Sleep and Daytime Behavior in Children with Autism Spectrum Disorder

Sleep problems are common in children with autism spectrum disorder (ASD) and may exacerbate challenging daytime behaviors and ASD symptoms. In early childhood, individuals with ASD often receive intensive behavioral interventions using a center-based model; however, no study has assessed direct relations between sleep and challenging behaviors in this common developmental context. The current study examined relations between sleep and challenging behaviors in 42 children with ASD (2-10 years of age). All children attended a center-based intervention program five days per week. Child sleep was assessed using a multi-method approach (actigraphy, parent-report sleep diary, and the Children’s Sleep Habits Questionnaire). During the sleep assessment week, daytime behaviors were recorded by each child’s behavioral clinicians. Daytime challenging behaviors included repetitive behaviors, aggression, negative affect, and self-injury. Regression models were used to assess relations between parent-reported sleep problems and average challenging behaviors. Similarly, linear mixed effects models were used to assess relations between sleep and each challenging behavior at both the group (between-child) and individual (within-child, daily) levels. Overall, results indicate that sleep and challenging behaviors in children with ASD are associated. However, in the current study, only wake after sleep onset and self-injurious behavior exhibited daily associations. This finding suggests that between-person differences in sleep and challenging behavior mattered more than daily fluctuations in our sample. Within the treatment context, challenging behaviors can influence child treatment progress. However, sleep may not be the primary mechanism for these behaviors.