Efficacy of a New Family-Based Cognitive-Behavioral Intervention for Insomnia in Children with ASD

Poster Presentation
Saturday, May 12, 2018: 11:30 AM-1:30 PM
Hall Grote Zaal (de Doelen ICC Rotterdam)
M. O. Mazurek1, W. S. Chan2, M. Munoz3, J. E. Muckerman4, T. N. Takahashi4, S. Takamatsu3, P. Sahota3 and C. S. McCrae3, (1)University of Virginia, Charlottesville, VA, (2)Psychiatry, Dartmouth College, Lebanon, NH, (3)University of Missouri, Columbia, MO, (4)Thompson Center for Autism & Neurodevelopmental Disorders, University of Missouri, Columbia, MO
Background: Insomnia affects up to 80% of children with autism spectrum disorder (ASD) and has significant detrimental effects on daytime functioning and well-being for both children and parents. Despite the clinical importance of this issue, empirically supported treatments for insomnia in children with ASD are lacking. Cognitive-behavioral therapy for childhood insomnia (CBT-CI) represents a promising approach, but it has not been previously tested in children with ASD.

Objectives: The objective of this study was to test the preliminary efficacy of a family-based cognitive behavioral therapy for insomnia that was specifically adapted for children with ASD (CBT-CI-A). Primary outcomes included child and parent sleep (subjective and objective), child daytime behavior, and parent fatigue.

Methods: Participants included 31 children with ASD and insomnia (ages 6-12, 74% male) and their parents (ages 28-48, 13% male) who participated in an 8-session clinical trial of the newly developed CBT-CI-A. Nineteen families participated in face-to-face therapy sessions, while twelve families participated in remote sessions delivered via videoconferencing technology. Child and parent sleep were assessed by actigraphy (Actiwatch-L®, Respironics) and daily completion of electronic sleep diaries for two weeks at baseline, post-treatment, and 1-month follow-up. Parent diaries assessed daily fatigue (0–100 scale). Averages were calculated across each two-week assessment period for sleep onset latency, total wake time, total sleep time, sleep efficiency, and fatigue (parent only). Child daytime behavior was assessed at each time point via the Aberrant Behavior Checklist.

Results: Data from the face-to-face delivery condition are presented here, but complete data for the entire sample and comparisons between delivery-format will be included in the final presentation. For the face-to-face delivery, paired samples t-tests revealed moderate-large improvements in child objective sleep [onset latency (~18 minutes), total wake time (~41 minutes), total sleep time (~17 minutes), efficiency (~6%); within group effect sizes (ES)=.52-1.28], and moderate-large improvements in child subjective sleep [onset latency (~30 minutes), total wake time (~44 minutes), sleep efficiency (~6%); ES=.68-1.80], bed/waketime regulation (~30 minutes each, ES=.76-2.17), and daytime behavior [irritability, social withdrawal, stereotypy, inappropriate speech; ES=.52-.86]. Treatment gains were maintained at 1-month follow-up [ES=.25-2.23]. Parent improvements were found in objective total sleep time (~19 minutes, ES=.41), subjective sleep [onset latency (~10 minutes), wake after sleep onset (~12 minutes), total wake time (~25 minutes), sleep efficiency (~5%); ES=.49-1.01)], and fatigue (~10 points, ES=.52). Parent treatment gains were generally maintained with additional objective sleep improvements at 1-month follow-up [onset latency (~5 minutes), wake after sleep onset (~5 minutes), total wake time (~10 minutes); ES=.45-.98].

Conclusions: The results of this pilot study suggest that the newly developed CBT-CI-A is an efficacious treatment for insomnia in children with ASD and their families. Sleep markedly improved for children with ASD and their parents according to both objective and subjective measures. Importantly, children’s daytime behaviors also improved. These findings suggest that CBT-CI-A is a promising treatment for insomnia in children with ASD. Larger scale studies are needed to further evaluate the effectiveness of this treatment in larger samples using randomized clinical trial designs, active control groups, and long-term follow-up.