Sleep problems in children aged 4-6 years old with autism spectrum disorder: A cross-sectional study
Keywords:
Sleep problems, Autism spectrum disorder, Typical development, Developmental functioningAbstract
Background: Sleep problems are commonly reported in children with Autism Spectrum Disorder (ASD), negatively affecting their behavior, learning, and overall quality of life. However, studies between children with ASD and typically developing (TD) children in southern Thailand remain limited.
Objective: To study sleep problems between children aged 4–6 years with ASD and TD, and to study sleep problems across different developmental levels within the ASD group.
Methods: A cross-sectional study was conducted using the Children’s Sleep Habits Questionnaire (CSHQ) to assess sleep problems. Developmental levels in the ASD group were evaluated using the Denver II screening tool, with subgroup analysis based on total- and nonverbal- developmental functioning.
Results: A total of 82 participants were enrolled, including 41 children with ASD (mean ages 57.1 ± 6.9 months) and 41 TD children (57.2 ± 7.1 months). Children with ASD had a significantly longer median nighttime awakening duration than TD group (2 (range 0–10) and 0 (range 0–2) minutes; p value 0.017). While total CSHQ scores were not different between groups. The ASD group showed significantly higher sleep duration scores (5 ± 1.5 vs. 4.2 ± 1.3; p value 0.01) and night waking scores (4.4 ± 1.2 vs. 3.8 ± 1; p value 0.024). After adjustment, only the night waking score remained significantly higher in ASD (adjusted B 0.59; 95% CI 0.08-1.10; p value 0.023). Effect size analyses confirmed longer nighttime awakenings (Cohen’s d=0.47), higher sleep duration score (Cohen’s d=0.57), and higher night waking score (Cohen’s d= 0.543) in ASD. No differences in sleep problems were observed when ASD participants were categorized by developmental level.
Conclusion: Sleep problems were observed in both TD and ASD children. However, nighttime awakenings and insufficient sleep duration were key concerns in ASD that warrant targeted assessment and management. Practical care should emphasize good sleep hygiene, consistent and appropriate bedtime routines, promotion of self-soothing skills, and minimizing nighttime disturbances.
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