Does Autism Risk Confer a Greater Risk for Sleep Problems?

Background: Elevated rates of sleep problems have been reported in children with autism spectrum disorder (ASD), their parents, and their younger siblings. In families raising children with ASD the mechanisms for familial sleep problems are unclear. Sleep problems may align with ASD risk and simply reflect an element of the broader autism phenotype. Conversely, sleep (particularly in young children) implicates parents; therefore, sleep disruption in families could evolve from one child having a sleep problem. The proposed study explores these hypotheses by assessing maternal and sibling sleep in families raising children with ASD (and a comparison group).

Objectives: The overall goals of this study were to: (1) assess if elevated autism risk is associated with elevated maternal and sibling sleep problems, (2) assess whether sleep problems align with developmental functioning/concerns, and (3) assess whether maternal sleep problems are associated with child sleep problems.

Methods: Participants included families raising children with ASD (high-risk group; n=45) and families with no history of ASD (low-risk group, n=55) who were part of a prospective, longitudinal study. When children were 30 or 36 months of age, mothers completed the Children’s Sleep Habits Questionnaire (CSHQ), the Child Behavior Checklist (CBCL), and the Pittsburgh Sleep Quality Index (PSQI). At 30 or 36 months children also completed a detailed developmental battery and were classified as having developmental concerns (DC group, n=36) or typical development (TYP group, n=36). Additionally, between 18 and 24 months of age a subgroup of children (n=72) wore an actigraph to objectively record their sleep for 7 consecutive 24-hour periods.

Results: General linear models were employed with terms for infant sex and family income where appropriate. Risk group status was not associated with sleep problems reported on the CSHQ or CBCL. Similarly, actigraphy indexed sleep patterns were not significantly different across the risk groups. When comparing children in the DC and TYP groups, sleep problems on the CSHQ were elevated for children in the DC group for sleep onset delay (p<.05), sleep anxiety (p<.05), and were slightly elevated for bedtime resistance (p=.05). On the CBCL, general sleep problem reports were also elevated for children in the DC group (p<.01). Additionally, children in the DC group slept less at night (p<.05) and had more variable nighttime sleep (p<.01). Maternal reports of their own sleep did not differ across risk groups or DC and TYP groups. However, mothers were more likely to endorse problems with their own sleep if their child had high nighttime sleep variability (measured via actigraphy), short sleep duration, sleep distress, and general sleep problems (all p<.05).

Conclusions: Sleep problems in families raising children with autism do not appear to align with general ASD risk. Rather sleep problems in this study were associated with developmental concerns. For parents, having a child with a sleep problem, not simply a child with ASD, was associated with elevated problems with their sleep. This study demonstrates the strong interconnectedness of family sleep in families with and without a history of ASD.