Sleep Quality and Daytime Functioning in Adolescents and Young Adults with Autism Spectrum Disorders

Background:   Children with Autism Spectrum Disorders (ASD) experience an increased prevalence of sleep problems relative to their typically developing peers.  Recent research has identified that approximately 66% of children with ASD experience at least moderately severe sleep problems (Souders et al., 2009).  Sleep problems, such as difficulty falling asleep and frequent and prolonged night wakings, are among the first reported parental concerns to healthcare professionals among children later diagnosed with ASD (Guinchat et al., 2012).  Children with ASD with problematic sleep demonstrate greater impairment in cognitive and behavioral domains compared to children with ASD without problematic sleep (Goldman et al., 2011).  Siblings’ and parents’ sleep is also disrupted by the autistic child with sleep problems (Chou et al., 2012; Lopez-Wagner et al., 2008).  Sleep problems in childhood may continue to persist into adolescence and adulthood, which may lead to further disturbances in individual functioning and family relationships. 

Objectives:   The objective of the current study was to examine how sleep quality and sleep architecture in individuals with ASD are related to psychological well-being, daytime functioning at school/work, and family relationships.  

Methods:   A well-characterized sample of adolescents and young adults with ASD and one of their parents were enrolled to participate.  Target participants were first screened for eligibility using the Autism Diagnostic Observation Schedule (ADOS-2; Lord et al., 2000). Next, home visits were scheduled.  During the first part of the visit, adolescents/young adults used pre-programmed iPads to report on sleep duration, sleep quality, psychological well-being, family relationships, and daytime functioning at school/work.  Parents/caregivers also completed measures on an iPad. In the latter part of the visit, participants were instructed in the use of pre-programmed Smart Phones. The phone “apps” kept logs of participants’ sleep quality for the next 7 nights and recorded well-being and relationship issues. Participants were also instructed to use a MicroMini Motionlogger actigraph, which collected objective sleep data to supplement subjective Smart Phone reports.  A week later, the research team returned to the home to pick up the actigraph and phone. 

Results:   Preliminary results suggest significant associations between disrupted sleep, daytime sleepiness, and individual and family functioning.  For example, adolescents who obtained more uninterrupted sleep during the night reported feeling more alert during the day compared to those who obtained less nighttime sleep.  Furthermore, adolescents who had lower sleep efficiency also demonstrated poorer daily functioning at school, such as falling asleep during class.  More nocturnal wakefulness was also associated with adolescent report of negative interactions with the participating parent, including higher perceived criticism.  In sum, these data suggest that poor sleep quality is related to negative outcomes in individual and family well-being.  Data on the full sample will be ready for presentation at IMFAR.

Conclusions:  Early results confirm the utility of objective and subjective methods of collecting data on sleep quality. Quality of nighttime sleep relates to the functioning of adolescents with ASD and their parents. Understanding these associations can be used to advance the quality of life for families with ASD through sleep interventions and clinical implications.