The Persistence of Sleep Disturbance in Children Evaluated for Autism Spectrum Disorders: Predictive Factors and the Impact of Co-occurring Diagnoses

Mounting research suggests that children with autism spectrum disorders (ASDs) and other clinical diagnoses demonstrate a higher prevalence of sleep problems than typically-developing children. Additionally, sleep problems are related to a number of cognitive, emotional, and behavioral concerns in pediatric populations. Limited research exists comparing sleep problems in children with ASDs with sleep problems in other clinical populations, or exploring the length of these sleep problems. The current study sought to explore the development and improvement of sleep problems over one year, as well as predictors to help identify children at high risk for persistent sleep problem. Impact of age, cognitive functioning, adaptive functioning, behavioral functioning, and number of co-occurring diagnoses were explored as predictors, and comparisons between clinical groups were made. Participants were 150 children referred for evaluation for ASDs in a hospital-based ASD assessment clinic. Measures of sleep, cognitive ability, developmental functioning, adaptive behavior, and behavioral functioning were administered in addition to other routine components of the multidisciplinary ASD assessment. The sleep measure was again administered one year later, with 49 patticipants responding. Results indicated that children with ASD did not demonstrate sleep problems at a higher prevalence than other clinically-referred children, but both children with ASD and other clinically-referred children demonstrated prevalence rates at least twice that of a previously-repo1ted typically-developing population. Additionally, unlike typically developing children, sleep problems were persistent over time, showing little decline one year later. Finally, the primary predictor of sleep problems across sleep-subdomains and age-groups was daytime behavior problems. These findings lend importance to the assessment and active treatment of sleep problems across clinically-referred populations, particularly for those children with elevated daytime behavioral problems