Sleep, Cognition, and Autism Spectrum Disorder

Background: Problems with sleep are common in children with autism spectrum disorder (ASD). Family-reported sleep quality issues have become a growing concern in this population, but the specific areas of sleep that cause the most difficulties are understudied. Further evidence indicates that sleep disturbances significantly impact information processing, but little is known about the impact of sleep dysfunction on cognition in ASD.

Objectives: The objective of this study was to examine the specific areas of sleep that are the most problematic in children with autism versus their typically developing peers, and the association between sleep and cognitive impairments in children with ASD.

Methods: The sample consisted of children with autism (n = 62) whose diagnosis was confirmed using the Autism Diagnostic Observation Schedule and the Autism Diagnostic Interview-Revised, and a demographically-matched typically-developing control group (n = 29). Parents or legal guardians completed the Child Sleep Habits Questionnaire, a well-validated measure of sleep quality and disturbance, and participants were assessed with a comprehensive battery of field standard neuropsychological and social-cognitive tests. General linear models and moderated multiple regression were used to examine group differences in domains of sleep quality, as well as the association between sleep quality and cognitive functioning within and across study groups.

Results: Children with autism were reported to have significantly more overall sleep problems as compared with their typically developing peers (t = 3.60, p = .0005), especially in sleep onset delay (t = 2.51, p = .014), sleep duration (t = 2.37, p = .0201), sleep anxiety (t = 3.56, p = .0006), and daytime sleepiness (t = 2.70, p = .0083). Furthermore, it was observed that greater sleep anxiety was related to poorer theory of mind performance (r = -0.27, p = .0142), and similar trend level effects were noted for total sleep problems and sleep-disordered breathing (all p < .090). Conversely sleep quality was not related to measures of neuropsychological impairment.

Conclusions: These results highlight the difficulties children with autism have in sleep onset delay, sleep duration, sleep anxiety, and daytime sleepiness, and also suggest that these challenges may be associated with core social-cognitive impairments in theory of mind. New treatment options that target the unique sleep challenges of children with ASD are needed, and may ultimately support improved social-cognitive functioning in this population.