Abstract
Sleep-related problems (SRPs) are common and problematic among anxious youth but have not been investigated in anxious youth with autism spectrum disorder (ASD). Participants were 102 youth (ages 7–16 years) with ASD and comorbid anxiety. Youth and their primary caregiver were administered the Pediatric Anxiety Rating Scale. Parents completed the Multidimensional Anxiety Scale for Children–Parent (MASC-P) Report, Social Responsiveness Scale, and the Child Behavior Checklist (CBCL). A measure of SRPs was created from items from the CBCL and MASC-P. Results suggest SRPs were relatively common among youth with ASD and comorbid anxiety. The number of SRPs endorsed directly associated with parent ratings of social deficits, internalizing and externalizing symptoms, and anxiety symptoms, as well as with clinician-rated anxiety symptoms. Parent-rated internalizing symptoms predicted frequency of SRPs over and above social deficits, externalizing symptoms, and parent- and clinician-rated anxiety symptoms. A subset of 40 participants who completed family-based cognitive–behavioral therapy (CBT) experienced reduced SRPs following treatment. Implications, study limitations, and recommendations for future research are discussed.
Similar content being viewed by others
References
National Sleep Foundation (1991) Sleep in America: a national survey of U.S. adults. Princeton, The Gallup Organization
Meltzer LJ, Mindell JA (2006) Sleep and sleep disorders in children and adolescents. Psychiatry Clinics of North America 29:1059–1076
Alfano CA, Ginsburg GS, Kingery JN (2007) Sleep-related problems among children and adolescents with anxiety disorders. J Am Acad Child Adolesc Psychiatry 46:224–232
Fallone G, Owens JA, Deane J (2002) Sleepiness in children and adolescents: clinical implications. Sleep Med Rev 6:287–306
Kheirandish L, Gozal D (2006) Neurocognitive dysfunction in children with sleep disorders. Dev Sci 9:388–399
Sadeh A, Gruber R, Raviv A (2002) Sleep, neurobehavioral functioning, and behavior problems in school-age children. Child Dev 73:405–417
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
Malow BA, Marzec ML, McGrew SG, Wang L, Henderson LM, Stone WL (2006) Characterizing sleep in children with autism spectrum disorders: a multidimensional approach. Sleep 29:1563–1571
Beebe DW, Wells CT, Jeffries J, Chini B, Kalra M, Amin R (2004) Neuropsychological effects of pediatric obstructive sleep apnea. J Int Neuropsychol Soc 10:962–975
Gregory AM, O’Connor TG (2002) Sleep problems in childhood: a longitudinal study of developmental change and association with behavioral problems. J Am Acad Child Adolesc Psychiatry 41:964–971
Gregory AM, Caspi A, Eley TC, Moffitt TE, O’Connor TG, Poulton R (2005) Prospective longitudinal associations between persistent sleep problems in childhood and anxiety and depressive disorders in adulthood. J Abnorm Child Psychol 33:157–163
Ong SH, Wickramaratne P, Tang M, Weissman MM (2006) Early childhood sleep and eating problems as predictors of adolescent and adult mood and anxiety disorders. J Affect Disord 96:1–8
Chase RM, Pincus DB (2011) Sleep-related problems in children and adolescents with anxiety disorders. Behav Sleep Med 9:224–236
Storch EA, Murphy TK, Lack CW, Geffken GR, Jacob ML, Goodman WK (2008) Sleep-related problems in pediatric obsessive–compulsive disorder. J Anxiety Disord 22:877–885
Alfano CA, Zakem AH, Costa NM, Taylor LK, Weems CF (2009) Sleep problems and their relation to cognitive factors, anxiety, and depressive symptoms in children and adolescents. Depress Anxiety 26:503–512
Storch EA, Milsom V, Lack CW, Pence SL, Geffken GR, Jacob ML et al (2009) Sleep-related problems in youth with Tourette’s Syndrome and chronic tic disorder. Child Adolesc Mental Health 14:97–103
Astill RG, Van der Heijden KB, Van Ijzendoorn MH, Van Someren EJW (2012) Sleep, cognition, and behavioral problems in school-age children: a century of research meta-analyzed. Psychol Bull 138:1109–1138
Anderson S, Morris J (2006) Cognitive behaviour therapy for people with Asperger syndrome. Behav Cogn Psychother 34:293–303
Matson JL, Nebel-Schwalm MS (2007) Comorbid psychopathology with autism spectrum disorder in children: an overview. Res Dev Disabil 28:341–352
Nadeau J, Sulkowski ML, Ung D, Wood JJ, Lewin AB, Murphy TK et al (2011) Treatment of comorbid anxiety and autism spectrum disorders. Neuropsychiatry 1:567–578
Williams PG, Sears LL, Allard A (2004) Sleep problems in children with autism. J Sleep Res 13:265–268
Krakowiak P, Goodlin-Jones B, Hertz-Picciotto I, Croen LA, Hansen RL (2008) Sleep problems in children with autism spectrum disorders, developmental delays, and typical development: a population-based study. J Sleep Res 17:197–206
Lord C, Rutter M, DiLavore PC, Risi S (1999) Autism diagnostic observation schedule. Western Psychological Services, Los Angeles
Polimeni MA, Richdale AL, Francis AJP (2005) A survey of sleep problems in autism, Asperger’s disorder and typically developing children. J Intellect Disabil Res 49:260–268
Tudor ME, Hoffman CD, Sweeney DP (2012) Children with autism: sleep problems and symptom severity. Focus Autism Other Dev Disabil 27:254–262
de Bruin EI, Ferdinand RF, Meester S, de Nijs PF, Verheij F (2007) High rates of psychiatric co-morbidity in PDD-NOS. J Autism Dev Disord 37:877–886
Leyfer OT, Folstein SE, Bacalman S, Davis NO, Dinh E, Morgan J et al (2006) Comorbid psychiatric disorders in children with autism: interview development and rates of disorders. J Autism Dev Disord 36:849–861
Muris P, Steerneman P, Merckelbach H, Holdrinet I, Meesters C (1998) Comorbid anxiety symptoms in children with pervasive developmental disorders. J Anxiety Disord 12:387–393
Manassis K, Russell K, Newton AS (2010) The Cochrane Library and the treatment of childhood and adolescent anxiety disorders: an overview of reviews. Evid Based Child Health 5:541–554
Silverman WK, Pina AA, Viswesvaran C (2008) Evidence-based psychosocial treatments for phobic and anxiety disorders in children and adolescents. J Clin Child Adolesc Psychol 37:105–130
Storch EA, Arnold EB, Lewin AB, Nadeau J, Jones AM, De Nadai AS et al (2013) The effect of cognitive–behavioral therapy versus treatment as usual for anxiety in children with autism spectrum disorders: a randomized, controlled trial. J Am Acad Child Adolesc Psychiatry 52:132–142
Wood J, Drahota A (2005) Behavioral interventions for anxiety in children with autism (BIACA). University of California—Los Angeles, Los Angeles
Kendall PC, Khanna MS (2008) Camp Cope-A-Lot Coach’s manual. Workbook, Ardmore
Wood JJ, Ehrenreich-May J, Alessandri M, Fujii C, Renno P, Laugeson E et al (2014) Cognitive behavioral therapy for early adolescents with autism spectrum disorders and clinical anxiety: a randomized, controlled trial. Behav Ther. doi:10.1016/j.beth.2014.01.002
Le Couteur A, Lord C, Rutter M (2003) The autism diagnostic interview—revised. Western Psychological Services, Los Angeles
Silverman WK, Albano AM (1996) The anxiety disorders interview schedule for DSM-IV-child and parent versions. Graywinds, San Antonio
de Bildt A, Sytema S, Ketelaars C, Kraijer D, Mulder E, Volkmar F et al (2004) Interrelationship between autism diagnostic observation schedule-generic (ADOS-G), autism diagnostic interview-revised (ADI-R), and the diagnostic and statistical manual of mental disorders (DSM-IV-TR) classification in children and adolescents with mental retardation. J Autism Dev Disord 34(2):129–137
RUPP (2002) The Pediatric Anxiety Rating Scale: development and psychometric properties. J Am Acad Child Adolesc Psychiatry 41:1061–1069
Walkup JT, Albano AM, Piacentini J, Birmaher B, Compton SN, Sherrill JT et al (2008) Cognitive behavioral therapy, sertraline, or a combination in childhood anxiety. N Engl J Med 359:2753–2766
Storch EA, Ehrenreich May J, Wood JJ, Jones AM, de Nadai AS, Lewin A et al (2012) Multiple informant agreement on the anxiety disorders interview schedule in youth with autism spectrum disorders. J Child Adolesc Psychopharmacol 22:292–299
March J (1998) Manual for the Multidimensional Anxiety Scale for Children. Multi-Health Systems, Toronto
March JS, Parker JD, Sullivan K, Stallings P, Conners CK (1997) The Multidimensional Anxiety Scale for Children (MASC): factor structure, reliability, and validity. J Am Acad Child Adolesc Psychiatry 36:554–565
Constantino J (2002) The Social Responsiveness Scale. Western Psychological Services, Los Angeles
Bölte S, Poustka F, Constantino JN (2008) Assessing autistic traits: cross-cultural validation of the social responsiveness scale (SRS). Autism Res 1:354–363
Chou MC, Chou WJ, Chiang HL, Wu YY, Lee JC, Wong CC et al (2012) Sleep problems among Taiwanese children with autism, their siblings and typically developing children. Res Autism Spectr Disord 6:665–672
Wood JJ, Drahota A, Sze K, Har K, Chiu A, Langer DA (2009) Cognitive behavioral therapy for anxiety in children with autism spectrum disorders: a randomized, controlled trial. J Child Psychol Psychiatry 50:224–234
Achenbach TM, Edelbrock C (2001) Manual for the child behavior checklist. Queen City Printers, Burlington
Aschenbrand SG, Angelosante AG, Kendall PC (2005) Discriminant validity and clinical utility of the CBCL with anxiety-disordered youth. J Clin Child Adolesc Psychol 34:735–746
Heubeck BG (2000) Cross-cultural generalizability of CBCL syndromes across three continents: from the USA and Holland to Australia. J Abnorm Child Psychol 28:439–450
Schlomer GL, Bauman S, Card NA (2010) Best practices for missing data management in counseling psychology. J Couns Psychol 57:1
Arbuckle JL (1996) Full information estimation in the presence of incomplete data. In: Marcoulides GA, Schumacher RE (eds) Advanced structural equation modeling: issues and techniques, pp 243–277
Cotton S, Richdale A (2006) Brief report: parental descriptions of sleep problems in children with autism, Down syndrome, and Prader–Willi syndrome. Res Dev Disabil 27:151–161
Richdale AL, Schreck KA (2009) Sleep problems in autism spectrum disorders: prevalence, nature, and possible biopsychosocial aetiologies. Sleep Med Rev 13:403–411
Wood JJ, Drahota A, Sze K, Van Dyke M, Decker K, Fujii C et al (2009) Brief report: effects of cognitive behavioral therapy on parent-reported autism symptoms in school-age children with high-functioning autism. J Autism Dev Disord 39:1608–1612
Acknowledgments
This work was supported in part by grants from the All Children’s Hospital Research Foundation, the University of South Florida Internal Grants Program, and the National Institutes of Child Health and Human Development to Dr. Storch (5R34HD065274-02). The views of this manuscript do not necessarily reflect those of the National Institutes of Health.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Nadeau, J.M., Arnold, E.B., Keene, A.C. et al. Frequency and Clinical Correlates of Sleep-Related Problems Among Anxious Youth with Autism Spectrum Disorders. Child Psychiatry Hum Dev 46, 558–566 (2015). https://doi.org/10.1007/s10578-014-0496-9
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10578-014-0496-9