Comparison of Caregiver Perception of Sleep Behaviors of Infants at High and Low Risk for Autism Spectrum Disorders

Background:  Autism Spectrum Disorder (ASD) represents one of the most devastating neurobiological disorders of pre and postnatal brain development, with a prevalence of 1 in 110 children.  The recurrence rate in families with one child with ASD is estimated at 10-20%.  One of the most common medical conditions in children with ASD is chronic severe insomnia, with a prevalence of 60-80%. This is a 2-3 fold increase over typically developing children. Inadequate sleep has been shown to have detrimental effects on cognition, behavior, mood and quality of life.  Moreover, disruptive sleep in children has been shown to severely alter parents’ sleep quality and they report great stress and decreased family functioning.  Disturbed sleep emerges early in very young children and when left untreated can often become a chronic medical condition Very little is known about the natural history of sleep in young children with ASD.

Objectives: The purpose of this longitudinal study is to describe the caregiver perceptions of night sleep behaviors of infants at high and low risk for ASD at 6,  12 and 24 months. The secondary aim is to describe the relationship between sleep behaviors and cognitive, social and adaptive behaviors of infants at high and low risk for ASD.

Methods: The Infant Brain Imaging Study (IBIS) Network is an NIH funded Autism Center of Excellence and consists of a consortium of 7 universities in the U.S. and Canada.  The study involves the national recruitment of infants at high-risk for autism (having an older sibling diagnosed with ASD and a control group of typically-developing infants.   Measures include a battery of behavioral and developmental tests and structural brain imaging. To date data has been collected on 40 infants at high risk for ASD and 20 infants at low risk for ASD at the Center for Autism Research, The Children’s Hospital of Philadelphia (CHOP). Infant Behavior Questionnaire – Revised (IBQ-R) was completed by the primary caregiver at each visit. Five questions addressed night time sleep behaviors,  likert scale 1-7, 1 being “ never “and 7 being “always”.

Results:  No statistical differences between the mean scores of caregiver perception of sleep behaviors in the low risk and high risk infants at 6 months, (p=0. 51) or 12 months (p=0. 146) of age.  Using a cutoff of mean score of 3.5, 56% of the high risk infants (n=40) at 6 months had sleep problems compared to 50% of the low risk infants (n=20). At 12 months of age, 41% of the high risk infants (n=40) and 10% of the low risk infants (n=10) had sleep problems. Effect size was found to be 0.58 demonstrating that we are under powered at this point in the study to find a significant difference.

Conclusions: The Brief Infant Sleep Questionnaire was added to the battery of measures at CHOP. Caregiver perceptions of sleep behaviors in infants at 6, 12, and 24 months of age at high and low risk for ASD could provide insights into the sleep behaviors and the development of sleep problems in ASD.