Abstract
Sleep disturbances are common in people with autism spectrum disorder (ASD), but research on this topic is still limited in China. In the current study, we evaluated the prevalence of sleep problems in preschool-aged children with ASD and to examine the correlations between sleep disturbances and emotional/behavioral symptoms and repetitive behavior in the unique social context of China. This study recruited 475 preschool-aged children aged 3–6 years old, including 252 children with ASD (mean age 5.13 ± 1.15, 80.6% male) and 223 age-matched typically developing (TD) children (mean age 5.12 ± 0.97, 74.9% male). The parents of all children completed a sociodemographic questionnaire and the Childhood Sleep Habits Questionnaire. The parents of 114 ASD children completed the Strengths and Difficulties Questionnaire (SDQ) and the Repetitive Behavioral Questionnaire-2 (RBQ-2). The prevalence of sleep problems in preschool-aged children with ASD in this study was 81.7%, which was higher than that in TD children (61.0%). The scores for bedtime resistance, sleep anxiety, sleep duration, parasomnias, and sleep onset delay in the ASD group were significantly higher than those in the TD group (t=−7.664, P=0.000; t=−10.477, P=0.000; t=−4.133, P=0.000; Z=−3.916, P=0.000; Z=−7.093, P=0.000; respectively). Sleep onset delay explained 17.3% of the variance (adjusted R2 = 0.173) in the total SDQ score of children with ASD, and bedtime resistance explained a large proportion of total RBQ-2 score variance (adjusted R2 = 0.206). The high rate of sleep disturbances in preschool-aged children with ASD emphasizes the importance of screening for sleep problems in this population. Attention should also be directed toward formulating good sleep hygiene practices for preschool-aged children in the particular social context and cultural setting of China.
Highlights
Autism spectrum disorder (ASD) is a neurodevelopmental condition that has increased in prevalence over the past few decades, with a current rate of 1 in 59 children in the US [1]
We found that the subscale scores for bedtime resistance, sleep anxiety, sleep duration, parasomnias, and sleep onset delay in the autism spectrum disorder (ASD) group were still significantly higher than those in the typically developing (TD) group
We found that differences in the characteristics of sleep disturbances in children with and without ASD were reflected by significant group differences on five of the eight Children's Sleep Habits Questionnaire (CSHQ) subscales
Summary
Autism spectrum disorder (ASD) is a neurodevelopmental condition that has increased in prevalence over the past few decades, with a current rate of 1 in 59 children in the US [1]. ASD is often associated with comorbid conditions including emotional and behavioral dysregulation and psychiatric and medical issues [e.g., sleep disorders [4, 5]]. Being able to evaluate which problems are more likely to cause clinically significant impairments is important. For this reason, researchers are increasingly interested in studying sleep disturbances related to clinically elevated impairments in children with ASD [8, 9]
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