Poor Sleep Quality Is Associated with Discordant Peer Relationships Among Adolescents with Autism Spectrum Disorder

Background:  Individuals with Autism Spectrum Disorder (ASD) experience impairments in social communication and restricted and repetitive behaviors (RRBs) (Centers for Disease Control, 2016), and these deficits often make it difficult to form and maintain friendships with peers. For example, children with ASD who have deficient verbal abilities have fewer social interactions, have less satisfying relationships with peers, and feel lonelier (Bauminger & Kasari, 2000; Sigman et al., 1999). As children approach adolescence, there is typically a quantitative shift to the majority of leisure time being spent with peers (Larson, 2001), yet this is often not the case for adolescents with ASD, who spend a large amount of time with adults (Orsmond & Kuo, 2011). For individuals with ASD, the consequences of social impairments and compromised relationships may be compounded by other challenges associated with ASD, one of which is poor sleep quality. Between 32% to 71.5% of children and adolescents with ASD experience sleep problems (Deliens et al., 2015). Sleep problems include difficulty falling asleep, inconsistent sleep schedules, insufficient nighttime sleep, and daytime sleepiness that impairs daytime functioning (Goldman et al., 2012). Poor sleep quality and daytime sleepiness are common among adolescents with ASD, and consequences of poor sleep may make social interactions difficult. Connections between sleep quality and social relationships in ASD samples have been understudied.

Objectives: The goal of the present study was to examine the associations between nocturnal sleep problems and daytime sleepiness in relation to the quality of peer relationships among adolescents with and without ASD.

Methods: Participants were community samples of 19 adolescents with ASD (aged 11-20 years, M=16.88, SD=2.50; 84.2% boys) and 10 neurotypical (NT) adolescents without a family history of ASD (aged 13-18 years, M=15.73, SD=2.00; 60% boys). Clinical diagnoses for the group with ASD were confirmed using the ADOS-2 (Lord et al., 2012). Adolescents completed questionnaires about closeness and discord in relationships with a same-gender peer, and they reported on sleep-wake problems and daytime sleepiness using the Sleep Habits Survey (SHS; Wolfson & Carskadon, 1998). Adolescents also wore an actigraph sleep watch to bed for 7-nights and kept sleep diaries of bed/wake times.

Results: Pearson correlations revealed significant associations between adolescent-reports of sleep problems and discordant peer relationships; more sleep-wake problems and more daytime sleepiness were associated with more discord with peers in the sample with ASD, but not in the NT sample. The closeness aspect of peer relationships was not significantly associated with sleep quality.

Conclusions: Adolescents’ reports of more sleep problems and daytime sleepiness, but not actigraph indicators of sleep, were directly associated with discordant peer relationships. Adolescents who are already challenged in social interactions due to ASD may be especially vulnerable to intense negativity in peer relationships when they also experience poorer nighttime sleep and more daytime sleepiness. NT adolescents may be better able to regulate social interactions despite poor sleep and feeling tired. Conflicts with peers and daytime sleepiness in addition to nighttime sleep quality are important issues for clinicians to address in sleep and behavioral interventions.