Date Presented 3/31/2017
Weighted blankets are commonly used by occupational therapists for children with autism spectrum disorder and sensory processing difficulties. The findings of this case series indicate that a portion of the participants responded positively to the weighted blanket intervention and increased their sleep quality.
Primary Author and Speaker: Bryan Gee
Additional Authors and Speakers: Tyler McOmber, Jesse Sutton, Kimberly Lloyd
BACKGROUND AND PURPOSE: Sleep and rest disturbances are important self-care challenges that are commonly faced by many individuals with autism spectrum disorder (ASD), with 44%–83% of individuals with ASD reporting sleep disturbances (Tumiran et al., 2013). Such disturbances are characterized by diminished duration of sleep due to difficulty falling asleep and difficulty staying asleep. Occupational therapists may work with individuals to establish healthy sleep routines in their clients, commonly including children with ASD and their families. Weighted blankets are an example of a sensory-based intervention commonly used in helping children with ASD attain adequate sleep participation. The purpose of this study was to explore parental perspectives related to the effectiveness of weighted blankets for sleep quality in children diagnosed with ASD, sensory overresponsivity (SOR), and sleep difficulties.
DESIGN: An ABA single-subject design was used for this study: A(1) phase, baseline data collection (up to 9 days); B phase, implementation of the weighted blanket (14 days); and A(2) phase, withdrawal of the intervention (9 days).
METHOD: Four participants were selected for the study based on the following criteria: The children had a diagnosis of ASD, evidenced a sleep disturbance according to the Child Sleep Habits Questionnaire, struggled with SOR as evidenced by a threshold score on the Sensory Processing Measure, were ages 3–6 yr, and lived within a reasonable driving distance of the offices of the principal investigator. Caregiver inclusion criteria included report that their child had difficulty falling asleep and/or staying asleep, daily reliable Internet access throughout the duration of the study, ability and willingness to complete an online survey daily for 30 days, and ability and willingness to implement a weighted blanket as part of the child’s sleep routine for 14 consecutive days.
During each phase (ABA) of the study, caregivers completed a daily survey assessing sleep quality, time to fall asleep, sleep duration, and behavioral ratings on waking. Sleep quality and movement were tracked using an external monitoring device attached to the participant’s bed. Data were analyzed through visual analysis of repeated-measure graphs that were generated. Visual analyses of the data points and the trend lines was conducted.
RESULTS: Moderate improvement of the measured constructs related to sleep quality in the four participants were observed. The participants exhibited evidence of an increase in total amount of sleep per night as well as a slight decrease in time to fall asleep. However, morning mood did not consistently improve with the use of the weighted blanket for two of the four participants. Based on the online survey and the movement tracking device, it was determined that the participants slept between 1 and 3 extra hours a night as a result of the weighted blanket.
DISCUSSION: Sleep disturbance in children with ASD and SOR is a challenging issue to address. Occupational therapy using weighted blankets can assist children with ASD to calm, organize, fall asleep, and remain asleep. This study provides a springboard justifying the need for additional research related to improving the quality of sleep in children with ASD and SOR using more robust single-subject design methodology and measurement resources.
IMPACT STATEMENT: This is the first occupational therapy–based study looking at weighted blankets with children with ASD and SOR. Further, it helps assess what part of the ASD population responds best to weighted blankets to improve sleep quality.
References
Gee, B. M., Peterson, T. G., Buck, A., & Lloyd, K. (2016). Improving sleep quality using weighted blankets among young children with an autism spectrum disorder. International Journal of Therapy and Rehabilitation, 23, 173–181. https://doi.org/10.12968/ijtr.2016.23.4.173
Tumiran, M. A., Mohamad, S. P., Saat, R. M., Yusoff, M. Y. Z. M., Rahman, N. N. A., & Adli, D. S. H. (2013). Addressing sleep disorder of autistic children with Qur’anic sound therapy. Health, 5(8A2), 73–79. https://doi.org/10.4236/health.2013.58A2011
