The Indian Journal of Pediatrics

, Volume 86, Issue 1, pp 12–17 | Cite as

Sleep Dysfunction and Behavioral Daytime Problems in Children with Autism Spectrum Disorders: A Comparative Study

  • Prahbhjot MalhiEmail author
  • Amandeep Kaur
  • Pratibha Singhi
  • Naveen Sankhyan
Original Article



To compare parent reported sleep behaviors of children with Autism Spectrum Disorders (ASD) and normal healthy controls and to examine the association of sleep disturbances with daytime behavioral difficulties in children with ASD.


Sixty ASD children (85% boys) (Mean age=6.1 y, SD=2.4) were recruited from the Psychology unit of the Department of Pediatrics of a tertiary care hospital. An age and socio-economic status matched group of typically developing (TD) children (N=60) were also recruited. The Children's Sleep Habits Questionnaire (CSHQ) was used to measure sleep problems. The Childhood Psychopathology Measurement Schedule was used to measure day time behavioral difficulties.


Sleep problems were nearly two times more prevalent among children with ASD (88.3%) as compared to the TD group (46.7%) (χ2=23.74, P=0.0001). The total CSHQ and 6 out of the 8 subscales scores of the ASD group were also significantly higher than the TD group. Overall, children with ASD displayed significant more bedtime resistance than controls (t= 3.95, P=0.001). The sleep duration subscale showed that children with ASD, relative to the TD group, slept too little (χ2=23.08, P=0.0001), did not sleep the right amount of time (χ2= 11.86, P=0.003), and displayed significant variation in the duration of time slept (χ2=11.96, P=0.003). In addition, parent reported sleep dysfunction had a significant relationship with daytime reported behavior difficulties (r=0.53, P=0.01) in children with ASD. Stepwise multiple regression analysis revealed that 30% of the variance in number of daytime behavioral problems was explained by only two variables: total CSHQ scores and duration of night awake time (F=11.18, P=0.001).


Children with ASD are at a high risk for sleep problems and this is associated with daytime behavior disturbances. Pediatricians should routinely screen ASD children for sleep problems and initiate timely and appropriate interventions.


Autism spectrum disorders Sleep dysfunction Behavior problems 



The authors are thankful to all the families who participated in this study.

Authors’ Contributions

PM, PS, and NS: Conceptualized and designed the study; AK: Collected the data and did the literature search; PM: Coordinated and supervised data collection, conducted the statistical analysis, and wrote the manuscript with critical inputs from all the authors and all the authors approved the final manuscript. PM will act as guarantor for this paper.

Compliance with Ethical Standards

Conflict of Interest



  1. 1.
    Schreck KA, Mulick JA, Smith AF. Sleep problems as possible predictors of intensified symptoms of autism. Res Dev Disabil. 2004;25:57–66.CrossRefGoogle Scholar
  2. 2.
    Couturier JL, Speechley KN, Steele M, Norman R, Stringer B, Nicolson R. Parental perception of sleep problems in children of normal intelligence with pervasive developmental disorders: prevalence, severity, and pattern. J Am Acad Child Adolesc Psychiatry. 2005;44:815–22.CrossRefGoogle Scholar
  3. 3.
    Souders MC, Mason TB, Valladares O, et al. Sleep behaviors and sleep quality in children with autism spectrum disorders. Sleep. 2009;32:1566–78.CrossRefGoogle Scholar
  4. 4.
    Krakowiak P, Goodlin-Jones B, Hertz-Picciotto I, Croen LA, Hansen RL. Sleep problems in children with autism spectrum disorders, developmental delays, and typical development: a population-based study. J Sleep Res. 2008;17:197–206.CrossRefGoogle Scholar
  5. 5.
    Aathira R, Gulati S, Tripathi M, et al. Prevalence of sleep abnormalities in Indian children with autism spectrum disorder: a cross-sectional study. Pediatr Neurol. 2017;74:62–7.CrossRefGoogle Scholar
  6. 6.
    Sivertsen B, Posserud MB, Gillberg C, Lundervold AJ, Hysing M. Sleep problems in children with autism spectrum problems: a longitudinal population-based study. Autism. 2012;16:139–50.CrossRefGoogle Scholar
  7. 7.
    Hodge D, Carollo TM, Lewin M, Hoffman CD, Sweeney DP. Sleep patterns in children with and without autism spectrum disorders: developmental comparisons. Res Dev Disabil. 2014;35:1631–8.CrossRefGoogle Scholar
  8. 8.
    Doo S, Wing YK. Sleep problems of children with pervasive developmental disorders: correlation with parental stress. Dev Med Child Neurol. 2006;48:650–5.CrossRefGoogle Scholar
  9. 9.
    Delahaye J, Kovacs E, Sikora D, et al. The relationship between health-related quality of life and sleep problems in children with autism spectrum disorders. Res Autism Spectr Disord. 2014;8:292–303.CrossRefGoogle Scholar
  10. 10.
    Sikora DM, Johnson K, Clemons T, Katz T. The relationship between sleep problems and daytime behavior in children of different ages with autism spectrum disorders. Pediatrics. 2012;130:S83–90.CrossRefGoogle Scholar
  11. 11.
    Mazurek MO, Sohl K. Sleep and behavioral problems in children with autism spectrum disorder. J Autism Dev Disord. 2016;46:1906–15.CrossRefGoogle Scholar
  12. 12.
    Maski K, Owens JA. Insomnia, parasomnias, and narcolepsy in children: clinical features, diagnosis, and management. Lancet Neurol. 2016;15:1170–81.CrossRefGoogle Scholar
  13. 13.
    Minkel JD, Banks S, Htaik O, et al. Sleep deprivation and stressors: evidence for elevated negative affect in response to mild stressors when sleep deprived. Emotion. 2012;12:1015–20.CrossRefGoogle Scholar
  14. 14.
    Tudor ME, Hoffman CD, Sweeney DP. Children with autism: sleep problems and symptom severity. Focus Autism Dev Disabil. 2012;27:254–62.CrossRefGoogle Scholar
  15. 15.
    Veatch OJ, Sutcliffe JS, Warren ZE, Keenan BT, Potter MH, Malow BA. Shorter sleep duration is associated with social impairment and comorbidities in ASD. Autism Res. 2017;10:1221–38.CrossRefGoogle Scholar
  16. 16.
    Owens JA, Spirito A, McGuinn M. The children’s sleep habits questionnaire (CSHQ): psychometric properties of a survey instrument for school-aged children. Sleep. 2000;23:1043–51.CrossRefGoogle Scholar
  17. 17.
    Narendhran R, Bharti B, Malhi P. Children sleep habits questionnaire (CSHQ): psychometric validation in Indian school children. Indian J Sleep Med. 2008;3:102–6.Google Scholar
  18. 18.
    Malhotra S, Varma VK, Verma SK, Malhotra A. A childhood psychopathology measurement schedule: development and standardization. Indian J Psychiatry. 1988;30:325–32.Google Scholar
  19. 19.
    Schopler E, Reichler R, Rochen RB. The childhood autism rating scale. Los Angeles: Western Psychological Services; 1988.Google Scholar
  20. 20.
    Alpern GD. Developmental profile 3. Los Angeles: Western Psychological Services; 2007.Google Scholar
  21. 21.
    Cortese S, Faraone SV, Konofal E, Lecendreux M. Sleep in children with attention-deficit/hyperactivity disorder: meta-analysis of subjective and objective studies. J Am Acad Child Adolesc Psychiatr. 2009;48:894–908.Google Scholar
  22. 22.
    Reynolds KC, Patriquin M, Alfana CA, Loveland KA, Pearson DA. Parent-reported problematic sleep behaviors in children with comorbid autism spectrum disorder and attention-deficit/hyperactivity disorder. Res Autism Spectr Disord. 2017;39:20–32.CrossRefGoogle Scholar
  23. 23.
    Mayes SD, Calhoun S, Bixler EO, Vgontzas AN. Sleep problems in children with autism, ADHD, anxiety, depression, acquired brain injury, and typical development. Sleep Med Clin. 2009;4:19–25.CrossRefGoogle Scholar
  24. 24.
    Goldman SE, McGrew S, Johnson KP, Richdale AL, Clemons T, Malow BA. Sleep is associated with problem behaviors in children and adolescents with autism spectrum disorders. Res Autism Spectr Disord. 2011;5:1223–9.CrossRefGoogle Scholar
  25. 25.
    Taylor MA, Schreck KA, Mulick JA. Sleep disruption as a correlate to cognitive and adaptive behavior problems in autism spectrum disorders. Res Dev Disabil. 2012;33:1408–17.CrossRefGoogle Scholar
  26. 26.
    Fadini CC, Lamônica DA, Fett-Conte AC, et al. Influence of sleep disorders on the behavior of individuals with autism spectrum disorder. Front Hum Neurosci. 2015;9:347.CrossRefGoogle Scholar
  27. 27.
    Corkum P, Tannock R, Moldofsky H, Hogg-Johnson S, Humphries T. Actigraphy and parental ratings of sleep in children with attention deficit/hyperactivity disorder (ADHD). Sleep. 2001;24:303–12.CrossRefGoogle Scholar
  28. 28.
    Didden R, Korzilius H, van Aperlo B, van Overloop C, de Vries M. Sleep problems and daytime problem behaviours in children with intellectual disability. J Intellect Disabil Res. 2002;46:537–47.Google Scholar
  29. 29.
    Touchette É, Petit D, Séguin JR, Boivin M, Tremblay RE, Montplaisir JY. Associations between sleep duration patterns and behavioral/cognitive functioning at school entry. Sleep. 2007;30:1213–9.CrossRefGoogle Scholar
  30. 30.
    Allik H, Larsson JO, Smedje H. Sleep patterns of school-age children with Asperger syndrome or high-functioning autism. J Autism Dev Disord. 2006;36:585–95.CrossRefGoogle Scholar

Copyright information

© Dr. K C Chaudhuri Foundation 2018

Authors and Affiliations

  • Prahbhjot Malhi
    • 1
    Email author
  • Amandeep Kaur
    • 2
  • Pratibha Singhi
    • 1
  • Naveen Sankhyan
    • 1
  1. 1.Department of PediatricsPost Graduate Institute of Medical Education and ResearchChandigarhIndia
  2. 2.Department of PediatricsAll India Institute of Medical SciencesNew DelhiIndia

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