Sleep Issues In ASD: Behavioral Implications for Adolescents

Background: It is estimated that two-thirds of children and adolescents on the autism spectrum have sleep problems. The most common type of sleep problems reported in ASD include delayed sleep onset, waking during nighttime sleep, and early awakening. Greater night-to-night variability, breathing problems, morning rise problems, and daytime sleepiness have also been reported. Behavioral conditions (e.g., autism symptoms, social interaction problems, stereotypic behavior) have been found to be associated with sleep problems in children with ASD. However, the relationship between problem behaviors and sleep problems in adolescents with ASD is currently not well understood. 

Objectives: The present study aims to explore the relationship between sleep disturbance and (1) social impairment, (2) problem behavior, and (3) peer relations in adolescents with ASD.

Methods: As part of a larger, ongoing, longitudinal study (NIH-ACE, Estes, PI) of adolescents with ASD (ASD; Mean age=14 years, 5months) and an age-matched, typically developing control group (TYP) were assessed for sleep problems via parent report on the Pediatric Sleep Questionnaire (PSQ), yielding four subscales and an overall score for symptoms of sleep related breathing disorders (SRBDs). Social impairment was assessed with the Social Responsiveness Scale (SRS). Problem behaviors were assessed with the Aberrant Behavior Checklist (ABC) utilizing the Irritability, Agitation, Social Withdrawal, Stereotypic Behavior, Stereotyped Speech, and Hyperactivity subscales, and the Conner’s 3rd Edition (Conner’s), utilizing the Hyperactivity and Aggression subscales.   Peer relations were assessed with the Conner’s Peer relations subscale.

Results: The ASD group (n=22; Mean IQ=104) demonstrated significantly higher rates of SRBDs than the TYP group (n=24; Mean IQ=124; p<0.05).  Analyses will investigate (1) whether in the social impairment domain, worse social impairment on the SRS is significantly related to higher levels of SRBDs in the ASD and TYP groups; (2) whether in the problem behavior domain, higher levels of problem behaviors are significantly related to higher levels of SRBDs in the ASD and TYP groups, and (3) whether in the peer relations domain, worse peer relations are related to higher levels of SRBDs in the ASD and TYP groups.

Conclusions: This study is consistent with previous research demonstrating that sleep problems frequently occur in ASD.  We will investigate whether these sleep problems may have an impact on daytime functioning in the domains of problem behavior, social impairment, and peer relations in adolescents with ASD. If these relationships are found, they will have implications for assessment and intervention with adolescents with ASD.  It would suggest that widening the scope of clinical assessment protocols to include sleep disturbance is warranted.  It would also suggest that sleep disturbance may be an important target for ASD intervention programs aiming to improve adolescent functioning. Further research is needed to clarify the direction of these relationships, specifically whether sleep disturbance causes behavioral and social impairments in ASD, or vice versa, or whether an unidentified factor may contribute to the co-occurrence of daytime and nighttime difficulties.  Future studies may also benefit from the use of more direct methods of sleep quality assessment such as polysomnography or actigraphy.