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

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Hongyu Chen¹, Ting Yang¹, Jie Chen¹

¹Children's Hospital of Chongqing Medical University, Chongqing Key Laboratory of Childhood Nutrition and Health, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, 400014, China.

|August 17, 2021

Insights

Children with Autism Spectrum Disorder (ASD) experience more sleep problems, including bedtime resistance and anxiety. These issues correlate with core ASD symptoms but not developmental level, highlighting the need for sleep assessments in clinical practice.

Area of Science:

Neuroscience
Developmental Psychology
Pediatrics

Background:

Autism Spectrum Disorder (ASD) is frequently associated with sleep disturbances.
Understanding sleep patterns in ASD children in China is crucial.

Purpose of the Study:

To investigate sleep conditions in Chinese children with ASD.
To explore the relationship between sleep problems and core ASD symptoms and developmental levels.

Main Methods:

Cross-sectional study of 1310 ASD and 1158 typically-developing (TD) children aged 2-7 years in China.
Utilized the Children's Sleep Habits Questionnaire (CSHQ) for sleep assessment.
Assessed neurodevelopmental level (CNBS-R2016), ASD diagnosis (DSM-5, CARS), and autism behaviors (SRS, ABC).

Main Results:

ASD children showed significantly higher sleep disorder prevalence (67.4%) than TD children (51%).
Common issues included bedtime resistance (25.6%), sleep anxiety (22.7%), sleep onset delay (17.9%), and daytime sleepiness (14.7%).
Sleep onset delay and anxiety correlated with higher autism behavior scores; daytime sleepiness and bedtime resistance linked to more severe ASD symptoms.

Conclusions:

Children with ASD exhibit a higher prevalence of sleep problems.
Specific sleep issues like bedtime resistance and anxiety are linked to core ASD symptoms, not developmental level.
Routine sleep assessments and sleep hygiene education are vital in ASD clinical care.

Read full analysis

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 ).

Keywords:

ASD Children Multicenter Sleep hygiene Sleep problems

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