A quarterly publication of the Autism Research Institute

The Autism Research Review International is quarterly publication of the Autism Research Institute

Fall, 2022 | Number 4, Volume 36

Simple intervention reduces sleep problems in kids with ASD

The implementation of simple behavioral strategies may help to improve the sleep of many children with autism spectrum disorders (ASD), according to a new study from researchers in Australia and the United Kingdom. 

The study, by Nicole Papadopoulos and colleagues, involved 123 children who participated in an intervention called Sleeping Sound ASD and 122 children who did not participate. All of the children were between 5 and 13 years of age and had moderate to severe sleep problems. Children with medical conditions known to impact sleep were excluded. 

The researchers asked the children and parents in the intervention group to attend two 50-minute in-person sessions. It was important to involve the children in selecting and implementing sleep strategies, they say, in order to optimize results and encourage cooperation with the program. The first session focused on assessing the children’s sleep problems, providing information about sleep, and setting goals. Parents and children then worked together to choose from a variety of sleep strategies in order to create individualized sleep management plans. The second session focused on reinforcing sleep strategies, monitoring sleep patterns by reviewing a sleep diary, and addressing any issues reported by parents or children. Parents and children also participated in a phone call two weeks after the second session. 

The sleep intervention involved behavioral techniques such as these: 

• Bedtime fading—scheduling the initial bedtime at the time when the child normally fell asleep, and then moving the bedtime earlier in 15-minute increments. 

• Graduated extinction—weaning the child from the need to have a parent in the room by having the parent visit fewer and fewer times. 

• Offering a “bedtime pass”—granting the child one “free pass” to leave the bedroom each night. 

Using the Children’s Sleep Habits Questionnaire (CSHQ) to assess the children’s sleep problems three months after the start of the intervention, the researchers detected significant improvements. Areas of improvement included bedtime resistance, sleep onset delay, sleep duration, and total CSHQ score. Smaller but still significant effects were seen for sleep anxiety, night waking, and parasomnias. There was some reduction in benefit by the six-month mark, leading the researchers to suggest a “booster session” at six months to reinforce the use of the strategies. Some improvements were seen in secondary behaviors such as internalizing symptoms, emotional behavioral disturbances, and quality of life, but these were not statistically significant. 

The researchers conclude, “The sleeping sound ASD intervention is an efficacious and practical way to reduce sleep problems for autistic children.”

Editor’s note: The causes of sleep problems in children and adults with ASD are multifactorial. Autistic individuals and caregivers who are struggling with this problem can find additional information in the new book Understanding and Treating Sleep Disturbances in Autism, edited by Jane Johnson and myself. 


Citations

“Sleeping Sound Autism Spectrum Disorder (ASD): a randomised controlled trial of a brief behavioural sleep intervention in primary schoolaged autistic children,” Nicole Papadopoulos, Emma Sciberras, Harriet Hiscock, Katrina Williams, Jane McGillivray, Cathrine Mihalopoulos, Lidia Engel, Matthew Fuller-Tyszkiewicz, Susannah T. Bellows, Deborah Marks, Patricia Howlin, and Nicole Rinehart, Journal of Child Psychology and Psychiatry, October 2022 (free online). Address: Nicole Rinehart, School of Educational Psychology and Counselling, Faculty of Education, Monash University, 19 Ancora Imparo Way, Clayton VIC 3800, Australia, [email protected]

—and— 

“Bedtime routines and sleep strategies help autistic kids sleep, study reveals,” news release, Monash University, October 28, 2022.