Sleep Problems in Children With Autism Spectrum Disorder and in Their Caregivers

RESEARCH HYPOTHESIS: This descriptive study addressed the hypothesis that the presence of greater sleep problems in children with autism spectrum disorder (ASD) is associated with greater sleep problems in their primary caregiver.

RATIONALE: Sleep problems have been widely reported in children with ASD; however, very little research has examined the impact of child sleep problems on their primary family caregiver. Sleep problems in children with ASD can potentially impact the daily functioning of the caregiver as well as the functioning of the child with ASD.

DESIGN: This quantitative descriptive study collected information from a mailed or online survey.

PARTICIPANTS: A convenience sample of 62 caregivers of children with ASD were recruited from the Southwest Autism Research and Resource Center in Phoenix, AZ. Participants were the primary family caregiver of a child 6 to 11 yr old with a diagnosis of ASD. This diagnosis was confirmed by a prior administration of an Autism Diagnostic Observational Survey–2.

METHOD: The study survey included the caregivers’ report of their own sleep using the Sleep Habits Questionnaire, a measure that is typically used with individuals with unidentified sleep disorders. The caregivers also reported the quality of their child’s sleep using the Children’s Sleep Habits Questionnaire (CSHQ).

ANALYSIS: Descriptive statistics were computed for all variables. Bivariate correlations examined relationships between child sleep problems and caregiver sleep duration. T tests computed relationships between caregiver sleep disorder symptoms and child sleep problems.

RESULTS: In this sample, 75% of the children received a cut-off score of 41 or above on the CSHQ, indicating sleep problems. The average sleep duration of caregivers was 6.4 (SD = .97) hr per night and 82% of caregivers had short sleep duration, defined as 7 hr per night. Significant relationships were found between shorter caregiver sleep duration and more child sleep problems (r = –.39, p = .002). Additionally, other caregiver sleep disorder symptoms included difficulty staying asleep, early morning awakening, and insufficient sleep and were associated with greater child sleep problems (all ps < .05). Caregivers who reported the insomnia symptom of difficulty falling asleep were more likely to report that their children with ASD had sleep onset delay, t(60) = 4.16, p < .01). There were 22% of the biological parents who indicated that they had symptoms of restless legs syndrome (RLS). Notably, parents with symptoms of RLS had children with more night waking, t(48) = –2.41, p = .02).

DISCUSSION: This descriptive study found the presence of sleep problems in both children with ASD and in their caregivers. Significant relationships were found between many sleep issues in caregivers and sleep problems in their child with ASD. Results suggest that caregiver sleep duration was driven by their child’s poor sleep rather than the sleep issues of the caregiver. The relationships between difficulty falling asleep in caregivers and sleep onset delay in children as well as RLS in caregivers and restless sleep in children suggest possible biological mechanisms that may be common to the parent and the child. There are many probable connections between the sleep problems of children with ASD and the sleep problems of their caregivers that are likely rooted in genetic, environmental, and behavioral factors.

IMPACT STATEMENT: Occupational therapists are encouraged to examine the sleep issues of children with ASD in tandem with the sleep problems of their caregivers. Interventions for child sleep problems and the promotion of healthy sleep must consider the family as a unit.