 

Methods: A sample of young children with autism between the ages of 24 months and 60 months are being recruited for this pilot study.  The children must have at least one significant sleep problem (bedtime resistance, delayed sleep onset, sleep association problems, night wakings, morning wakings).  Parent(s) / primary caregiver will participate in five parent training sessions.  A home visit is also made in the beginning of the program. Parent training topics include: 1) Basic behavioral principles; 2) Addressing prevention techniques and bedtime routines; 3) Addressing reinforcement and extinction procedures; 4) Addressing delayed sleep onset and sleep association procedures; 5) Booster and maintenance.  The sessions include didactic training, completion of parent activities and the use of video vignettes.  While the parent training is manualized, it also allows for individualization, for example based on the types of sleep disturbances, functioning level of the child, and parent preferences of procedures.

Results: Participants thus far presented with bedtime resistance, delayed sleep latency, sleep association problems and frequent night wakings.  Treatment integrity and parent adherence has been 100% as has been parent attendance and parent satisfaction.  Parents rated improvements in sleep as measured on the composite sleep index of the Modified Simond & Parraga Sleep Questionnaire.  Improvements in parental stress have also been reported.  Actigraphy data supporting improvements have been variable.

Conclusions: This manualized parent training program to address an array of sleep problems can be delivered successfully.  Further study is warranted to determine the efficacy of the program as well as to determine any predictors of success.