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Sleep problems in children with autism spectrum disorder: examining the contributions of sensory over-responsivity and anxiety.

TitleSleep problems in children with autism spectrum disorder: examining the contributions of sensory over-responsivity and anxiety.
Publication TypeJournal Article
Year of Publication2015
AuthorsMazurek, MO, Petroski, G
JournalSleep Medicine
Date Published2015 Feb
KeywordsAdolescent, Age Factors, airp, Anxiety, Arousal, Autism Spectrum Disorder, Checklist, Child, Child, Preschool, Female, Humans, Male, Sensation Disorders, Sleep Initiation and Maintenance Disorders, Sleep Wake Disorders, Surveys and Questionnaires

OBJECTIVES: Children with autism spectrum disorder (ASD) are at high risk for sleep problems. Previous research suggests that sensory problems and anxiety may be related to the development and maintenance of sleep problems in children with ASD. However, the relationships among these co-occurring conditions have not been previously studied. The current study examined the interrelations of these symptoms in a large well-characterized sample of children and adolescents with ASD.

METHODS: The current study examined the relationships among sleep problems, sensory over-responsivity, and anxiety in 1347 children enrolled in the Autism Speaks Autism Treatment Network. The primary measures included the Children's Sleep Habits Questionnaire, the Child Behavior Checklist, and the Short Sensory Profile.

RESULTS: In bivariate correlations and multivariate path analyses, anxiety was associated with all types of sleep problems (ie, bedtime resistance, sleep-onset delay, sleep duration, sleep anxiety, and night wakings; p < 0.01 to p < 0.001; small to medium effect sizes). Sensory over-responsivity (SOR) was correlated with all sleep problems in bivariate analyses (p < 0.01 to p < 0.001; small effect sizes). In multivariate path models, SOR remained significantly associated with all sleep problems except night awakenings for older children, while SOR was no longer significantly associated with bedtime resistance or sleep anxiety for younger children.

CONCLUSIONS: Children with ASD who have anxiety and SOR may be particularly predisposed to sleep problems. These findings suggest that some children with ASD and sleep disturbance may have difficulties with hyperarousal. Future research using physiological measures of arousal and objective measures of sleep are needed.


Lead Author
Micah O. Mazurek

Study Aims and Objectives
To examine the relationships among three common co-occurring problems for children with an Autism Spectrum Disorder (ASD): sleep problems, sensory problems, and anxiety.

Methods - Sample, Procedure, Study Measures, Analysis
The current study included 1347 children with ASD (84.8% male) between the ages of 2 and 17. Parents completed questionnaires about their children’s sleep, sensory over-responsivity (being overly sensitive to light, sound, or touch), and anxiety. Possible relationships between these problems were explored.

Results – Main Finding(s)
Anxiety was associated with sensory over-responsivity and both were associated with specific sleep problems, including bedtime resistance, difficulties falling asleep, getting less sleep, and waking up at night. The relationships between anxiety, sensory problems, and sleep were notable even after controlling for other factors, including the child’s age, IQ, and sex.

Conclusion – Summary Statement
Children with ASD who have anxiety or sensory problems may be particularly likely to have sleep problems. Findings from this study suggest that some children with ASD may have heightened responses to sensory input such as noise, light, and temperature, which may make falling and staying asleep more difficult. Further research is needed to examine bodily responses to stress and sensory input in children with ASD who have trouble sleeping. These findings can be used to develop more effective treatments for these problems.

Alternate JournalSleep Med.
PubMed ID25600781
Grant ListUA3 MC11054 / / PHS HHS / United States