Sleep problems and executive functions in children with autism spectrum disorder

Abstract

Sleep problems are common and often associated with an array of negative effects on their daytime functioning in children. While sleep problems are especially prevalent in children with Autism Spectrum Disorder (ASD), the research on the role of sleep problems, especially insomnia, in relation to executive function (EF) and the effects of sleep-focused interventions in preschool children with ASD remained limited. Study one was a cross-sectional study that examined the associations of sleep problems, specifically insomnia symptoms (Bedtime Resistance, Sleep Onset Delay and Night Wakings), with EF, behavioral and emotional problems, and parental functioning in a sample of preschool children with ASD (n=197; aged 3-6 years). 90.4% of the sample were identified as having sleep problems based on the cutoff score on the Children’s Sleep Habits Questionnaire (CSHQ). Bedtime Resistance, Sleep Duration, Parasomnias and Daytime Sleepiness were significantly associated with daytime emotional and behavioral problems after controlling for socio-demographic factors. Daytime Sleepiness was also found to be associated with parents’ sleep and mood problems, while Sleep Anxiety was associated with parents’ overall sleep problems. Hierarchical multiple regression analysis showed that Night Wakings was significantly associated with behavioral manifestation of EF deficits, after controlling for socio-demographic factors and other sleep problems. The results suggested insomnia having an independent role in the association between sleep problems and EF in young children with ASD. Study two was a randomized controlled trial that examined the efficacy of a telehealth-delivered parent-based sleep-focused intervention in treating insomnia in preschool children with ASD. A total of 62 parents/caregivers with a child with ASD and comorbid insomnia (aged 3-6 years) were randomized to receive either three weekly group sessions of sleep-focused intervention via zoom with telephone support (n=30) or treatment as usual (TAU, n=32). Assessments were conducted at baseline and post-treatment (8 weeks after baseline assessment). Participants in the intervention group had significantly greater improvements in overall sleep problems (CSHQ total score; p<.05), Bedtime Resistance (p<.05) and Sleep Onset Delay (p<.05) at post-treatment as compared to the TAU participants. The treatment effects ranged from medium to large (partial η²=.076 to .084). In addition, children in the intervention group showed significant improvements in overall behavioral and emotional problems (p<.05), especially externalizing problems (p<.05) as measured by Strengths and Difficulties Questionnaire (SDQ), and parental stress level (p<.05) as measured by Depression, Anxiety and Stress Scale (DASS-21) at post-treatment as compared to the TAU participants. Intervention effects ranged from medium to large (partial η²=.081 to .101). The findings supported the promising effects of a brief parent-based sleep intervention delivered via telehealth on improving sleep and daytime behaviors, and reducing parental stress level in preschool children with ASD. The findings of the present thesis highlighted the negative association between sleep problems in preschoolers with ASD, especially the independent role of insomnia, and EF. The positive treatment effects of a parent-based sleep intervention delivered via telehealth had important implications for increasing access to timely treatment for children with ASD in need. Further research with a longitudinal design and interventional studies with a longer follow up are needed for this unique clinical population.