Systematic review of the collateral effects of behavioral sleep interventions in children and adolescents with autism spectrum disorder

Abstract

BackgroundChildren with autism spectrum disorder (ASD) experience high rates of sleep problems. Interventions based on the principles of Applied Behavior Analysis (ABA) significantly reduce such sleep problems. Insufficient sleep is linked to a variety of adverse consequences for children with ASD, such as ASD symptom severity and internalizing and externalizing difficulties. In spite of these associations, no systematic reviews have been conducted that explore the collateral benefits of behavioral sleep interventions. AimTo evaluate the empirical evidence investigating the collateral effects of behavioral sleep interventions in children and adolescents with ASD. MethodsTo meet inclusion criteria, studies included participants between 2–18 years with a diagnosis of ASD, directly treated sleep problems and included at least one measure of collateral treatment effects. Data were extracted on participant characteristics, research design, intervention characteristics, sleep measures and results, social validity, collateral effect measures and results. Methodological rigor was evaluated and each study was coded as strong, adequate or weak. ResultsTen studies met inclusion criteria and all reported an improvement in at least one aspect of children’s sleep. Eight of the 10 studies demonstrated collateral improvement in one or more aspects of children’s daytime functioning following a behavioral sleep intervention. This included a reduction in stereotypic behaviors, internalizing and externalizing difficulties and quality of life. ConclusionsWhile the mechanisms underlying change are not known, outcomes of this review suggest that behavioral sleep interventions may be followed by collateral improvement in children’s daytime functioning and wellbeing. However, only four studies had strong or adequate methodological rigor, indicating the necessity of further research.