Abstract
This study examined the associations between sleep and challenging behaviors for average and night-to-night fluctuations in sleep, in 39 children with autism spectrum disorder (ASD) receiving intensive behavioral intervention (IBI). Child sleep was recorded (via actigraphy) for five nights in conjunction with clinician-reported observations of challenging behaviors. Results indicated that on average, poor sleep was associated with higher rates of repetitive behavior, negative affect, and a composite of overall challenging behaviors. These findings suggest that average sleep patterns are important within the context of IBI (rather than night-to-night fluctuations). Interventions aimed at improving overall patterns of sleep may have important cascading effects on challenging behaviors and developmental outcomes for children with ASD and their families.
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Aathira, R., Chakrabarty, B., Dang, N., Gulati, S., Gupta, A., Kabra, M., et al. (2017). Prevalence of sleep abnormalities in indian children with autism spectrum disorder: A cross-sectional Study. Pediatric Neurology, 74, 62–67. https://doi.org/10.1016/j.pediatrneurol.2017.05.019.
Adams, H. L., Matson, J. L., & Jang, J. (2014). The relationship between sleep problems and challenging behavior among children and adolescents with autism spectrum disorder. Research in Autism Spectrum Disorders, 8(9), 1024–1030.
Aeschbach, D., Postolache, T. T., Sher, L., Matthews, J. R., Jackson, M. A., & Wehr, T. A. (2001). Evidence from the waking electroencephalogram that short sleepers live under higher homeostatic sleep pressure than long sleepers. Neuroscience, 102, 493–502.
Allik, H., Larrson, J. O., & Smedje, H. (2006). Sleep patterns in children with asperger syndrome or high-functioning autism. Journal of Autism and Developmental Disorders, 36, 585–595. https://doi.org/10.1007/s10803-006-0099-9.
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th edn.). Arlington, VA: American Psychiatric Association.
Ancoli-Israel, S., Martin, J. L., Blackwell, T., Liu, L., et al. (2015). The SBSM guide to actigraphy monitoring: Clinical and research applications. Behavioral Sleep Medicine, 13, S4–S38.
Anders, T. F., Iosif, A. M., Schwichtenberg, A. J., Tang, K., & Goodlin-Jones, B. L. (2011). Six-month sleep-wake organization and stability in preschool-age children with autism, developmental delay, and typical development. Behavioral Sleep Medicine, 9(2), 92–106. https://doi.org/10.1080/15402002.2011.557991.
Becker, S. P., Sidol, C. A., Van Dyk, T. R., Epstein, J. N., & Beebe, D. W. (2016). Intraindividual variability of sleep/wake patterns in relation to child and adolescent functioning: A systematic review. Sleep Medicine Reviews. https://doi.org/10.1016/j.smrv.2016.07.004.
Bei, B., Manber, R., Trinder, J., & Wiley, J. F. (2016). Beyond the mean: A systematic review on the correlates of daily intraindividual variability of sleep/wake patterns. Sleep Medicine Reviews, 28, 108–124. https://doi.org/10.1016/j.smrv.2015.06.003.
Bertoglio, K., & Hendren, R. L. (2009). New developments in autism. Psychiatric Clinics of North America, 32, 1–14. https://doi.org/10.1016/j.psc.2008.10.004.
Berument, S. K., Rutter, M., Lord, C., Pickles, A., & Bailey, A. (1999). Autism screening questionnaire: Diagnostic validity. British Journal of Psychiatry, 175, 444–451. https://doi.org/10.1192/bjp.175.5.444.
Chorney, J. M., McMurtney, C. M., Chambers, C. T., & Bakeman, R. (2014). Developing and modifying behavioral coding schemes in pediatric psychology: A practical guide. Journal of Pediatric Psychology, 40, 154–164. https://doi.org/10.1093/jpepsy/jsu099.
Cohen, S., Fulcher, B. D., Rajaratnam, S. M., Conduit, R., Sullivan, J. P., St Hilaire, M. A., et al. (2018). Sleep patterns predictive of daytime challenging behavior in individuals with low-functioning autism. Autism Research, 11, 391–403. https://doi.org/10.1002/aur.1899.
Cooper, J. O., Heron, T. E., & Heward, W. L. (2007). Applied behavior analysis. Upper Saddle River, NJ: Pearson Education, Inc.
Cremone, A., de Jong, D. M., Kurdziel, L. B., Desrochers, P., Sayer, A., LeBourgeois, M. K., et al. (2018). Sleep tight, act right: Negative affect, sleep and behavior problems during early childhood. Child Development, 89(2), e42–e59.
Crutchfield, S. A., Mason, R. A., Chambers, A., Wills, H. P., & Mason, B. A. (2015). Use of a self-monitoring application to reduce stereotypic behavior in adolescents with autism: A preliminary investigation of I-Connect. Journal of Autism and Developmental Disorders, 45(5), 1146–1155.
Davis, T. N., & Rispoli, M. (2018). Introduction to the special issue: Interventions to reduce challenging behavior among individuals with autism spectrum disorder. Behavior Modification, 42(3), 3085–3313.
Didden, R., Korzilius, H., van Aperlo, B., van Overloop, C., & de Vries, M. (2002). Sleep problems and daytime behaviours in children with intellectual disability. Journal of Intellectual Disability Research, 46, 537–547. https://doi.org/10.1046/j.1365-2788.2002.00404.x.
Doehring, P., Reichow, B., Palka, T., Phillips, C., & Hagopian, L. (2014). Behavioral approaches to managing severe problem behaviors in children with autism spectrum and related developmental disorders: A descriptive analysis. Child and Adolescent Psychiatric Clinics of North America, 23, 25–40. https://doi.org/10.1016/j.chc.2013.08.001.
Doran, S. M., Van Dongen, H. P., & Dinges, D. F. (2001). Sustained attention performance during sleep deprivation: Evidence of state instability. Archives Italiennes de Biologie, 139, 253–267.
El-Sheikh, M. (2011). Sleep and development: Familial and socio-cultural considerations. Oxford: Oxford University Press.
Fuligni, A. J., Arruda, E. H., Krull, J. L., & Gonzales, N. A. (2017). Adolescent sleep duration, variability, and peak levels of achievement and mental health. Child Development. https://doi.org/10.1111/cdev.12729.
Gabriels, R. L., Cuccaro, M. L., Hill, D. E., Ivers, B. J., & Goldson, E. (2005). Repetitive behaviors in autism: Relationships with associated clinical features. Research in Developmental Disabilities, 26, 169–181. https://doi.org/10.1016/j.ridd.2004.05.003.
Glickman, G. (2010). Circadian rhythms and sleep in children with autism. Neuroscience & Biobehavioral Reviews, 34(5), 755–768.
Goel, N., Rao, H., Durmer, J. S., & Dinges, D. F. (2009). Neurocognitive consequences of sleep deprivation. Seminars in Neurobiology, 29, 330–339. https://doi.org/10.1055/s-0029-1237117.
Goldman, S. E., McGrew, S., Johnson, K. P., Richdale, A. L., Clemons, T., & Malow, B. A. (2011). Sleep is associated with problem behaviors in children and adolescents with autism spectrum disorders. Research in Autism Spectrum Disorders, 5, 1223–1229. https://doi.org/10.1016/j.rasd.2011.01.010.
Goldman, S. E., Surdyka, K., Cuevas, R., Adkins, K., Wang, L., & Malow, B. A. (2009). Defining the sleep phenotype in children with autism. Developmental Neuropsychology, 34, 560–573. https://doi.org/10.1080/87565640903133509.
Goodlin-Jones, B. L., Tang, K., Liu, J., & Anders, T. F. (2008). Sleep patterns in preschool-age children with autism, developmental delay, and typical development. Journal of the American Academy of Child & Adolescent Psychiatry, 47(8), 930–938.
Gruber, R., Anders, T. F., Beebe, D., Bruni, O., Buckhalt, J. A., et al. (2016). A call for action regarding translational research in pediatric sleep. Sleep Health, 2, 88–89. https://doi.org/10.1016/j.sleh.2016.03.003.
Haidet, K. K., Tate, J., Divirgilio-Thomas, D., Kolanowski, A., & Happ, M. B. (2009). Methods to improve reliability of video-recorded behavioral data. Research in Nursing & Health, 32, 465–474.
Hirata, I., Mohri, I., Kato-Nishimura, K., Tachibana, M., Kuwada, A., Kagitani-Shimono, K., et al. (2016). Sleep problems are more frequent and associated with problematic behaviors in preschoolers with autism spectrum disorder. Research in Developmental Disabilities, 49, 86–99.
Hodge, D., Carollo, T. M., Lewin, M., Hoffman, C. D., & Sweeney, D. P. (2014). Sleep patterns in children with and without autism spectrum disorders: Developmental comparisons. Research in Developmental Disabilities, 35, 1631–1638. https://doi.org/10.1016/j.ridd.2014.03.037.
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. https://doi.org/10.1177/10883576050200040101.
Hox, J., & Roberts, K. J. (2011). Handbook of advanced multilevel analysis. New York, NY: Taylor & Francis Group.
Humphreys, J. S., Gringas, P., Blair, P. S., Scott, N., Henderson, P. J., & Emond, A. M. (2014). Sleep patterns in children with autistic spectrum disorders: A prospective cohort study. Archives of Disease in Childhood, 99, 1–5. https://doi.org/10.1136/archdischild.
Hundley, R. J., Shui, A., & Malow, B. A. (2016). Relationship between subtypes of restricted and repetitive behaviors and sleep disturbance in autism spectrum disorder. Journal of Autism and Developmental Disorders, 46, 3448–3457. https://doi.org/10.1007/s10803-016-2884-4.
Ipsiroglu, O. S., Hung, Y. H. A., Forson Chan, M. L. R., Veer, D., Soo, S., Ho, G., et al. (2015). “Diagnosis by behavioral observation” home-videosomnography: A rigorous ethnographic approach to sleep of children with neurodevelopmental conditions. Frontiers in Psychiatry, 6, 1–15. https://doi.org/10.3389/fpsyt.2015.00039.
Jenni, O. G., & LeBourgeois, M. K. (2006). Understanding sleep-wake behavior and sleep disorders in children: The value of a model. Current Opinion in Psychiatry, 19(3), 282.
Kamphuis, J., Meerlo, P., Koolhaas, J. M., & Lancel, M. (2012). Poor sleep as a causal factor in aggression and violence. Sleep Medicine, 13, 327–334. https://doi.org/10.1016/j.sleep.2011.12.006.
Kerkhof, G. A., & Van Dongen, H. P. A. (2010). Human sleep and cognition: Basic research. New York, NY: Elsevier.
Klintwall, L., Eldevik, S., & Eikeseth, S. (2015). Narrowing the gap: Effects of intervention on developmental trajectories in autism. Autism, 19(1), 53–63.
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. https://doi.org/10.1111/j.1365-2869.2008.00650.x.
Lord, C., Risi, S., Lambrecht, L., Cook, E. H., Leventhal, B. L., DiLavore, P. C., et al. (2000). The autism diagnostic observation schedule-generic: A standard measure of social and communication deficits associated with the spectrum of autism. Journal of Autism and Developmental Disorders, 30, 205–223. https://doi.org/10.1023/A:1005592401947.
Lord, C., Rutter, M., & Le Couteur, A. (1994). Autism diagnostic interview-revised: A revised version of a diagnostic interview for caregivers of individuals with possible pervasive developmental disorders. Journal of Autism and Developmental Disorders, 24, 659–685. https://doi.org/10.1007/BF02172145.
Lovaas, I. O. (1987). Behavioral treatment and normal education and intellectual functioning in young autistic children. Journal of Consulting and Clinical Psychology, 55, 3–9. https://doi.org/10.1037/0022-006X.55.1.3.
Lukowski, A. F., & Milojevich, H. M. (2017). Sleep problems and temperament in young children with down syndrome and typically developing controls. Journal of Intellectual Disability Research, 61, 221–232. https://doi.org/10.1111/jir.12321.
Malow, B. A., Adkins, K. W., Reynolds, A., Weiss, S. K., Loh, A., Fawkes, D., et al. (2014). Parent-based sleep education for children with autism spectrum disorders. Journal of Autism and Developmental Disorders, 44, 216–228. https://doi.org/10.1007/s10803-013-1866-z.
Malow, B. A., Marzec, M. L., McGrew, S. G., Wang, L., Henderson, L. M., & Stone, W. L. (2006). Characterizing sleep in children with autism spectrum disorders: A multidimensional approach. Sleep, 29(12), 1563–1571.
Matson, J. L. (2009). Applied behavior analysis for children with autism spectrum disorders. New York, NY: Springer.
Matson, J. L., & Nebel-Schwalm, M. (2007). Assessing challenging behaviors in children with autism spectrum disorders: A review. Research in Developmental Disabilities, 28(6), 567–579.
Mayes, S. D., & Calhoun, S. L. (2009). Variables related to sleep problems in children with autism. Research in Autism Spectrum Disorders, 3(4), 931–941. https://doi.org/10.1016/j.rasd.2009.04.002.
Mazurek, M. O., & Sohl, K. (2016). Sleep and behavioral problems in children with autism spectrum disorder. Journal of Autism and Developmental Disorders, 46, 1906–1915. https://doi.org/10.1007/s10803-016-2723-7.
Meltzer, L. J., Montgomery-Downs, H. E., Insana, S., & Walsh, C. M. (2012). Use of actigraphy in pediatric sleep research. Sleep Medicine Reviews, 16, 463–475. https://doi.org/10.1016/j.smrv.2011.10.002.
Merikanto, I., Pesonen, A. K., Kuula, L., Lahti, J., Heinonen, K., Kajantie, E., & Räikkönen, K. (2017). Eveningness as a risk for behavioral problems in late adolescence. Chronobiology International, 34(2), 225–234.
Mindell, J. A., & Owens, J. A. (2015). A clinical guide to pediatric sleep: Diagnosis and management of sleep problems. Philadelphia: Wolters Kluwer.
Moore, M., Evans, V., Hanvey, G., & Johnson, C. (2017). Assessment of sleep in children with autism spectrum disorder. Children, 4(8), 72.
National Autism Center. (2009). National standards report. Randolph, MA: National Autism Center.
National Research Council. (2001). Educating children with autism. Washington, D.C.
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, 1–9. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/11145319.
Peters-Scheffer, N., Didden, R., Korzilius, H., & Sturmey, P. (2011). A meta-analytic study on the effectiveness of comprehensive ABA-based early intervention programs for children with autism spectrum disorders. Research in Autism Spectrum Disorders, 5, 60–69. https://doi.org/10.1016/j.rasd.2010.03.011.
Phung, J. N., & Goldberg, W. A. (2017). Poor sleep quality is associated with discordant peer relationships among adolescents with autism spectrum disorder. Research in Autism Spectrum Disorders, 34, 10–18.
Richdale, A. L., & Schreck, K. A. (2009). Sleep problems in autism spectrum disorders: Prevalence, nature, & possible biopsychosocial aetiologies. Sleep Medicine Reviews, 13, 403–411. https://doi.org/10.1016/j.smrv.2009.02.003.
Sadeh, A., Alster, J., Urbach, D., & Lavie, P. (1989). Actigraphically based automatic bedtime sleep-wake scoring: Validity and clinical applications. Journal of Ambulatory Monitoring, 2, 209–216.
Sadeh, A., Sharkey, K. M., & Carskadon, M. A. (1994). Activity-based sleep-wake identification: An empirical test of methodological issues. Sleep, 17, 201–207.
Sannar, E. M., Palka, T., Beresford, C., Peura, C., Kaplan, D., Verdi, M., et al. (2017). Sleep problems and their relationship to maladaptive behavior severity in psychiatrically hospitalized children with Autism Spectrum Disorder (ASD). Journal of Autism and Developmental Disorders. https://doi.org/10.1007/s10803-017-3362-3.
Scheithauer, M. C., & Zarcone, J. (2015). Evaluating the relationship between sleep and problem behavior in children with disabilities. Behavior Analysis Practice, 8, 27–36. https://doi.org/10.1007/s40617-015-0041-8.
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. https://doi.org/10.1016/j.ridd.2003.04.007.
Schwichtenberg, A. J., Hensle, T., Honaker, S., Miller, M., Ozonoff, S., & Anders, T. (2016). Sibling sleep-What can it tell us about parental sleep reports in the context of autism? Clinical Practice in Pediatric Psychology, 4(2), 137–152. https://doi.org/10.1037/cpp0000143.
Schwichtenberg, A. J., Shah, S. E., & Poehlmann, J. (2013). Sleep and attachment in preterm infants. Infant Mental Health Journal, 34, 37–46. https://doi.org/10.1002/imhj.21374.
Schwichtenberg, A. J., Young, G. S., Hutman, T., Iosif, A. M., Sigman, M., Rogers, S. J., & Ozonoff, S. (2013). Behavior and sleep problems in children with a family history of autism. Autism Research, 6(3), 169–176. https://doi.org/10.1002/aur.1278.
Sikora, D. M., Johnson, K., Clemons, T., & Katz, T. (2012). The relationship between sleep problems and daytime behavior in children of different ages with autism spectrum disorders. Pediatrics, 130, 83–90. https://doi.org/10.1542/peds.2012-0900F.
Sletten, T. L., Segal, A. Y., Flynn-Evans, E. E., Lockley, S. W., & Rajaratnam, S. M. W. (2015). Inter-individual differences in neurobehavioural impairment following sleep restriction are associated with circadian rhythm phase. PLoS ONE, 10, 1–16. https://doi.org/10.1371/journal.pone.0128273.
Smith, C. E., Carr, E. G., & Moskowitz, L. J. (2016). Fatigue as a biological setting event for severe problem behavior in autism spectrum disorder. Research in Autism Spectrum Disorders, 23, 131–144.
Smith, T., Eikeseth, S., Klevstrand, M., & Lovaas, I. O. (1997). Intense behavioral treatment for preschoolers with severe mental retardation and pervasive developmental disorder. American Journal on Mental Retardation, 102, 238–249. Retrieved from http://web.a.ebscohost.com.ezproxy.lib.purdue.edu/ehost/.
Souders, M. C., Mason, T., Valladares, O., Bucan, M., Levy, S. E., Mandell, D. S., et al. (2009). Sleep behaviors and sleep quality in children with autism spectrum disorders. Sleep, 32, 1566–1578.
Souders, M. C., Zavodny, S., Eriksen, W., Sinko, R., Connell, J., Kerns, C., et al. (2017). Sleep in children with autism spectrum disorder. Current Psychiatry Reports, 19(6), 34.
Tudor, M. E., Hoffman, C. D., & Sweeney, D. P. (2012). Children with autism: Sleep problems and symptom severity. Focus on Autism and Other Developmental Disabilities, 27, 254–262. https://doi.org/10.1177/1088357612457989.
Van Dyk, T. R., Thompson, R. W., & Nelson, T. D. (2016). Daily bidirectional relationships between sleep and mental health symptoms in youth with emotional and behavioral problems. Journal of Pediatric Psychology, 41, 983–992. https://doi.org/10.1093/jpepsy/jsw040.
Veatch, O. J., Sutcliffe, J. S., Warren, Z. E., Keenan, B. T., Potter, M. H., & Malow, B. A. (2017). Shorter sleep duration is associated with social impairment and comorbidities in ASD. Autism Research, 10, 1221–1238. https://doi.org/10.1002/aur.1765.
Wiggins, L. D., Bakeman, R., Adamson, L., & Robins, D. L. (2007). The utility of the social communication questionnaire in screening for autism in children referred for early intervention. Focus on Autism and Other Developmental Disabilities, 22, 33–38. https://doi.org/10.1177/10883576070220010401.
Wild-Hartman, J. A., Wichers, M., van Bemel, A. L., Derom, C., Theiry, E., et al. (2013). Day-to-day associations between subjective sleep and affect in regard to future depression in a female population-based sample. British Journal of Psychiatry, 202, 407–412. https://doi.org/10.1192/bjp.bp.112.123794.
Wise, M. S., Nichols, C. D., Grigg-Damberger, M. M., Marcus, C. L., Witmans, M. B., et al. (2011). Executive summary of respiratory indications for polysomnography in children: An evidencebased review. Sleep, 34(3), 389–398.
Wolfson, A. R., Carskadon, M. A., Acebo, C., Seifer, R., Fallone, G., Labyak, S. E., et al. (2003). Evidence for the validity of a sleep habits survey for adolescents. Sleep, 26(2), 213–216.
Yoder, P., & Symons, F. (2010). Observational measurement of behavior. New York, NY: Springer.
Acknowledgments
First and foremost, we thank the families who generously participated in this study. We also thank Cornerstone Autism Center, Little Start Center, and the Indiana Behavior Analysis Academy for their incredible assistance with both recruitment and data collection. Finally, we thank Kathleen Welling, Amy Barton, and Amelia Reising for their hours of assistance with project management and data entry/preparation.
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This Research was supported in part by grants from the Gadomski Foundation, the Purdue University Center for Families, and the Purdue University Graduate Student Government.
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EA participated in the design of the study, collected data, conducted analyses, and drafted the manuscript. AJS participated in the design of the study, provided expertise in sleep methodology, drafted sections of the manuscript, and reviewed/edited the manuscript. MB participated in the design of the study, provided expertise in behavior analysis, and reviewed the manuscript. SC advised in the plan of analyses and interpretation of the data and reviewed the manuscript. All authors read and approved the final manuscript.
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Abel, E.A., Schwichtenberg, A.J., Brodhead, M.T. et al. Sleep and Challenging Behaviors in the Context of Intensive Behavioral Intervention for Children with Autism. J Autism Dev Disord 48, 3871–3884 (2018). https://doi.org/10.1007/s10803-018-3648-0
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DOI: https://doi.org/10.1007/s10803-018-3648-0