Objectives: To test the efficacy of parent-based sleep education for children with ASD on child sleep, child behavior, and family functioning. The aim of our larger study is to compare individualized and group sessions.
Methods: We carried out a multisite protocol at three sites within our Autism Treatment Network (ATN). Children ranged in age from 2-10 years, and were enrolled in the ATN, with their clinical diagnosis of ASD (by DSM-IV criteria) confirmed by the Autism Diagnostic Observation Schedule. All had sleep onset delay, defined by a sleep latency of 30 minutes or greater. Children were evaluated for medical co-occurring conditions that affect sleep, and children with these conditions were either excluded or treated prior to enrollment in the protocol. Parents met with an educator in either individualized and group sessions to: (1) Learn techniques related to appropriate timing of sleep and sleep hygiene (e.g., daytime habits, evening habits, sleep environment); (2) Develop and implement an individualized bedtime routine; and (3) Discuss strategies to interact with their child to minimize bedtime resistance and night wakings. The Children’s Sleep Habits Questionnaire (CSHQ), Family Inventory of Sleep Habits (FISH), Repetitive Behavior Scale (RBS), Parenting Sense of Competence (PSOC), and Pediatric Quality of Life Scale (Peds-QL), and two weeks of actigraphy, were completed before and one-month after parent education. Parents received training in actigraphy collection procedures and educators at each site followed a manualized curriculum, with fidelity checks performed to ensure completeness and consistency in the education provided.
Results: Data from 33 children [24 boys, 9 girls; ages 6.2 ± 2.4 years (mean ± standard deviation)] completing the protocol have been analyzed to date. As our results are preliminary, we combined group (n = 13) and individual (n = 20) education. Paired t-tests were used to analyze results. Actigraphy showed an improvement in sleep latency from 58.3 ± 24.7 minutes to 40 ± 24.7 minutes (p =0.002); sleep duration and night wakings were not significantly improved. Parents also reported improvements in CSHQ sleep-onset delay (p < 0.001), RBS compulsive behavior (p = 0.01); PSOC parenting satisfaction (p = 0.05) and parenting efficacy (p = 0.05) and total peds-QL (p = 0.007) with treatment.
Conclusions: Based on our preliminary findings, parent-based sleep education improves sleep latency and aspects of child and family functioning in children with ASD.
We acknowledge the members of the Autism Treatment Network (ATN) for use of the data and the families who participated in the Registry. The ATN is funded by Autism Speaks and a cooperative agreement (UA3 MC 11054) from HRSA to the Massachusetts General Hospital.