Association of Child and Adolescent Sleep Problems with Child and Parental Health

Background: The stress of caring for a child with autism spectrum disorder (ASD) and problematic behaviors can affect caregivers’ physical and mental health. Studies have shown that the presence of additional medical conditions in the child with ASD has a negative effect on quality of life beyond having ASD alone. We hypothesize that co-occurring sleep problems in children with ASD can affect child and parental medical and mental health beyond effects of the child's ASD alone.

Objectives: The purpose of this study is to examine the relationship of co-occurring sleep problems in children with ASD and medical and mental health in the child and parents .

Methods: U.S.-based primary 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. Commonly co-occurring medical conditions in the child (gastrointestinal, sleep, epilepsy, etc.) were documented. Parents were asked about their own medical and mental health conditions such as hypertension, overweight, diabetes, anxiety, and depression. Participants also responded regarding any extra visits beyond routine health supervision to health professionals for their child or themselves.

Results:

579 mothers/child dyads were analyzed. Responding parents were the primary caregiver, primarily white (89%) and non-Hispanic (92%); mean age of 43.2 (SD 7.26; range 25-65) years. Children were primarily male (81%), white (84%), and non-Hispanic (88%); mean age of 12.1 (SD 3.61; range 3-17) years. On the CSDI parents rated their child’s sleep problems as Severe (score≥4) =363 (63%); Not Severe (score<4) =216 (37%). There was no statistically significant difference in maternal age, race (white/non-white), or ethnicity (Hispanic/Non-Hispanic) between those with and without severe sleep problems.

According to parents’ reports, children classified as Severe sleep problems required additional visits for non-routine medical care to their primary care provider (χ²(1) = 12.7643, p = 0.000), specialist (χ² (1) = 13.3529, p = 0.000) or emergency room (χ²(1) = 7.0662, p = 0.008) as compared to those with Not Severe sleep problems. Mothers of children with Severe sleep problems were more likely to be overweight (χ² (1) = 9.1322, p = 0.003) ) diabetic (χ²(1) = 5.9005, p = 0.015), and report higher rate of anxiety or depression (χ²(1) = 6.8281, p = 0.009).

Conclusions:

Children with ASD and co-occurring sleep problems require additional primary care provider, specialist or emergency room visits. Primary caregivers of children with ASD and severe sleep problems had increased prevalence of overweight, diabetes and anxiety or depression. Co-occurring sleep problems in ASD have serious implications on child medical support and parent health, with subsequent economic burden on the family. A better understanding of those factors that impact caregiver burden could help healthcare providers identify appropriate services and treatments to promote better health for their child with ASD and reduce negative effects on caregiver health status.