Skip to main content
SpringerLink
Log in

Sleep Problems and Their Correlates in Children with Autism Spectrum Disorder: An Indian Study

  • Original Paper
  • Published:
Journal of Autism and Developmental Disorders Aims and scope Submit manuscript

Abstract

Sleep problems were studied in both typically developing (TD) children and those with autism spectrum disorder (ASD) using the Sleep Disturbance Scale for Children. Factors associated with these problems were also studied in children with ASD. Seventy-three children with ASD and their age and sex matched TD controls in age group of 3–12 years were enrolled in the study. Higher sleep problems were found in children with ASD than TD children. Most common sleep problem reported in children with ASD was Sleep Wake Transition Disorders, followed by Disorder of Initiation and Maintenance; while in TD controls, it was Sleep Breathing Disorders. Apart from severity of Autism; hyperactivity, sensory issues and poor motor skills were significantly associated with sleep problems, which may be important targets for intervention in children with sleep problems.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  • Aathira, R., Gulati, S., Tripathi, M., Shukla, G., Chakrabarty, B., Sapra, S., Dang, N., et al. (2017). Prevalence of sleep abnormalities in Indian children with Autism Spectrum Disorder; a cross sectional study. Pediatric Neurology. https://doi.org/10.1016/j.pediatrneurol.2017.05.019.

    Article  PubMed  Google Scholar 

  • Achenbach, T. M. (1991). Manual for the child behaviour checklist 4-18 and 1991 profile. Burlington: University of Vermont, Research Center for Children, Youth and Families. Department of Psychiatry.

    Google Scholar 

  • Achenbach, T. M., & Rescorla, L. A. (2001). Manual for the ASEBA school age forms and profiles. Burlington: University of Vermont, Research Center for Children, Youth and Families.

    Google Scholar 

  • Adams, H. L., Matson, J. L., Cervantes, P. E., & Goldin, R. L. (2014). The relationship between autism symptom severity and sleep problems: Should bidirectionality be considered? .Research in Autism Spectrum Disorders, 8(3), 193–199. https://doi.org/10.1016/j.rasd.2013.11.008.

    Article  Google Scholar 

  • Ali, N. J., Pitson, D. J., & Stradling, J. R. (1993). Snoring, sleep disturbance, and behaviour in 4–5 year olds. Archives of Disease in Childhood, 68(3), 360–366.

    Article  PubMed  PubMed Central  Google Scholar 

  • Allik, H., Larsson, J. O., & Smedje, H. (2006). Sleep patterns in school age children with Asperger syndrome or high-functioning autism: A follow up study. Journal of Autism & Developmental Disorders, 38(9), 1625–1633. https://doi.org/10.1007/s10803-008-0543-0.

    Article  Google Scholar 

  • Alpern, G. D. (2007). Developmental profile 3 (DP-3). Los Angeles: Western Psychological Services.

    Google Scholar 

  • American Academy of Sleep Medicine. (2014). International Classification of sleep disorders (3rd ed.). Darien: American Academy of Sleep Medicine.

    Google Scholar 

  • American Psychiatric Association (APA). (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington: American Psychiatric Publishing.

    Book  Google Scholar 

  • Arora, N. K., Nair, M. K. C., Gulati, S., Deshmukh, V., Mohapatra, A., Mishra, D., et al. (2018) Neurodevelopmental disorders in children aged 2–9 years: Population-based burden estimates across five regions in India. PLoS Medicine, 15(7), e1002615. https://doi.org/10.1371/journal.pmed.1002615.

    Article  PubMed  PubMed Central  Google Scholar 

  • Association of Sleep Disorders Centers and the Association for the Psychophysiological Study of Sleep. (1979). Diagnostic classification of sleep and arousal disorders. Sleep, 2, 1–137.

    Article  Google Scholar 

  • Barathy, C., Prabha, S., & Shanthi, A. K. (2017). Study of sleep pattern in children aged 1–12 years attending OPD at tertiary care hospital, Puducherry, India. International Journal of Contemporary Pediatrics, 4, 1980–1985.

    Article  Google Scholar 

  • Beebe, D. W., Rausch, J., Byars, K. C., Lanphear, B., & Yolton, K. (2012). Persistent snoring in preschool children: Predictors and behavioral and developmental correlates. Pediatrics, 130(3), 382–389. https://doi.org/10.1542/peds.2012-0045.

    Article  PubMed  PubMed Central  Google Scholar 

  • Bharti, B., Malhi, P., & Kashyap, S. (2006). Patterns and problems of sleep in school going children. Indian Pediatrics, 43(1), 35–38.

    PubMed  Google Scholar 

  • Brand, S., Jossen, S., Holsboer-Trachsler, E., Pühse, U., & Gerber, M. (2015). Impact of aerobic exercise on sleep and motor skills in children with autism spectrum disorders—A pilot study. Neuropsychiatric Disease and Treatment, 11, 1911–1920. https://doi.org/10.2147/NDT.S85650.

    Article  PubMed  PubMed Central  Google Scholar 

  • Bruni, O., Ottaviano, S., Guidetti, V., Romoli, ,M., Innocenzi, M., Cortesi, F., Giannotti, F., et al. (1996). The Sleep Disturbance Scale for Children (SDSC). Construction and validation of an instrument to evaluate sleep disturbances in childhood and adolescence. Journal of Sleep Research, 5, 251–261.

    Article  PubMed  Google Scholar 

  • Buckley, A. W., Rodriguez, A. J., Jennison, K., Buckley, J., Thurm, A., Sato, S., & Swedo, S. (2010). Rapid eye movement sleep percentage in children with autism compared with children with developmental delay and typical development. Archives of Pediatrics & Adolescent Medicine. 164(11), 1032–1037. https://doi.org/10.1001/archpediatrics.2010.202.

    Article  Google Scholar 

  • Chervin, D. R., Archbold, K. H., Dillon, J. E., Panahi, P., Pituch, K. J., Dahl, E. R., et al. (2002). Inattention, hyperactivity, and symptoms of sleep-disordered breathing. Pediatrics, 109(3), 449–456.

    Article  PubMed  Google Scholar 

  • Conners’ Rating Scales-Revised Technical Manual. (2000). North Tonawanda. New York: Multi Health Systems.

    Google Scholar 

  • Conners, C. K. (2003). Conners 3rd edition. Toronto: MHS.

    Google Scholar 

  • Doo, S., & Wing, Y. K. (2006). Sleep problems of children with pervasive developmental disorders: Correlation with parental stress. Developmental Medicine and Child Neurology, 48, 650–655.

    Article  PubMed  Google Scholar 

  • Dunn, W. (1999). Sensory profile. San Antonio: Psychological Corporation.

    Google Scholar 

  • Elrod, M. G., & Hood, B. S. (2015). Sleep differences among children with autism spectrum disorders and typically developing peers: A meta-analysis. Journal of Developmental & Behavioral Pediatrics, 36(3), 166–177. https://doi.org/10.1097/DBP.0000000000000140.

    Article  Google Scholar 

  • Fadini, C. C., Lamônica, D. A., Fett-Conte, A. C., Osório, E., Zuculo, G. M., Giacheti, C. M., & Pinato, L. (2015). Influence of sleep disorders on the behaviour of individuals with autism spectrum disorder. Frontiers in Human Neurosciences, 9, 347.

    Google Scholar 

  • Ferreira, V. R., Carvalho, L. B., Ruotolo, F., de Morais, J. F., Prado, L. B., & Prado, G. F. (2009). Sleep disturbance scale for children: Translation, cultural adaptation, and validation. Sleep medicine, 10(4), 457–463. https://doi.org/10.1016/j.sleep.2008.03.018. (Epub 2008 Aug 15).

    Article  PubMed  Google Scholar 

  • Glickman, G. (2010). Circadian rhythms and sleep in children with autism. Neuroscience & Biobehavioural Reviews, 34, 755–768. (PubMed: 19963005).

    Article  Google Scholar 

  • Goldman, S. E., Adkins, K. W., Calcutt, M. W., Carter, M. D., Goodpaster, R. L., Wang, L., et al. (2014). Melatonin in children with autism spectrum disorders: Endogenous and pharmacokinetic profiles in relation to sleep. Journal of Autism and Developmental Disorders, 44(10), 2525–2535. https://doi.org/10.1007/s10803-014-2123-9.

    Article  PubMed  PubMed Central  Google Scholar 

  • 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(3), 1223–1229. https://doi.org/10.1016/j.rasd.2011.01.010.

    Article  Google Scholar 

  • Goldman, S. E., Richdale, A. L., Clemons, T., & Malow, B. A. (2012). Parental sleep concerns in autism spectrum disorders: Variations from childhood to adolescence. Journal of Autism and Developmental Disorders, 42(4), 531–538. https://doi.org/10.1007/s10803011-1270-5.

    Article  PubMed  Google Scholar 

  • 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(5), 560–573. https://doi.org/10.1080/87565640903133509.

    Article  PubMed  PubMed Central  Google Scholar 

  • Green, S. A., & Carter, A. S. (2014). Predictors and course of daily living skills development in toddlers with autism spectrum disorders. Journal of Autism and Developmental Disorders, 44 (2), 256–263. https://doi.org/10.1007/s10803-011-1275-0.

    Article  PubMed  PubMed Central  Google Scholar 

  • Henderson, J. A., Barry, T. D., Bader, S. H., & Jordan, S. S. (2011). The relation among sleep, routines,and externalizing behavior in children with an autism spectrum disorder. Research in Autism Spectrum Disorder, 5, 758–767. https://doi.org/10.1016/j.rasd.2010.09.003.

    Article  Google Scholar 

  • 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, 49–50, 86–99. https://doi.org/10.1016/j.ridd.2015.11.002.

    Article  PubMed  Google Scholar 

  • 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(7), 1631–1638. https://doi.org/10.1016/j.ridd.2014.03.037.

    Article  PubMed  Google Scholar 

  • Hollway, J. A., & Aman, M. G. (2011). Sleep correlates of pervasive developmental disorders: A review of the literature. Research in Developmental Disabilities, 32(5), 1399–1421. https://doi.org/10.1016/j.ridd.2011.04.001.

    Article  PubMed  Google Scholar 

  • Hollway, J. A., Aman, M. G., & Butter, E. (2013). Correlates and risk markers for sleep disturbance in participants of the autism treatment network. Journal of Autism and Developmental Disorders. https://doi.org/10.1007/s10803-013-1830-y.

    Article  PubMed  Google Scholar 

  • Honomichl, R. D., Goodlin-Jones, B. L., Burnha, M., Gaylor, E., & Anders, T. F. (2002). Sleep patterns of children with pervasive developmental disorders. Journal of Autism and Developmental Disorders, 32(6), 553–561.

    Article  PubMed  PubMed Central  Google Scholar 

  • Humphreys, J. S., Gringras, P., Blair, P. S.. Scott, N., Henderson, J., Fleming, P. J., et al. (2013). Sleep patterns in children with autistic spectrum disorders: A prospective cohort study. Published Online First: 23 September 2013. Archives of Disease in Childhood. https://doi.org/10.1136/archdischild-2013-304083.

    Article  PubMed  PubMed Central  Google Scholar 

  • Juneja, M., Mishra, D., Russell, P. S., Gulati, S., Deshmukh, V., Tudu, P., et al. (2014). INCLEN diagnostic tool for autism spectrum disorder (INDT-ASD): Development and validation. Indian Pediatrics, 51, 359–365.

    Article  PubMed  Google Scholar 

  • Juneja, M., & Sairam, S. (2018). Autism spectrum disorder—An Indian perspective. Recent Advances in Autism. http://www.smgebooks.com/autism/chapters/AUT-18-12.pdf.

  • Krakowiak, P., Goodlin, J. B., Picciotto, I. H., 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.

    Article  PubMed  PubMed Central  Google Scholar 

  • Kulman, G., Lissoni, P., Rovelli, F., Roselli, M. G., Brivio, F., & Sequeri, P. (2000). Evidence of pineal endocrine hypofunction in autistic children. Neuroendocrinology Letters, 21, 31–34.

    PubMed  Google Scholar 

  • Liu, X., Hubbard, J. A., Fabes, R. A., & Adam, J. B. (2006). Sleep disturbances and correlates of children with autism spectrum disorders. Child Psychiatry and Human Development, 37, 179–191.

    Article  PubMed  Google Scholar 

  • Malow, B., Marzec, M., McGrew, S., Wang, L., Henderson, L., & Stone, W. (2006). Characterizing sleep in children with autism spectrum disorders: A multi-dimensional approach. Sleep, 29, 15–63.

    Article  Google Scholar 

  • 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.

    Article  Google Scholar 

  • Mazurek, M. O., & Petroski, G. F. (2014). Sleep problems in children with autism spectrum disorder: Examining the contributions of sensory over-responsivity and anxiety. Sleep Medicine. https://doi.org/10.1016/j.sleep.2014.11.006.

    Article  PubMed  Google Scholar 

  • Melke, J., Goubran-Botros, H., Chaste, P., Betancur, C., Nygren, G., Anckarsater, H., Rastam, M., et al. (2008). Abnormal melatonin synthesis in autism spectrum disorders. Molecular Psychiatry, 13(1), 90–98.

    Article  PubMed  Google Scholar 

  • Miano, S., Bruni, O., Elia, M., Trovato, A., Smerieri, A., Verrillo, E., et al. (2007). Sleep in children with autistic spectrum disorder: A questionnaire and polysomnographic study. Sleep Medicine, 9(1), 64–70. https://doi.org/10.1016/j.sleep.2007.01.014.

    Article  PubMed  Google Scholar 

  • Ministry of Social Justice and Empowerment. (2009). Scientific report on research project for development of indian scale for assessment of autism. New Delhi: Government of India.

    Google Scholar 

  • Musthaq, I., & Suman, P. (2014). Study of the sleep disturbances in children with autism spectrum disorder. European Academic Research, 2(1), 1100–1117.

    Google Scholar 

  • Olsson, M. B., Carlsson, L. H., Westerlund, J., Gillberg, C., & Fernell, E. (2013). Autism before diagnosis: Crying, feeding and sleeping problems in the first two years of life. Acta Paediatrica, 10, 635–639. https://doi.org/10.1111/apa.12229.

    Article  Google Scholar 

  • Owens, J. A., & Mindell, J. A. (2003). A clinical guide to pediatric sleep: Diagnosis and management of sleep problems. (158). Philadelphia: Lippincott Williams & Wilkins.

    Google Scholar 

  • Raina, S. K., Chander, V., Bhardwaj, A. K., Kumar, D., Sharma, S., Kashyap, V., et al. (2017). Prevalence of autism spectrum disorder among rural, urban, and tribal children (1–10 years of age). Journal of Neurosciences in Rural Practice, 8(3), 368–374. https://doi.org/10.4103/jnrp.jnrp_329_16.

    Article  PubMed  PubMed Central  Google Scholar 

  • Ravikiran, S. R., Kumar, P. M., & Latha, K. S. (2011). Sleep problems in preschool and school aged rural Indian children. Indian Pediatrics, 48(3), 221–223. (Epub 2010 Nov 30).

    Article  PubMed  Google Scholar 

  • Reynolds, A. M., & Malow, B. A. (2011).Sleep and autism spectrum disorders. Pediatric Clinics of North America. 58(3), 685–698. https://doi.org/10.1016/j.pcl.2011.03.009.

    Article  PubMed  Google Scholar 

  • Richdale, A. L., Baker, E., Short, M., & Gradisar, M. (2014). The role of insomnia, pre-sleep arousal and psychopathology symptoms in daytime impairment in adolescents with high-functioning autism spectrum disorder. Sleep Medicine, 15(9), 1082–1088. https://doi.org/10.1016/j.sleep.2014.05.005.

    Article  PubMed  Google Scholar 

  • Richdale, A. L., & Prior, M. R. (1995). The sleep/wake rhythm in children with autism. European Child and Adolescent Psychiatry, 4, 175–186.

    Article  PubMed  Google Scholar 

  • Robins, D. L., Casagrande, K., Barton, M., Chen, C. M., Dumont-Mathieu, T., & Fein, D. (2014). Validation of the modified checklist for autism in toddlers, revised with follow-up (M-CHAT-R/F). Pediatrics, 133(1), 37–45. https://doi.org/10.1542/peds.2013-1813.

    Article  PubMed  PubMed Central  Google Scholar 

  • Romeo, D. M., Bruni, O., Brogna, C., Ferri, R., Galluccio, C., Clemente, V. D., Di Jorio, M., et al. (2013). Application of the Sleep Disturbance Scale for Children (SDSC) in preschool age. European Journal of Pediatric Neurology, 17, 374–382.

    Article  Google Scholar 

  • Ronald, A. (1944). Problem children problem parents. Indian Journal of Pediatrics, 11, 20–29.

    Article  Google Scholar 

  • Rudra, A., Belmonte, M. K., Soni, P. K., Banerjee, S., Mukerji, S., & Chakrabarti, B. (2017). Prevalence of autism spectrum disorder and autistic symptoms in a school-based cohort of children in Kolkata, India. Autism Research, 10(10), 1597–1605. https://doi.org/10.1002/aur.1812.

    Article  PubMed  PubMed Central  Google Scholar 

  • Rutter, M., Bailey, A., & Lord, C. (2003). The social communication questionnaire: Manual. Torrance: Western Psychological Services.

    Google Scholar 

  • Schopler, E., Van Bourgondien, M. E., Wellman, G. J., & Love, S. R. (2010). Childhood autism rating scale, second edition [manual]. Torrance: Western Psychological Services.

    Google Scholar 

  • Schreck, K. A., & Mulick, J. A. (2000). Parental report of sleep problems in children with autism. Journal of Autism and Developmental Disorders, 30(2), 127–135.

    Article  PubMed  Google Scholar 

  • Schreck, K. A., & Richdale, A. L. (2011). Knowledge of childhood sleep: A possible variable in under or misdiagnosis of childhood sleep problems. Journal of Sleep Research, 20(4), 589–597. https://doi.org/10.1111/j.1365-2869.2011.00922.x.

    Article  PubMed  Google Scholar 

  • Simola, P., Niskakangas, M., Liukkonen, K., Virkkula, P., Pitkäranta, A., Kirjavainen, T., & Aronen, E. T. (2010). Sleep problems and daytime tiredness in Finnish preschool-aged children—A community survey. Child Care Health Development, 36(6), ,805–811.

    Article  Google Scholar 

  • Sivertsen, B., Posserud, M. B., Gillberg, C., Lundervold, J. A., & Hysing, M. (2012). Sleep problems in children with autism spectrum problems: A longitudinal population-based study. Autism, 16, 139. https://doi.org/10.1177/1362361311404255.

    Article  PubMed  Google Scholar 

  • Sparrow, S., Balla, D., & Cicchetti, D. (1984). Vineland adaptive behaviour scales–Interview edition. Circle. Pines: AGS.

    Google Scholar 

  • Spruyt, K., & Gozal, D. (2011). Pediatric sleep questionnaires as diagnostic or epidemiological tools: A review of currently available instruments. Sleep Medicine Reviews, 15(1), 19–32. https://doi.org/10.1016/j.smrv.2010.07.005.

    Article  PubMed  Google Scholar 

  • Spruyt, K., O’brien, L. M., Cluydts, R., Verleye, G. B., & Ferri, R. (2005). Odds, prevalence and predictors of sleep problems in school-age normal children. Journal of Sleep Research, 14, 163–176.

    Article  PubMed  Google Scholar 

  • Taylor, M. A., Schreck, K. A., & Mulick, J. A. (2012). Sleep disruption as a correlate to cognitive and adaptive behavior problems in autism spectrum disorders. Research in Developmental Disabilities, 33(5), 1408–1417. https://doi.org/10.1016/j.ridd.2012.03.013.

    Article  PubMed  Google Scholar 

  • Wachob, D., & Lorenzi, D. G. (2015). Brief report: Influence of physical activity on sleep quality in children with autism. Journal of Autism and Developmental Disorders. https://doi.org/10.1007/s10803-015-2424-7.

    Article  PubMed  Google Scholar 

  • Wang, G., Liu, Z., Xu, G., Jiang, F., Lu, N., Baylor, A., et al. (2016). Sleep disturbances and associated factors in Chinese children with autism spectrum disorder: A retrospective and cross sectional study. Child Psychiatry And Human Development, 47, 248. https://doi.org/10.1007/s10578-015-0561-z.

    Article  PubMed  Google Scholar 

  • Williams, G. P., Sears, L. L., & Allard, A. M. (2004). Sleep problems in children with autism. Journal of Sleep Research, 13(3), 265–268.

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Maulana Azad Medical College, Bahadur Shah Zafar Marg, New delhi, 110002, India

    Vernika Tyagi, Monica Juneja & Rahul Jain

Authors
  1. Vernika Tyagi
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Monica Juneja
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Rahul Jain
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

MJ planned the study, provided intellectual output and helped in writing the manuscript. RJ provided intellectual output and helped in writing the manuscript. VT was involved in data collection and drafting of manuscript.

Corresponding author

Correspondence to Vernika Tyagi.

Ethics declarations

Conflict of interest

The authors declare that none of the authors have any conflict of interest.

Ethical Approval

The study was ethically approved by the ethical committee of the university.

Informed Consent

Informed consent was taken from parents of all children who participated in the study.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Tyagi, V., Juneja, M. & Jain, R. Sleep Problems and Their Correlates in Children with Autism Spectrum Disorder: An Indian Study. J Autism Dev Disord 49, 1169–1181 (2019). https://doi.org/10.1007/s10803-018-3820-6

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10803-018-3820-6

Keywords

Search

Navigation