Anxiety and Sleep Disturbance in Youth with Autism Spectrum Disorder

Background: Sleep problems are prevalent in individuals with ASD, with up to 50-80% of children with ASD experiencing sleep disturbance (Williams, Sears & Allard, 2004). There are many factors that may contribute to insomnia in children with ASD. In the typically developing literature, anxiety symptoms are related to sleep disturbance (Alfano, Beidel, Tuner, & Lewin, 2006). In ASD, greater anxiety has also been related to sleep problems in broad samples of children and adolescents with ASD using parent-report questionnaires (Mazurek & Petroski, 2015). However, little is known about specific anxiety subtypes that may be related to greater sleep disturbance in youth with ASD.

Objectives: This study aimed to investigate the relation between specific anxiety subtypes and sleep disturbance in a well-characterized sample of youth with ASD.

Methods: Participants were 43 youth with ASD (aged: 7-14; IQ > 70). Sleep diaries were completed by parents at home for three nights. Parent (i.e., Multidimensional Anxiety Scale for Children-parent version; MASC-P), child (i,e., Multidimensional Anxiety Scale for Children-child version; MASC-C) and diagnostician (i.e., Pediatric Anxiety Rating Scale; PARS) reports of anxiety symptoms were collected.

Results: Preliminary results from correlational analyses suggest sleep disturbance is related to parent, child, and clinician-reports of anxiety. More nighttime awakenings were significantly related to greater total anxiety reported on the MASC-P (r=.657, p=.001), MASC-C (r=.438, p=.041), and PARS (r=.434, p=.038). Sleep quality was also significantly related to anxiety symptoms. Poorer sleep quality was related to greater overall anxiety on the MASC-P (r=-.513, p=.009). In regard to specific anxiety types, greater separation anxiety reported on the PARS and MASC-P was related to poorer sleep quality (r=-.466, p=.033; r=-.513, p=.009, respectively). Additionally, more nighttime awakenings were related to social anxiety symptoms reported on the MASC-P (r=.514, p=.014).

Conclusions: Findings from this study suggest anxiety may contribute to sleep disturbance in youth with ASD and no intellectual disability. In particular, sleep problems may be especially prevalent in children with separation anxiety and social anxiety. These results indicate that sleep is an important treatment target for anxious youth with ASD. Future research should continue to investigate insomnia as a determinant and/or consequence of anxiety in youth with ASD and examine other factors that may contribute to insomnia and anxiety in these youth.