Behavioral Concerns Associated with Sleep Disturbance Severity in Children with ASD

Background: Sleep problems are commonly reported in children with ASD. Sleep difficulties are known to be associated with increased behavioral problems and can have negative impact on both child and family functioning.

Objectives: To examine the relationship of parent-reported behavioral concerns with sleep problems in children and adolescents with ASD as measured by the Composite Sleep Disturbance Index (CSDI).

Methods: U.S.-based primary caregivers of children with ASD were recruited from the Interactive Autism Network, a 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 were asked to rate their child’s behavior on a scale from 0 to 3 with 0 = absent and 3 representing most severe.

Results: 610 parent/child dyads were analyzed. Responding parents were the primary caregiver, primarily female (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, parents rated their child’s sleep problems, scoring as severe (≥4) in 377 (62%) or not severe (<4) in 233 (38%). 370 (60.7%) reported no or minimal behavioral concerns while 240 (39.3%) rated behavioral problems as Moderate, severe, or very severe. The percentage of parents rating their child’s behavioral problems as severe/very severe rose from 6% within the group with no sleep problems to 25% within the group with severe sleep problems. (χ2(6) = 64.17, P=0.000).

Conclusions: Sleep problems and behavioral difficulties in children with ASD are associated, with the prevalence of reported severe behavioral problems increasing with increasing severity of sleep based on parent report. These data confirm the association between behavioral issues and sleep issues in children with ASD. The presence of parent reported behavioral problems in a child with ASD should prompt screening for other comorbid conditions, such as sleep problems.