Sleep Problems in Children with ASD: Effects on Parental Employment

Background:

Sleep problems are a frequent co-occurring medical condition in individuals with autism spectrum disorder (ASD), with reported prevalence up to 80%. Co-occurring sleep problems affect family quality of life. However, the mechanisms by which co-occurring sleep problems have this impact are not clear.

Objectives:

To examine the relationship between sleep problems in children and adolescents with ASD as measured by the Composite Sleep Disturbance Index (CSDI) and parental decision to work outside the home.

Methods:

U.S.-based parents of children with ASD were recruited from a validated and verified national autism registry. Parents completed an online survey on co-occurring conditions that incorporated family and child demographic information including the CSDI, a validated tool that scores the frequency and duration of six sleep habits (scored 0-2) over the previous month; total score range= 0-12; score ≥ 4 indicates a severe sleep problem. Parents also answered questions regarding family employment and parental health and well-being. Descriptive statistics, independent t-tests, and Pearson chi-square (χ²) tests were performed.

Results:

610 parent/child dyads were analyzed. Responding parents were the primary caregiver, primarily women (94%), white (89%), and non-Hispanic (92%); mean age of 43.3 (SD 7.2; range 25-65) years. Children were primarily male (81%), white (84%), and non-Hispanic (88%); mean age of 12.1 (SD 3.6; range 3-17) years. On the CSDI, 377 (62%) subjects were classified as severe and 233 (38%) as not severe. Parental age, race (white/non-white), and ethnicity (Hispanic/Non-Hispanic) did not differ between those with severe and not severe sleep problems. For parents who are employed outside the home, there was no difference in percentage who work full-time vs. part-time. However, there was a significant difference in employment status associated with sleep problems, with fewer parents of children with severe sleep problems being able to work outside the home compared to those with non-severe sleep concerns. Parents of children with severe sleep problems reported needing to stay home to care for their child with ASD much more frequently than those without severe sleep problems (43% vs 26%, χ² (1) = 10.80, p = 0.001). The proportion of working parents missing 5 or more days of work annually due to their child’s ASD was higher for those with severe compared to non-severe sleep problems (37% vs. 16%; χ² (2) = 19.64, p = 0.000).

Conclusions:

We found a strong association between the presence of severe sleep problems in the child with ASD and parental employment as well as work attendance. Parents of children with ASD and severe sleep problems tend to stay at home more frequently than parents of children with ASD without severe sleep problems, and miss more days of work. Co-occurring sleep problems may affect employment status in parents of children with ASD. Since identification and treatment of sleep problems in children with ASD may have benefits not only for the child, but also for family economic status and overall quality of life, children with ASD should be regularly screened for sleep problems.

This study was supported by Neurim Pharmaceuticals.