Good Night, Sleep Tight: The Impact of Early Bedtime Behaviors on Toddlerhood Sleep Problems in Infants at Heightened Risk for ASD
Previous work has demonstrated that children with Autism Spectrum Disorder (ASD) have difficulty falling asleep and staying asleep, which leads to decreased duration of sleep. These disturbances of sleep can impact daily learning and behavioral and emotional regulation (Souders 2009), which are marked deficits for those with ASD and the targets for early interventions. Sleep education and interventions have been documented to improve sleep and behavioral symptoms for those children with ASD (Malow 2013) yet little is known about the early sleep characteristics that relate to later sleep problems in children with ASD.
To examine how early components of sleep and the methods used to put infants to sleep at 12 and 24 months impact sleep difficulties at 24 months.
Data were collected from parent report measures of children at 12 and 24 months at one clinical site that were seen as part of a longitudinal study on the brain and cognitive development of infants at risk for ASD. Thus far, the data include 49 toddlers at high risk for ASD (HR) (mean age=24.54 months) and 21 typically developing low risk (LR) toddlers (mean age=24.34 months). We examined differences between groups on scores from the Sleep Problem subscale on the CBCL (The Child Behavior Checklist for ages 1 ½ to 5 yrs; Achenbach & Rescorla, 2000) and responses on the BISQ (Brief Infant Sleep Questionnaire; Sadeh 2004) including nighttime sleep duration, number of night wakings, duration of sleep onset, and the method and location of sleep onset and investigated how these variables correlated across development.
Our preliminary data reveal a significant increase in Sleep Problem scores for toddlers with ASD, a subset of 15 infants in the HR group, (M=59.33, SD= 10.728) as compared to LR toddlers (M=51.33, SD=3.168) at 24 months of age (p<.05). When we considered all high risk infants, this difference remained significant (HR mean score was 55.71, SD=8.631). In addition, correlations were examined for HR infants between BISQ data at 12 months and Sleep Problem scores at 24 months on the CBCL and indicated that duration of sleep onset (r= .566, p<.05) and number of night wakings (r= .695, p<.01) at 12 months correlate with CBCL Sleep Problem scores at 24 months. In addition, sleep problems at 24 months were significantly related to whether the child was put down for bed with support (i.e. rocking, feeding, and/or holding) or without support (r= .449, p<.05) and whether the child slept in their own bed or in their parent’s or sibling’s bed (r= .553, p<.01).
These results indicate that there are characteristics of sleep as early as 12 months that relate to sleep problems a year later. Understanding these early characteristics may improve methods for sleep therapies and facilitate early intervention of sleep difficulties before reaching a level of clinical significance.