Primary caregiver education level and sleep problems in children with autism spectrum disorder

Sleep problems in children with autism spectrum disorder are prevalent and persistent but also treatable. Little is known about how and why parents of such children seek help for sleep disturbance. Via an online survey ( n = 244 respondents), we gathered information about parents’ attributions about children’s sleep problems and beliefs about causes and on sources of information about, and their decisions regarding, help-seeking. Eighty-two percent of parents reported seeking some kind of help for their child’s sleep disturbance, and the average parent had tried six different treatment strategies, most commonly medical. Alignment of parents’ treatment choices with empirical evidence about treatment efficacy was poor, but belief in effectiveness was closely related to frequency of use of a treatment. In a Principal Components Analysis, parental attributions loaded on two factors: one which suggests the sleep problems are viewed as intrinsic to autism and stable (factor one) and the other as located within the child, stable, and treatment resistant (factor two). These findings have important implications for parental education and clinical practice in the treatment of sleep problems in children with autism spectrum disorder. Lay abstract Sleep problems are commonly reported among parents of children with autism spectrum disorder (ASD). Without effective treatment, such problems are unlikely to resolve. To date, we know very little about how and why parents of children with ASD seek help for sleep disturbance. Via an online survey, we gathered information about how parents make sense of their children’s sleep problems, beliefs about their causes, sources of information, and help-seeking behavior. The analysis of responses from 244 parents revealed that parents commonly view sleep problems (a) as a consequence of their child’s ASD, and unlikely to change over time (stable), and (b) as located within the child (intrinsic), stable over time, and difficult to treat. Despite this, parents also rated sleep problems as being important to treat. Eighty-two percent of parents surveyed reported seeking some kind of help for their child’s sleep disturbance, and the average parent had tried six different treatment strategies, most commonly medical approaches (e.g. melatonin). The alignment between parents’ treatment choices and those strategies that are supported by research was poor, but belief in the effectiveness of treatments was closely related to how often the treatment was used. These findings have important implications for parental education and clinical practice in the treatment of sleep problems in children with ASD.

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Sleep problems in children with autism spectrum disorder: a multicenter survey

BMC Psychiatry ◽

10.1186/s12888-021-03405-w ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Hongyu Chen ◽

Ting Yang ◽

Jie Chen ◽

Li Chen ◽

Ying Dai ◽

...

Keyword(s):

Autism Spectrum Disorder ◽

Daytime Sleepiness ◽

Sleep Problems ◽

Sleep Onset ◽

Children With Autism ◽

Autism Spectrum ◽

Spectrum Disorder ◽

Onset Delay ◽

Multicenter Survey ◽

Core Symptoms

Abstract Background High prevalence of sleep problems have been reported in children with Autism Spectrum Disorder (ASD). This study aims to investigate the sleep conditions of ASD children in China, and explore the relationship between the common sleep problems and core symptoms and developmental levels. Methods Using a cross-sectional design, we included 2 to 7-year-old children from 13 cities in China: 1310 with ASD and 1158 with typically-developing (TD) children. The neurodevelopmental level was evaluated with the revised Children Neuropsychological and Behavior Scale (CNBS-R2016). ASD were diagnosed with DSM-5 and Child Autism Rating Scale (CARS). the Social Responsiveness Scale (SRS), the Autism Behavior Checklist (ABC) and the communication warning behavior sub-scale in CNBS-R2016 valued autism behaviors. The children’ s sleep habits questionnaire (CSHQ) assessed sleep conditions. Results The prevalence of sleep disorders in ASD children was significantly higher than that in TD (67.4% vs. 51%, p < 0.01), and among them the four dimensions with the highest prevalence of sleep problems were bedtime resistance (25.6%), sleep anxiety (22.7%), sleep onset delay (17.9%) and daytime sleepiness (14.7%). ASD children with sleep onset delay or sleep anxiety had higher ABC, SRS scores and higher scores on communication warning behavior with sleep anxiety, with daytime sleepiness had higher ABC, SRS and CARS scores, and with bedtime resistance had higher SRS total scores. Differences in the neurodevelopmental level were not significant. Conclusion Children with ASD have a higher prevalence of sleep problems. Bedtime resistance, anxiety, sleep onset delay and daytime sleepiness may be related to the core symptoms, but not be related to the developmental level in ASD children. In the clinic, sleep assessment should be included in the routine of ASD visits, and during the intervention, sleep hygiene education is as important as the treatment of biological factors. Trial registration The study was approved by the ethics committee of the Children’s Hospital of Chongqing Medical University, Approval Number: (2018) IRB (STUDY) NO. 121, and registered in the Chinese Clinical Trial Registry (Registration number: ChiCTR2000031194).

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Sleep Problems Influence Emotional/Behavioral Symptoms and Repetitive Behavior in Preschool-Aged Children With Autism Spectrum Disorder in the Unique Social Context of China

Frontiers in Psychiatry ◽

10.3389/fpsyt.2020.00273 ◽

2020 ◽

Vol 11 ◽

Author(s):

Yu-Qi Kang ◽

Xiao-Rong Song ◽

Geng-Fu Wang ◽

Yuan-Yuan Su ◽

Pei-Ying Li ◽

...

Keyword(s):

Autism Spectrum Disorder ◽

Social Context ◽

Sleep Problems ◽

Repetitive Behavior ◽

Children With Autism ◽

Autism Spectrum ◽

Spectrum Disorder ◽

Behavioral Symptoms ◽

Preschool Aged Children

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Variations in Genes Related to Sleep Patterns in Children With Autism Spectrum Disorder

Biological Research For Nursing ◽

10.1177/1099800419843604 ◽

2019 ◽

Vol 21 (3) ◽

pp. 335-342 ◽

Cited By ~ 2

Author(s):

Ann E. E. Johansson ◽

Janice S. Dorman ◽

Eileen R. Chasens ◽

Christine A. Feeley ◽

Bernie Devlin

Keyword(s):

Autism Spectrum Disorder ◽

Suprachiasmatic Nucleus ◽

Sleep Problems ◽

Children With Autism ◽

Autism Spectrum ◽

Spectrum Disorder ◽

Sleep Patterns ◽

Large Sample ◽

Melatonin Synthesis ◽

Children With Asd

Background: Sleep disturbance is a frequent comorbidity in children with autism spectrum disorder (ASD), affecting an estimated 40–80% of cases. Previous reports have shown relationships between several circadian rhythm–related genes and sleep problems in ASD. The purpose of the present study was to relate variation in and around melatonin synthesis and suprachiasmatic nucleus genes to sleep problems in a large sample of children with ASD. Method: This secondary analysis used existing genotypic and phenotypic data for 2,065 children, aged 4–18 years, from the Simons Simplex Collection (SSC). Sleep problems were measured with the SSC Sleep Interview. Expression quantitative trait loci and single nucleotide polymorphisms in 25 circadian genes were chosen primarily for their impact on expression levels of target genes in the brain. Associations between variants and composite sleep problems, nighttime problems, daytime problems, and sleep duration problems were calculated using logistic regression analysis. Age, sex, nonverbal IQ, ASD severity, gastrointestinal distress, seizures, and ancestry were included as covariates. Transmission disequilibrium tests were performed to test for overtransmission of alleles in the same variants. Results: No significant associations or transmission disequilibrium were found between gene variants and sleep problems in this sample of children with ASD. Conclusion: Variation in expression of investigated genes in the melatonin synthesis and suprachiasmatic nucleus pathways did not have notable impacts on sleep problems in this large sample of children with ASD. Future research could explore translational and posttranslational effects of these genes or the effects of genes in other sleep-homeostasis pathways on sleep patterns.

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