Association for Behavior Analysis International

Sleep problems are ubiquitous among children and adolescents with autism spectrum disorder (ASD). Without effective treatment these sleep problems are unlikely to resolve, resulting in adverse secondary effects on the daytime functioning and wellbeing of people with ASD and their families. Sleep problems in children with ASD are underpinned by a combination of biopsychosocial factors and treatments include both pharmacological and behavioral approaches. However, to date we know little about how parental attributions about sleep problems and child and family complexity variables affect treatment selection, perceptions of efficacy, and outcome. This symposium contains a series of data-based presentations evaluating these important issues, including: (a) the efficacy of individualized, assessment-informed behavioral interventions for sleep problems in children with ASD, (b) child and family complexity variables and their impact on treatment outcomes, (c) parental attributions about sleep problems in their child with ASD, and (d) the collateral child and family benefits of effective sleep treatment.

Sleep problems are prevalent and persistent in young children, especially children diagnosed with Autism Spectrum Disorder (ASD). These problems negatively impact the health and development of young children and are often challenging to address for caregivers and clinicians. Pharmacological interventions, such as melatonin, are commonly recommended for pediatric sleep problems despite limited research on their efficacy and social acceptability. Function-based behavioral interventions show merit as a promising alternative but has yet to draw to focus of mainstream treatment providers. This present study evaluated the efficacy of personalized and assessment-based behavioral intervention on the sleep problems of children diagnosed with ASD. Nighttime infrared video and sleep diary were used to measure sleep interfering behaviors, sleep onset delay, night and early waking, the total amount of sleep, as well as other relevant variables in the participating children. Parents and caregivers were encouraged to assist with treatment development during the assessment process and served as interventionists at home following behavioral skills training. A multiple-baseline-across-subjects designed was used to evaluate the treatments. Parents also provided feedback on the acceptability of each treatment and on their satisfaction with the outcomes.

Sufficient quality of sleep is essential to an individual’s health, wellbeing, and development. Sleep problems affect a large number of children with Autism Spectrum Disorder (ASD) and are likely to persist if not effectively treated resulting in profound negative effects on the daytime functioning and well-being of children with ASD and their families. Behaviourally-based treatments, including extinction, adaptations to the sleep-wake schedule, reinforcement, and modifications to sleep hygiene practices have strong empirical support. Increasingly, these interventions are individualized based on the outcomes of Functional Behavioural Assessment (FBA). The present study evaluated the collateral effects of resolving sleep problems on children’s daytime behaviour and ASD symptomatology, and parental mental health, sleep, and relationship quality. Data is presented for 40 participants with ASD between 2-18 years of age who received a FBA-based, parent-implemented intervention. The Child Behavior Checklist, Gilliam Autism Rating Scale-3, Pittsburgh Sleep Quality Index, Depression, Anxiety, and Stress Scale, and Relationship Quality Index were administered during baseline and short-term follow-up to assess the collateral benefit of any improvement in sleep. Preliminary data indicates significant improvement in all measures of collateral behaviour change and well-being. This data and the implications thereof will be discussed.

Sleep problems of varying types and topographies are commonly reported among parents of children with autism spectrum disorder (ASD). Without effective treatment, sleep problems in children with ASD are likely to persist and can result in adverse long-term effects. Although the literature indicates higher rates of sleep problems in individuals with ASD, compared to typically developing children, little is known about the interaction between parental attributions about their child’s sleep problem and treatment selection; how parental beliefs align with research evidence; and the interaction between sleep problem type and child and family impacts. The purpose of this study was to examine the types of sleep problems reported by parents of children with ASD; parental attributions about the locus, stability and controllability of sleep problems; and the secondary impact of sleep problems on children and families. Data from 221 respondents collected via an online survey will be presented. Overall findings and implications will be discussed.

Case complexity in families of children with sleep problems and autism may be expected to present barriers to the effectiveness of treatment based on Functional Behaviour Assessment (FBA). This study investigated the extent to which this was the case in up to 40 families who completed, and 15 who did not complete, an intervention for their sleep problems. Families were rated on complexity using a scale developed from that presented by Kazdin (2006). The scale rated child comorbidity, parental mental diagnoses, child health, scope and severity of child dysfunction, socioeconomic disadvantage, parent and family functioning, risk, and barriers that emerged during treatment. The complexity scale was correlated with retention in the intervention programme and measures of sleep outcome including the Children’s Sleep Habits Questionnaire and the Sleep Problem Severity Score. The results indicated that, for families who completed the intervention programme, complexity in and of itself did not predict sleep-related outcomes. Complexity did however predict retention in the programme. Results are discussed in the light of best practice for assessment in FBA, the need for intervention to specifically target parental behaviours and support for families embarking on such an intervention