Characterising the Relationships between Sleep Patterns, Anxiety Profiles, School Attendance and Daytime Behaviour in Female Adolescents with and without a Diagnosis of Autism

Background: There is a wealth of literature for the role sleep plays in the growth, development, health and well-being of adolescents. In recent years, research in gender and autism has developed at pace, developing our understanding of the way autism needs present in females and the challenges they experience as a result of this. This field is still, however, widely under-researched.

Objectives: To examine the role sleep plays within female adolescents and the influence it has on anxiety and daytime behaviours, both at home and at school.

Methods: Using a multi-informant research design, including both subjective and objective sleep measures, a cross-sectional, quantitative, correlational study examining the relationships between sleep patterns, anxiety profiles, school attendance and school behaviours in typically developing female adolescents and female adolescents with autism was carried out. Actigraphy data were collected, alongside self-report (Pittsburgh Sleep Quality Index, Beck Youth Inventories II, Strengths & Difficulties Questionnaire), parent-report (Child Sleep Habits Questionnaire, Strengths & Difficulties Questionnaire) and teacher report (Strengths & Difficulties Questionnaire, Child Behaviours Checklist) questionnaires for anxiety and behaviour. School attendance information was also collected.

Results: 33 female participants (16 without a diagnosis; 17 with a diagnosis), between 11-16 years of age, completed the study. Sleep patterns in isolation were broadly similar between both groups and all participants were getting 2-4 hours less than the 2017 National Sleep Foundation recommendations. However, differences were found between the two groups, between sleep patterns and each of the outcomes examined with a significant number of correlations found between these factors in female adolescents with autism. In females with a diagnosis of autism, positive correlations were found between self-reported anxiety and sleep disturbances. Anxious behaviours were reported by parents to increase as the scores in each sleep domain increased also. A linear regression demonstrated that each of the following sleep domains significantly predicted the total difficulties in behaviours score reported by parents of females without a diagnosis in the SDQ, accounting for a significant proportion of the variance found in parent reported behaviour scores. Sleep anxiety also significantly predicted the total difficulties score reported. For teacher reported behaviours in females with a diagnosis, the most frequent negative correlations occurred also with actigraphy mean bed time, indicating the importance of this factor across both groups of participants.

Conclusions: These findings have implications not only for parents and professionals in considering the impact of poor sleep patterns on outcomes at home and school, but also for developing adolescents’ awareness and understanding about the important role sleep plays in their wellbeing. Future research should examine sleep patterns and sleep hygiene using subjective sleep measures and eliciting personal account on sleep to understand in more depth the relationship between sleep