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Sleep Problems and Sensory Sensitivities Are Strongly Related in Children with ASD
Objectives: To examine whether a relationship between sleep and sensory processing is also apparent during early ASD development (below the age of 36 months) and whether longitudinal changes in sleep problems are associated with changes in sensory processing.
Methods: 195 children with ASD (mean age 3.77±1.54 years old, 45 females) were recruited at the Negev Autism Center (www.negevautism.org). All children fulfilled DSM 5 and Autism Diagnostic Observation Schedule (ADOS) criteria for ASD. Parents filled out the Children Sleep Habits Questionnaire (CSHQ), a caregiver questionnaire that quantifies the severity of sleep problems, and the Sensory Profile (SP), a caregiver questionnaire that quantifies sensory processing. In 44 of these cases, both questionnaires were filled out again (after ~1.5 years) by parents during an annual follow-up visit. The relationships between sleep and sensory measures were examined at both time-points.
Results: ASD children exhibited abnormally high rates of sleep disturbances (75% had total sleep disturbance scores >41 on the CSHQ) and sensory processing (52%) in comparison to typical development norms. Total sleep disturbance scores were most strongly associated with sensory sensitivity and avoidance scores in children under 36 months old (avoiding: r=0.56, p<0.001, sensitivity: r=0.59 p<0.001) and in older children with ASD (avoiding: r=0.47 p<0.001, sensitivity: r=0.56 p<0.001). Most importantly, changes in sleep disturbance scores over a period of 1.5 years were positively correlated with changes in sensory sensitivity and avoidance (avoiding r=0.39 p=0.04, sensitivity: r=0.45 p=0.01).
Conclusions: These results demonstrate that ASD children exhibit relatively large sleep and sensory abnormalities, which are strongly associated. This association is apparent not only in cross-sectional assessments, but also when examining longitudinal changes in sleep and sensory measures. We speculate that sleep problems and sensory sensitivities enhance one another in a vicious cycle that is likely to have considerable impact on the family’s well-being and on the efficacy of behavioral interventions. Specific targeted interventions for these particular children are currently lacking.