Skip to main content
Intended for healthcare professionals
Restricted access
Research article
First published online September 27, 2012

Children With Autism: Sleep Problems and Symptom Severity

Abstract

Relationships between the specific sleep problems and specific behavioral problems of children with autism were evaluated. Mothers’ reports of sleep habits and autism symptoms were collected for 109 children with autism. Unlike previous research in this area, only children diagnosed with autism without any commonly comorbid diagnoses (e.g., intellectual disability, epilepsy) were included in the analysis. Consistent with prior work, a positive correlation between the severity of sleep problems and the severity of autism symptoms was obtained. Sleep onset delay and sleep duration were positively correlated with autism symptoms and autism severity. Sleep onset delay was the strongest predictor of communication deficit, stereotyped behavior, and autism severity. These results provide support for specific sleep problem and symptom relationships that are unique to autism and suggest the importance of including the treatment of sleep problems as part of a comprehensive behavioral intervention for children with autism.

Get full access to this article

View all access and purchase options for this article.

References

Acock A. C. (2005). Working with missing values. Journal of Marriage and Family, 67, 1012–1028.
Allik H., Larsson J. O., Smedje H. (2006). Sleep patterns of school-age children with Asperger syndrome or high-functioning autism. Journal of Autism and Developmental Disorders, 36, 585–595.
American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders (4th ed., text rev.). Washington, DC: Author.
American Sleep Disorders Association. (1990). International classification of sleep disorders: Diagnostic and coding manual. Rochester, MN: Author.
Autism Society of America. (1994). Definition of autism. Advocate: Newsletter of the Autism Society of America, 26, 3.
California Department of Developmental Services. (2008). Information about regional centers. Available from http://www.dds.ca.gov
Carr E. G. (1992). Emerging themes in the functional analysis of problem behavior. Journal of Applied Behavior Analysis, 27, 393–399.
Chervin R. D., Archbold K. H., Dillon J. E., Panahi P., Pituch K. J., Dahl R. E., Guilleminault C. (2002). Inattention, hyperactivity, and symptoms of sleep-disordered breathing. Pediatrics, 109, 449–456.
Christodulu K. V., Durand V. M. (2004). Reducing bedtime disturbance and night waking using positive bedtime routines and sleep restriction. Focus on Autism and Other Developmental Disabilities, 19, 130–139.
Corkum P., Tannock R., Moldofsky H., Hogg-Johnson S., Humphries T. (2001). Actigraphy and parental ratings of sleep in children with attention deficit/hyperactivity disorder. Sleep, 24, 3030–3312.
Cortesi F., Giannotti F., Ottaviano S. (2005). Sleep problems and daytime behavior in childhood idiopathic epilepsy. Epilepsia, 40, 1557–1565.
Cotton S., Richdale A. (2006). Brief report: Parental descriptions of sleep problems in children with autism, Down syndrome, and Prader-Willi syndrome. Research in Developmental Disabilities, 27, 151–161.
DeVincent C. J., Gadow K. D., Delosh D., Geller L. (2007). Sleep disturbance and its relation to DSM-IV psychiatric symptoms in preschool-age children with pervasive developmental disorder and community controls. Journal of Child Neurology, 22, 161–169.
Didden R., Korzilius H., van Aperlo B., van Overloop C., de Vries M. (2002). Sleep problems and daytime problem behaviours in children with intellectual disability. Journal of Intellectual Research, 46, 537–547.
Elia M., Ferri R., Musumeci S. A., Del Gracco S., Bottitta M., Scuderi C.,. . .Grubar J. C. (2000). Sleep in subjects with autistic disorder: A neurophysiological and psychological study. Brain & Development, 22, 88–92.
Filipek P. A., Accardo P. J., Ashwal S., Baranek G. T., Cook E. H. Jr., Dawson G,. . .Volkmar F. R. (2000). Practice parameters: Screening and diagnosis of autism. American Academy of Neurology, 55, 468–479.
Gilliam J. E. (1995). Gilliam Autism Rating Scale. Austin, TX: Pro-Ed.
Gilliam J. E. (2006). Gilliam Autism Rating Scale–Second edition. Austin, TX: Pro-Ed.
Goodlin-Jones B., Schwichtenberg A. J., Iosif A. M., Tang K., Liu J., Anders T. F. (2009). Six-month persistence of sleep problems in young children with autism, developmental delay, and typical development. Journal of the American Academy of Child & Adolescent Psychiatry, 48, 847–854.
Gottlieb D. J., Vezina R. M., Chase C. (2003). Symptoms of sleep-disordered breathing in 5-year-old children with sleepiness and problem behaviors. Pediatrics, 112, 870–877.
Guénolé F., Godbout R., Nicolas A., Franco P., Claustrat B., Baleyte J. (2011). Melatonin for disordered sleep in individuals with autism spectrum disorders: Systematic review and discussion. Sleep Medicine Reviews, 15, 379–387.
Hoban T. F. (2000). Sleeplessness in children with neurodevelopmental disorders: Epidemiology and management. CNS Drugs, 14, 11–22.
Hoffman C. D., Sweeney D. P., Gilliam J. E., Apodaca D. D., Lopez-Wagner M. C., Castillo M. M. (2005). Sleep problems and symptomology in children with autism. Focus on Autism and Other Developmental Disabilities, 20, 194–200.
Hoffman C. D., Sweeney D. P., Gilliam J. E., Lopez-Wagner M. C. (2006). Sleep problems in children with autism and in typically developing children. Focus on Autism and Other Developmental Disabilities, 21, 146–152.
Hoffman C. D., Sweeney D. P., Lopez-Wagner M. C., Hodge D., Nam C., Botts B. (2008). Children with autism: Sleep problems and mothers’ stress. Focus on Autism and Other Developmental Disabilities, 23, 155–165.
Honomichl R. D., Goodlin-Jones B. L., Burnham M. M., Gaylor E., Anders T. F. (2002). Sleep patterns of children with pervasive developmental disorders. Journal of Autism and Other Developmental Disorders, 29, 143–147.
Kheirandish L., Gozal D. (2006). Neurocognitive dysfunction in children with sleep disorders. Developmental Science, 9, 388–399.
Krakowiak P., Goodlin-Jones B., Hertz-Picciotto I., Croen L. A., Hansen R. L. (2008). Sleep problems in children with autism spectrum disorders, developmental delays, and typical development: A population based study. Journal of Sleep Research, 17, 197–206.
Lecavalier L. (2005). An evaluation of the Gilliam Autism Rating Scale. Journal of Autism and Developmental Disorders, 35, 795–805.
Liu X., Hubbard J. A., Fabes R. A., Adam J. A. (2006). Sleep disturbances and correlates of children with autism spectrum disorders. Child Psychiatry & Human Development, 37, 179–191.
Maganti R., Hausman N., Koehn M., Sandok E., Glurich I., Mukesh B. N. (2006). Excessive daytime sleepiness and sleep complaints among children with epilepsy. Epilepsy & Behavior, 8, 272–277.
Malow B. A., Marzec M. L., McGrew S. G., Wang L., Hendersen L. M., Stone W. L. (2006).Characterizing sleep in children with autism spectrum disorders: A multidimensional approach. Sleep, 29, 1563–1571.
Matson J. L., Nebel-Schwalm M. S. (2005). Comorbid psychopathology with autism spectrum disorder in children: An overview. Research in Developmental Disabilities, 28, 341–352.
Mindell J. A. (1993). Sleep disorders in children. Health Psychology, 12, 151–162.
National Institutes of Health. (2003). National sleep disorders research plan. Washington, DC: U.S. Department of Health and Human Services, National Center on Sleep Disorders Research.
National Research Council. (2001). Educating children with autism. Washington, DC: National Academic Press.
O’Connor A. B., Healy O. (2010). Long-term post-intensive behavioral intervention outcomes for five children with autism spectrum disorder. Research in Autism Spectrum Disorders, 4, 594–604.
Owens J. A., Spirito A., McGuinn M. (2000). The Children’s Sleep Habits Questionnaire (CSHQ): Psychometric properties of a survey instrument for school-aged children. Sleep, 23, 1043–1051.
Oyane N. M. F., Bjorvatn B. (2005). Sleep disturbances in adolescents and young adults with autism and Asperger syndrome. Autism: The International Journal of Research and Practice, 9, 83–94.
Paavonen E. J., Vehkalahti K., Vanhala R., von Wendt L., Nieminen-von Wendt T., Aronen E. T. (2008).Sleep problems in children with Asperger syndrome. Journal of Autism and Developmental Disorders, 38, 41–51.
Patzold L. M., Richdale A. L., Tonge B. J. (1998). An investigation into sleep characteristics of children with autism and Asperger’s disorder. Journal of Paediatric Child Health, 34, 528–533.
Randazzo A. C., Meuhlbach M. J., Schweitzer P. K., Walsh J. K. (1998). Cognitive function following acute sleep restriction in children ages 10-14. Sleep, 21, 861–868.
Richdale A. L. (1999). Sleep problems in autism: Prevalence, cause and intervention. Developmental Medicine & Child Neurology, 41, 60–66.
Richdale A. L., Francis A., Gavidia-Payne S., Cotton S. (2000). Stress, behaviour and sleep problems in children with an intellectual disability. Journal of Intellectual & Developmental Disability, 25, 147–161.
Richdale A. L., Schreck K. A. (2009). Sleep problems in autism spectrum disorders: Prevalence, nature, & possible biopsychosocial aetiologies. Sleep Medicine Reviews, 13, 403–411.
Ritvo E. R., Freeman B. J. (1978). National Society for Autistic Children definition of the syndrome of autism. Journal of Autism and Childhood Schizophrenia, 8, 162–167.
Sadeh A., Gruber R., Raviv A. (2002). Sleep, neurobehavioral functioning, and behavior problems in school-age children. Child Development, 73, 405–417.
Schreck K. A., Mulick J. A. (2000). Parental report of sleep problems in children with autism. Journal of Autism and Developmental Disorders, 30, 127–135.
Schreck K. A., Mulick J. A., Smith A. F. (2004). Sleep problems as possible predictors of intensified symptoms of autism. Research in Developmental Disabilities, 25, 57–66.
Schwichtenberg A. J., Iosif A. M., Goodlin-Jones B., Tang K., Anders T. (2011). Daytime sleep patterns in preschool children with autism, developmental delay, and typical development. American Journal of Intellectual and Developmental Disabilities, 116, 142–152.
South M., Williams B. J., McMahon W. M., Owley T., Filipek P. A., Shernoff E.,. . .Ozonoff S. (2002). Utility of the Gilliam Autism Rating Scale in research and clinical populations. Journal of Autism and Developmental Disorders, 32, 593–599.
Statistical Package for the Social Sciences. (2006). Statistical Package for the Social Sciences (Release 15.0) [Computer software]. Chicago: Author.
Stuart M., McGrew J. H. (2009). Caregiver burden after receiving a diagnosis of an autism spectrum disorder. Research in Autism Spectrum Disorders, 3, 86–97.
Waterhouse L., Morris R., Allen D., Dunn M., Fein D., Feinstein C.,. . .Wing L. (1996). Diagnosis and classification in autism. Journal of Autism and Developmental Disorders, 26, 59–86.
Wiggs L. D. (2003). Pediatric sleep disorders: The need for multidisciplinary sleep clinics. International Journal of Pediatric Otorhinolarynology, 67, 115–120.
Wiggs L., Stores G. (2004). Sleep patterns and sleep disorders in children with autistic spectrum disorders: Insights using parent report and actigraphy. Developmental Medicine & Child Neurology, 46, 372–380.
Williams P. G., Sears L. L., Allard A. (2004). Sleep problems in children with autism. Journal of Sleep Research, 13, 265–268.

Cite article

Cite article

Cite article

OR

Download to reference manager

If you have citation software installed, you can download article citation data to the citation manager of your choice

Share options

Share

Share this article

Share with email
EMAIL ARTICLE LINK
Share on social media

Share access to this article

Sharing links are not relevant where the article is open access and not available if you do not have a subscription.

For more information view the Sage Journals article sharing page.

Information, rights and permissions

Information

Published In

Article first published online: September 27, 2012
Issue published: December 2012

Keywords

  1. autism
  2. sleep problems
  3. stereotyped behaviors
  4. communication
  5. social interaction

Rights and permissions

© 2012 Hammill Institute on Disabilities.
Request permissions for this article.

Authors

Affiliations

Megan E. Tudor, MA
Stony Brook University, NY, USA
Charles D. Hoffman, PhD
California State University, San Bernardino, USA
Dwight P. Sweeney, PhD
California State University, San Bernardino, USA

Notes

Megan E. Tudor, MA, Department of Psychology, Stony Brook University, Stony Brook, NY 11794-2500, USA Email: [email protected]

Metrics and citations

Metrics

Journals metrics

This article was published in Focus on Autism and Other Developmental Disabilities.

VIEW ALL JOURNAL METRICS

Article usage*

Total views and downloads: 2884

*Article usage tracking started in December 2016


Articles citing this one

Receive email alerts when this article is cited

Web of Science: 82 view articles Opens in new tab

Crossref: 88

  1. GamerFit-ASD beta test: adapting an evidence-based exergaming and tele...
    Go to citation Crossref Google Scholar
  2. Effect of Children’s Autism Spectrum Disorder Severity on Family Strai...
    Go to citation Crossref Google Scholar
  3. Longitudinal Examination of Sleep Problems and Symptom Severity in Chi...
    Go to citation Crossref Google Scholar
  4. Parent-rated anxiety in autistic adolescents and young adults: Concurr...
    Go to citation Crossref Google Scholar
  5. Getting a Good Night’s Sleep: Sleep Problems, Their Etiology, and Pote...
    Go to citation Crossref Google Scholar
  6. Cross-country comparison of parental reports and objective measures of...
    Go to citation Crossref Google Scholar
  7. Maladaptive Behavior and Associated Factors among Young Children with ...
    Go to citation Crossref Google Scholar
  8. Parasympathetic functioning and sleep problems in children with autism...
    Go to citation Crossref Google Scholar
  9. COVID-19 Pandemic and Autism Spectrum Disorder, Consequences to Childr...
    Go to citation Crossref Google Scholar
  10. Sleep and Cognition in People with Autism Spectrum Condition: A System...
    Go to citation Crossref Google Scholar
  11. Familial sleep and autism spectrum disorder: a pilot actigraphy study ...
    Go to citation Crossref Google Scholar
  12. A cross-cultural comparison of sleep patterns between typically develo...
    Go to citation Crossref Google Scholar
  13. Rol de la terapia farmacológica en los trastornos del espectro autista
    Go to citation Crossref Google Scholar
  14. Sleep Problems and 6-Sulfatoxymelatonin as Possible Predictors of Symp...
    Go to citation Crossref Google Scholar
  15. Impact of Developmental Disability on Frequent School Absenteeism in U...
    Go to citation Crossref Google Scholar
  16. Collateral Child and Parent Effects of Function‑Based Behavioral Inter...
    Go to citation Crossref Google Scholar
  17. Suggested Solutions for Sleep Problems in Children with Intellectual D...
    Go to citation Crossref Google Scholar
  18. The Sensory Abnormality Mediated Partially the Efficacy of Repetitive ...
    Go to citation Crossref Google Scholar
  19. The Assessment and Treatment of Stereotypy in the Sleep Context
    Go to citation Crossref Google Scholar
  20. Examining the Relationship Between Sleep Quality, Social Functioning, ...
    Go to citation Crossref Google Scholar
  21. Introduction to Autism Spectrum Disorders (ASDs): Genetic and Environm...
    Go to citation Crossref Google Scholar
  22. Psychotropic Medications for Sleep Disorders in Autism Spectrum Disord...
    Go to citation Crossref Google Scholar
  23. Sleep Problems in Children and Adolescents with Autism: Type, Severity...
    Go to citation Crossref Google Scholar
  24. Sleep problems in children with autism spectrum disorder: a multicente...
    Go to citation Crossref Google Scholar
  25. The Brainstem-Informed Autism Framework: Early Life Neurobehavioral Ma...
    Go to citation Crossref Google Scholar
  26. Autism Spectrum Disorder and Intellectual Disability: A Pilot Study Ex...
    Go to citation Crossref Google Scholar
  27. Parental Quality of Life and Involvement in Intervention for Children ...
    Go to citation Crossref Google Scholar
  28. Associations Between Child Sleep Problem Severity and Maternal Well-Be...
    Go to citation Crossref Google Scholar
  29. Sleep disturbances in autism spectrum disorder without intellectual im...
    Go to citation Crossref Google Scholar
  30. Is autonomic function during resting-state atypical in Autism: A syste...
    Go to citation Crossref Google Scholar
  31. Sleep Disorders in Children With Autism Spectrum Disorder: Insights Fr...
    Go to citation Crossref Google Scholar
  32. Behaviour, cognition, and autism symptoms and their relationship with ...
    Go to citation Crossref Google Scholar
  33. Sleep phenotype of individuals with autism spectrum disorder bearing m...
    Go to citation Crossref Google Scholar
  34. Effects of Sleep Disturbances on Behavioral Problems in Preschool Chil...
    Go to citation Crossref Google Scholar
  35. Brief report: Measures of effectiveness for single-question sleep prob...
    Go to citation Crossref Google Scholar
  36. Autism Spectrum Disorder
    Go to citation Crossref Google Scholar
  37. Autism Spectrum Disorder Relationship Between Sleep and Behavior: The ...
    Go to citation Crossref Google Scholar
  38. The Association between Autistic Traits and Sleep Habits/Problems in T...
    Go to citation Crossref Google Scholar
  39. Barriers and facilitators to treating insomnia in children with autism...
    Go to citation Crossref Google Scholar
  40. Sleep Problems and Trajectories of Restricted and Repetitive Behaviors...
    Go to citation Crossref Google Scholar
  41. Child and Family Characteristics Associated with Sleep Disturbance in ...
    Go to citation Crossref Google Scholar
  42. Systematic review of the collateral effects of behavioral sleep interv...
    Go to citation Crossref Google Scholar
  43. Understanding the role of sleep and its disturbances in Autism spectru...
    Go to citation Crossref Google Scholar
  44. Auditory processing, co-morbidities, and parental report of sleep dist...
    Go to citation Crossref Google Scholar
  45. Sleep, brain development, and autism spectrum disorders: Insights from...
    Go to citation Crossref Google Scholar
  46. Practice guideline: Treatment for insomnia and disrupted sleep behavio...
    Go to citation Crossref Google Scholar
  47. An eHealth insomnia intervention for children with neurodevelopmental ...
    Go to citation Crossref Google Scholar
  48. Sleep disturbances and associated factors among 2-6-year-old male chil...
    Go to citation Crossref Google Scholar
  49. Associations between parenting stress, parent mental health and child ...
    Go to citation Crossref Google Scholar
  50. Problem Behavior in Autism Spectrum Disorder: Considering Core Symptom...
    Go to citation Crossref Google Scholar
  51. Shank3 modulates sleep and expression of circadian transcription facto...
    Go to citation Crossref Google Scholar
  52. Comparison of Online and Face-to-Face Parent Education for Children wi...
    Go to citation Crossref Google Scholar
  53. Characterizing the Interplay Between Autism Spectrum Disorder and Como...
    Go to citation Crossref Google Scholar
  54. Sleep Dysfunction and Behavioral Daytime Problems in Children with Aut...
    Go to citation Crossref Google Scholar
  55. Autism and arousal
    Go to citation Crossref Google Scholar
  56. Investigating autism etiology and heterogeneity by decision tree algor...
    Go to citation Crossref Google Scholar
  57. Sleep problems in adults with autism spectrum disorder and intellectua...
    Go to citation Crossref Google Scholar
  58. The bidirectional association between sleep problems and autism spectr...
    Go to citation Crossref Google Scholar
  59. Pharmacological Approach to Sleep Disturbances in Autism Spectrum Diso...
    Go to citation Crossref Google Scholar
  60. Gelişimsel Yetersizliği Olan Çocuklarda Uyku Sorunları Ve Davranışsal ...
    Go to citation Crossref Google Scholar
  61. Sleep Problems and Their Relationship to Maladaptive Behavior Severity...
    Go to citation Crossref Google Scholar
  62. Sleep and Challenging Behaviors in the Context of Intensive Behavioral...
    Go to citation Crossref Google Scholar
  63. Impact of a Brief Behavioral Intervention for Insomnia on Daytime Beha...
    Go to citation Crossref Google Scholar
  64. Melatonin and Comorbidities in Children with Autism Spectrum Disorder
    Go to citation Crossref Google Scholar
  65. Sleep problems in children with autism spectrum disorder and intellect...
    Go to citation Crossref Google Scholar
  66. Behaviorally-determined sleep phenotypes are robustly associated with ...
    Go to citation Crossref Google Scholar
  67. Sleep problems in adolescents with Asperger syndrome or high-functioni...
    Go to citation Crossref Google Scholar
  68. Shorter sleep duration is associated with social impairment and comorb...
    Go to citation Crossref Google Scholar
  69. Using Functional Behavioral Assessment to Develop a Multicomponent Tre...
    Go to citation Crossref Google Scholar
  70. Assessment of parent report and actigraphy for sleep in children with ...
    Go to citation Crossref Google Scholar
  71. The multi-component nature of statistical learning
    Go to citation Crossref Google Scholar
  72. Sleep problems in adolescents with Asperger syndrome or high-functioni...
    Go to citation Crossref Google Scholar
  73. Specific Medical Conditions Are Associated with Unique Behavioral Prof...
    Go to citation Crossref Google Scholar
  74. Sleep and melatonin secretion abnormalities in children and adolescent...
    Go to citation Crossref Google Scholar
  75. Severity of Autism Spectrum Disorders: Current Conceptualization, and ...
    Go to citation Crossref Google Scholar
  76. A Pilot Study of the Association of Markers of Cholesterol Synthesis w...
    Go to citation Crossref Google Scholar
  77. Health Care Transition Services for Youth With Autism Spectrum Disorde...
    Go to citation Crossref Google Scholar
  78. Plasma levels of serotonin, gastrointestinal symptoms,and sleep proble...
    Go to citation Crossref Google Scholar
  79. Sleep in Neurodevelopmental Disorders
    Go to citation Crossref Google Scholar
  80. Sleep Disturbances in Autism Spectrum Disorders
    Go to citation Crossref Google Scholar
  81. Frequency and Clinical Correlates of Sleep-Related Problems Among Anxi...
    Go to citation Crossref Google Scholar
  82. Pain as a predictor of sleep problems in youth with autism spectrum di...
    Go to citation Crossref Google ScholarPub Med
  83. The relationship between sleep and behavior in autism spectrum disorde...
    Go to citation Crossref Google Scholar
  84. Using a Behavioral Treatment Package for Sleep Problems in Children Wi...
    Go to citation Crossref Google Scholar
  85. Sleep in Individuals with an Intellectual or Developmental Disability:...
    Go to citation Crossref Google Scholar
  86. Sleep in Children with Neurodevelopmental Disorders
    Go to citation Crossref Google Scholar

Figures and tables

Figures & Media

Tables

View Options

Get access

Access options

If you have access to journal content via a personal subscription, university, library, employer or society, select from the options below:


Alternatively, view purchase options below:

Purchase 24 hour online access to view and download content.

Access journal content via a DeepDyve subscription or find out more about this option.

View options

PDF/ePub

View PDF/ePub

Full Text

View Full Text