Sleep Patterns In Adolescents with High-Functioning Autism Spectrum Disorder and Typically Developing Adolescents

Background:  While sleep problems are commonly reported in typically developing (TD) children the prevalence in children with a developmental disability such as high functioning autistic spectrum disorder (HFASD) is at least twice the rate.  Both subjective and objective measures of sleep have indicated that sleep initiation and sleep maintenance are problematic for these individuals.  Literature on the sleep patterns of TD adolescents consistently shows that significant physiological, psychological, and social changes in the sleep pattern occur at the onset of puberty.  However, no research to date has focussed exclusively on the sleep patterns of adolescents with HFASD and the impact sleep problems may have on their daytime functioning. 

Objectives:  This study investigates and describes the sleep patterns of adolescents with HFASD; examines the prevalence of insomnia as defined by the International Classification of Sleep Disorders (2^nd ed.) (ICSD-2) in HFASD as compared with TD adolescents; and examines the impact of poor sleep on daytime functioning in both groups of adolescents.

Methods:  27 adolescents aged 13-17 years with a diagnosis of HFASD have been recruited and returned data; data entry is ongoing. TD adolescents’ data from a similar, larger sleep study conducted at Flinders University, South Australia have been matched on age and sex with HFASD participants. Currently data have been analysed for 19 adolescents aged 13 to 17 years diagnosed with HFASD and 19 matched TD adolescents.  The adolescents completed questionnaires about sleep, puberty stage and daytime fatigue and a 7-day sleep/wake dairy; Actigraphy data were also collected for 16 participants over the 7-day diary period.

Results:  Preliminary analyses indicate that adolescents with HFASD have significantly shorter total sleep time (TST) and decreased sleep efficiency compared to TD adolescents.  Both groups of adolescents showed a delayed sleep-phase, reporting later bedtimes and wake times on weekends in comparison to schooldays; however, this appears more pronounced in TD adolescents.  Additionally sleep phase was related to puberty stage in the TD adolescents but this relationship was not found for HFASD adolescents. Although insomnia similarly occurred in both groups, adolescents with HFASD were more likely to experience two or all three complaints of ICSD-2-defined insomnia whereas TD adolescents only experienced one insomnia complaint.  A significant negative correlation between daytime fatigue and sleep efficiency was shown across both groups of adolescents.  Data on all 27 participants with HFASD will be available at the time of presentation.

Conclusions:  This is the first study to describe the sleep problems self-reported by high-functioning adolescents with HFASD. Preliminary analyses indicate several key findings, which suggest that adolescents with HFASD show the same sleep atypicalities as reported for children with an ASD that is reduced total sleep, poorer sleep efficiency and significant symptoms of insomnia.  In addition sleep phase appears to be not clearly associated with puberty in HFASD adolescents.  Our results indicate that sleep continues to be problematic in ASD during adolescence, and adds further weight to the need to understand the aetiology of these prevalent sleep problems and to develop effective prevention and treatment programs.