Journal of Autism and Developmental Disorders

, Volume 45, Issue 11, pp 3613–3623 | Cite as

Treatment for Sleep Problems in Children with Autism and Caregiver Spillover Effects

  • J. Mick TilfordEmail author
  • Nalin Payakachat
  • Karen A. Kuhlthau
  • Jeffrey M. Pyne
  • Erica Kovacs
  • Jayne Bellando
  • D. Keith Williams
  • Werner B. F. Brouwer
  • Richard E. Frye
Original Paper


Sleep problems in children with autism spectrum disorders (ASD) are under-recognized and under-treated. Identifying treatment value accounting for health effects on family members (spillovers) could improve the perceived cost-effectiveness of interventions to improve child sleep habits. A prospective cohort study (N = 224) was conducted with registry and postal survey data completed by the primary caregiver. We calculated quality of life outcomes for the child and the primary caregiver associated with treatments to improve sleep in the child based on prior clinical trials. Predicted treatment effects for melatonin and behavioral interventions were similar in magnitude for the child and for the caregiver. Accounting for caregiver spillover effects associated with treatments for the child with ASD increases treatment benefits and improves cost-effectiveness profiles.


Autism spectrum disorder Child health Caregiver health Child sleep habits Quality adjusted life year Cost-effectiveness analysis 



The project was supported by a Grant (R01MH089466) with JMT and KAK serving as principal investigators and a Grant (R03MH102495) with NP as the principal investigator both from the National Institute of Mental Health. The content of this article is solely the responsibility of the authors and does not necessarily represent the official views of the National Institute of Mental Health or the National Institutes of Health. The authors acknowledge the members of the Autism Treatment Network for use of the data. The data for the study were collected as part of the Autism Treatment Network, a program of Autism Speaks. Further support came from a cooperative agreement (UA3MC11054) from the US Department of Health and Human Services, Health Resources and Services Administration, Maternal and Child Health Research Program, to the Massachusetts General Hospital. The work described in this article represents the independent efforts of the authors with no restrictions from the funding source or the Autism Treatment Network. None of the authors of this study reported a conflict of interest associated with the preparation of the manuscript. Maria Melguizo, Nupur Chowdhury, Rebecca Rieger and Latunja Sockwell provided excellent research assistance.

Compliance of ethical standards

Conflict of interest

The authors declare they have no conflict of interest associated with the manuscript.

Human and animal rights

All procedures performed in studies involving human participants were in accordance with the ethical standard of the institutional research committees of the participating institutions and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.


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Copyright information

© Springer Science+Business Media New York 2015

Authors and Affiliations

  • J. Mick Tilford
    • 1
    • 2
    Email author
  • Nalin Payakachat
    • 2
  • Karen A. Kuhlthau
    • 3
    • 4
  • Jeffrey M. Pyne
    • 5
  • Erica Kovacs
    • 6
  • Jayne Bellando
    • 7
  • D. Keith Williams
    • 8
  • Werner B. F. Brouwer
    • 9
  • Richard E. Frye
    • 7
  1. 1.Department of Health Policy and ManagementUniversity of Arkansas for Medical SciencesLittle RockUSA
  2. 2.Division of Pharmaceutical Evaluation and PolicyUniversity of Arkansas for Medical SciencesLittle RockUSA
  3. 3.Department of PediatricsHarvard Medical SchoolBostonUSA
  4. 4.Center for Adolescent Health PolicyMassachusetts General HospitalBostonUSA
  5. 5.Center for Mental Healthcare and Outcomes Research, Central Arkansas Veterans Healthcare System and Psychiatric Research InstituteUniversity of Arkansas for Medical SciencesLittle RockUSA
  6. 6.Department of PsychiatryColumbia University Medical CenterNew YorkUSA
  7. 7.Department of PediatricsUniversity of Arkansas for Medical SciencesLittle RockUSA
  8. 8.Department of BiostatisticsUniversity of Arkansas for Medical SciencesLittle RockUSA
  9. 9.Department of Health Policy and ManagementErasmus UniversityRotterdamThe Netherlands

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