Table 2 Studies exploring the relationship between sleep and challenging behaviors in ASD
From: The relationship between sleep and behavior in autism spectrum disorder (ASD): a review
Study | Type of study | Participants | Measurements | Significant findings | Effect sizes ( r)1 |
|---|---|---|---|---|---|
Schreck et al.[62] | Cross sectional | 55 parents of children with mixed ASD functioning aged 5–12 years | GARS, BEDS, and PSQ | Fewer hours of sleep per night predicted ASD severity score, social skill deficit, and stereotypic behavior | 0.33–0.34b |
Liu et al.[20] | Cross sectional | 27 children with ASD symptoms, and 32 with other DD (M = 8.8) | ADOS, CHSQ, and PSQ | Hypersensitivity to stimuli, younger age, co-sleeping, medication, epilepsy, history of sleep problems, and ADHD was associated with sleep problems in individuals with ASD | 0.09a–0.31b |
DeVincent et al. [64] | Cross sectional | Parents of children with PDD (n = 112) and TYP (n = 497) aged 3–5 | Early childhood inventory-4 and PSQ | PDD children with sleep problems had higher rates of ADHD, oppositional behavior, and psychiatric symptoms compared to children without sleep problems | 0.22–0.26a |
Goodlin-Jones et al.[65] | Cross sectional | 68 HFASD children, matched to 57 with DD, 69 TYP, aged 24–69 months | Actigraphy, MELC, VABC, ADOS, ADIR, MSEL, SD, CSHQ, ESS, and CBCL | Controlling for diagnosis and age, night-time sleep problems determined by parent report were significantly associated with decrements in daytime behavior | 0.30–0.43b |
Mayes et al.[66] | Cross sectional | Parents of 477 children with a range of ASD diagnoses (aged 1–15) | CARS, PBS, PSQ, WISC, WPPSI, and GDS | Sleep problems increased with severity of ASD symptoms. Oppositional behavior, aggression, ADHD, and mood variability predicted sleep disturbance in ASD | 0.59c |
Goldman et al.[67] | Cross sectional | 42 mixed ASD samples and 16 TYP children aged 4–10 years | PCQ, CSHQ, RBS-R, CBCL, PSG, and Actigraphy | Poor sleepers with ASD had more ADHD symptoms and more restricted and repetitive behaviors (RRBs) than good sleepers. Sleep fragmentation was correlated with more RRBs | 0.48b–0.69c |
Moon et al.[68] | Case study | 3 children (aged 8–9 years) diagnosed with an ASD | Actigraphy, SD, CSHQ, CBCL, and PSQ | Daytime behavior improved for 2/3 ASD patients following an intensive sleep treatment | x |
Rzepecka et al.[69] | Cross sectional | 187 parents with child aged 5–18 years with an ID and/or ASD from Scotland | ADOS, CSHQ, SCAS-P, and ABC | Sleep problems were the highest predictor of challenging behaviors in ASD | 0.62c |
Henderson et al.[9] | Cross sectional | Parents of children aged 6–12 years with ASD, Asperger’s (n = 58), and non-ASD (n = 57) | CSBQ, CRQ, BRQ, CSHS, CSWS, and CBCL | In the ASD group, poor sleep quality and hygiene were related to higher levels of externalizing behaviors | 0.60c |
Goldman et al.[10] | Cross sectional | Parents of 1,784 children, ages 2–18 with high-functioning autism (USA) | ADOS, CHSQ, and PCQ | Poor sleepers had a higher percentage of behavioral problems on all PCQ scales (e.g., aggression, RRBs, stereotypy, and hyperactivity) than good sleepers | 0.11a–0.34b |
Sikora et al. [70] | Cross sectional | Parents of 1,193 children with mixed ASD diagnosis aged 4–10 years (USA) | CSHQ, VABS, and MSEL | Moderate-severe sleep problems in ASD resulted in higher daytime externalizing behavior and poorer adaptive skills than those with ASD with no sleep problems | x |
Anders et al.[71] | Cross sectional | Parents of children with an ID (n = 57), ASD (n = 68), and TYP (n = 69), aged 24–66 months | ADOS, ADIR, MSEL, CBCL, actigraphy, CSHQ, and WISC | Parent-reported sleep problem but not actigraphy recordings were associated with more core behavior problems in ASD | 0.12a–0.39b |
Tudor et al.[8] | Cross sectional | Parents of 109 children with a diagnosis of ASD (aged 3–18 years) | CSHQ, GARS, and PECS board | Sleep-onset delay and duration was positively correlated with ASD severity and symptoms and was the strongest predictor of communication deficits and stereotypic behavior | 0.34b–0.51c |
Park et al.[7] | Cross sectional | Parents of 166 ASD children and 111 unaffected siblings aged 4–15 years from Korea | ADIR, ADOS, CSHQ, WISC, and K-CBCL | Communication abnormalities and RRBs were associated with increased risk of sleep problems in ASD. ASD individuals had higher, internalizing, and externalizing problems compared to their unaffected siblings | 0.31–0.43b |
Taylor et al.[72] | Cross sectional | Parents of children with an ASD (n = 335) aged 1–10 years (M = 5.5) | BEDS, WISC, WPPSI, MSEL, SIB-R, and VABS | Children who slept fewer hours per night had lower IQ, verbal skills, adaptive functioning, socialization, and communication skills | 0.40–0.44b |
Holloway et al.[73] | Cross sectional | 1,583 ASD children from Autism Treatment Network aged 2–17 years | CSHQ, VABS, MSEL, Stanford Binet, CBCL, ADOS, and SSP | Anxiety, ASD severity, sensory sensitivity, and GI issues all predicted sleep disturbance. IQ positively predicted sleep disturbance | 0.17a–0.44b |
Schwichtenberg et al. [74] | Cross sectional | ASD siblings (n = 104) and families with no history of ASD (n = 76) | MSEL, ADOS, CBCL, and PCQ | For both groups, sleep problems were associated with elevated behavior problems (e.g., reactivity, anxiety, somatic complaints, withdrawal, inattention, and aggression) | 0.16–0.21a |
Mannion et al.[47] | Cross sectional | Parents of 89 children and adolescents (aged 3–16) with mixed ASD subtypes in Ireland | ASD-CC, GSI, and CSHQ | Avoidant behavior, under-eating, and GI symptoms predicted sleep problems in individuals with an ASD | 0.46b–0.50c |
May et al.[75] | Longitudinal | Gender-matched children with high-functioning autism (n = 46) and TYP (n = 38) aged 7–12 years from Melbourne (Australia) | Conner’s third edition, SCAS, and CSHQ | The ASD group had more sleep disturbance than the TYP group. Sleep disturbance decreased over the year in children with ASD, and this was associated with improved social ability | 0.41b–0.69c |
Richdale et al.[50] | Cross sectional | 27 adolescents with high-functioning autism (aged 15–16) and 27 matched TYP controls | SD, actigraphy, CSRQ, CED-S, DASS-21, and SAAQ | Sleep variables significantly accounted for 57% of the variance of daytime functioning symptoms of insufficient sleep in the high-functioning ASD group | 0.75c |
Adams et al.[23] | Cross sectional | 548 children and adolescents (2–18 years), with ASD symptoms | ASD-CC | Individuals with severe sleep problems had higher levels of total challenging behaviors than those with mild sleep problems | −0.47b |