Longitudinal relationship between sleep and emotional/behavioral problems in autism spectrum disorders: a cross-lagged panel analysis

Sleep, emotional, and behavioral problems are common comorbidities associated with autism spectrum disorder (ASD). Current longitudinal research on the temporal links between sleep problems and emotional-behavioral problems shows inconsistent results among preschool children with ASD. Hence, this longitudinal study aimed to examine the temporal associations between emotional-behavioral and sleep problems among preschool children with ASD across two time points. Among 124 enrolled preschool children with ASD, 70 completed follow-up and constituted the final analytic sample (mean age 36.7 ± 10.2 months at T1). They were evaluated for developmental quotient using the Griffiths Development Scales-Chinese version (GDS-C), ASD symptoms using Autism Behavior Checklist (ABC) and Childhood Autism Rating Scale (CARS), emotional and behavioral problems using the Child Behavior Checklist (CBCL), and sleep problems using the Children's Sleep Habits Questionnaire (CSHQ) at time 1 (T1). The evaluations were replicated at a follow-up appointment 18 months after T1 (time 2; T2). The cross-lagged panel model (CLPM) was employed to examine the potential relationship between CBCL and CSHQ scores in the children. The total CBCL score at T1 could predict the CSHQ at T2 (β = 0.348, t = 3.105, p = 0.002), whereas the CSHQ at T1 could not predict the CBCL at T2 (β = 0.117, t = 1.083, p = 0.279). Findings remained robust across five sensitivity subsets after excluding subgroups with distinct rehabilitation exposure, younger age, higher development quotients, girls, or mild ASD symptoms.

Emotional-behavioral problems predict sleep problems 18 months later in preschool ASD children. Screening of these symptoms during follow-up supports early sleep-risk monitoring.

• Sleep, emotional, and behavioral problems are common comorbidities associated with ASD. • Thus, researching their temporal correlation over time is necessary.

• Emotional and behavioral problems indicate a positive temporal correlation at T1, which was also evident for sleep problems at T2, in children with ASD. • Emotional and behavioral problems in preschool children with ASD can forecast sleep problems that develop 18 months later, providing guidance for clinical decision-making.