Efficacy of Sleep Education for Parents With Children With Autism Spectrum Disorder

SIGNIFICANCE: This research supports the role of occupational therapy in educating parents of children with autism spectrum disorder (ASD) regarding sleep preparation and sleep participation to promote improved sleep. Parents report sleep disturbances as one of their biggest concerns. Approximately 80% to 90% of children with ASD have sleep disturbances and experience a larger number of sleep disturbance issues compared to typically developing children. Children require adequate sleep to promote optimal functioning and health. Occupational therapists (OTs) are uniquely qualified to provide this sleep intervention, which includes changes in routines, strategies for sensory calming, environmental modifications, and behavioral strategies. Without adequate sleep, children and parents are predisposed to stress, mood disturbances, and behavioral changes.

INNOVATION: Although rest and sleep are part of the Occupational Therapy Practice Framework: Domain and Process, little exists in the occupational therapy textbooks and literature to describe roles and interventions for occupational therapy in this area. A review of the literature from multiple sources was conducted to determine evidence for sleep interventions in children with ASD. An educational program was designed for parents of children with ASD aimed at teaching them specific evidence-based sleep interventions to implement at home. Specific techniques included sensory calming strategies, sleep hygiene routines, sleep schedules, bedtime routines, environmental modifications, faded bedtime practices, and a bedtime pass technique. This novel educational approach was then conducted and researched to determine effectiveness.

RESEARCH QUESTION: How effective is an occupational-therapy-focused, parent-educational program designed to improve sleep preparation and sleep participation for children with ASD?

RATIONALE: The rates for diagnosis of ASD continue to climb, and sleep disturbances is one of the main concerns reported by parents. Rest and sleep are needed to support health and active engagement in all other occupations. The Framework supports the unique role of occupational therapy in addressing this area. This research is needed to show the effectiveness of sleep education provided by OTs, as it encompasses education for sensory calming, behavioral techniques, environmental modifications, and changes in daily sleep and bedtime routines.

METHOD: A pretest–posttest, one-group design was utilized. A knowledge-based pretest–posttest was designed and administered before and after the educational program. In addition, a standard tool, the Children’s Sleep Habits Questionnaire (CSHQ), was completed by parents at the beginning of the program to identify sleep disturbances that they reported to be troublesome. The CSHQ measures bedtime resistance, sleep anxiety, sleep onset delay, sleep duration, night wakings, daytime sleepiness, sleep-disordered breathing, and parasomnias. Parents of children with ASD volunteered to participate in a 2-hr educational small group program advertised and provided in community settings, and free child care was made available.

RESULTS: A one-tailed, paired t test was conducted to compare pre- and posttest scores on the knowledge-based test. Statistical analysis revealed a p value of .0003, indicating a significant increase in parental knowledge on the basis of the occupational therapy educational program provided. Descriptive statistics were used to determine characteristics of the participants.

CONCLUSIONS: In this study, we provided evidence that an occupational-therapy-designed, parent-educational program regarding sleep preparation and sleep participation is an effective treatment. Improving the quality of sleep for children with ASD improves the quality of life for the children and their families and promotes a healthy lifestyle.