Sleep problems and their correlates and comorbid psychopathology of children with autism spectrum disorders

Abstract

This study examined sleep problems and their correlates and comorbid psychopathology in children with autism spectrum disorders (ASDs). Participants consisted of 166 ASD children and 111 unaffected siblings aged 4–15 years. Parents completed a self-administered child sleep questionnaire. Of the children with ASDs, 47.0% (78/166) had at least one sleep problem. Children with ASDs were more likely to have bedtime resistance (OR 2.72, 95% CI 1.02–7.21), insomnia (OR 4.07, 95% CI 1.60–10.35), and daytime sleepiness (OR 7.62, 95% CI 1.17–49.38) compared to their unaffected siblings. Among children with ASDs, multivariate logistic regression analyses indicated that communication abnormalities and repetitive stereotyped behaviors were associated with increased risk of sleep problems. ASD children with sleep problems were more likely to have withdrawal problems, somatizing problems, aggressive behaviors, internalizing problems, externalizing problems, and total behavioral problems compared to those without sleep problems. Sleep problems are prevalent in children with ASDs and are associated with both internalizing and externalizing problems. Clinicians should pay close attention to sleep problems when assessing and treating autistic behaviors.

Introduction

Children and adolescents with an autism spectrum disorders (ASDs) are vulnerable to sleep difficulties, with approximately two-thirds of these children experiencing sleep problems at some point in childhood (Richdale, 2001). Studies find parent-reported sleep problem rates ranging from 50% to 80% for children with an ASD, compared with 9–50% among comparison groups (Allik et al., 2006b, Couturier et al., 2005, Malow et al., 2006, Polimeni et al., 2005). The severity of sleep problems in children with autism is of particular concern in light of the increased burden and stress experienced in parenting a child with an ASD and the potentially adverse effects of sleep problems and insufficient sleep on daytime behavior and functioning (Allik et al., 2006a, Honomichl et al., 2002, Patzold et al., 1998).

Sleep problems may occur as a result of (1) intrinsic biological or genetic abnormalities that alter brain architecture or biochemistry, (2) psychological or behavioral characteristics connected with core or associated features of ASDs, or (3) factors in the family home or environment, including child-rearing practices that are not conducive to good sleep (Richdale & Schreck, 2009).

Generally, typically developing (TD) children are used as a comparison group to investigate the prevalence and characteristics of sleep problems in children with ASDs (Allik et al., 2006b, Couturier et al., 2005, Malow et al., 2006, Polimeni et al., 2005). However, when comparing ASD children with TD children, it is difficult to account for family factors, such as inadequate parental supervision of bedtime and sleep behaviors (Blader et al., 1997, Liu et al., 2003, Liu et al., 2000). Additionally, children's sleep problems are associated with poor family functioning, including marital discord, poor maternal health, and poor parenting (Wiggs & Stores, 2004). In this respect, a comparison of ASD children with their own siblings may be more appropriate than a comparison of ASD children with TD children. Therefore, the present study used unaffected siblings of ASD children as a comparison group.

This study aimed to (1) compare the prevalence of variable sleep problems among ASD children and their own siblings and (2) determine the correlates and comorbid psychopathology of sleep problems in ASD children.