News and Knowledge

For individuals with autism, a good night’s sleep can be elusive. Treating the problem with medication comes with its own difficulties, including side effects and the effectiveness of the medication. While many research studies have focused on sleep problems in young children with autism spectrum disorder (ASD), few have been conducted that examine solutions for adolescents with ASD.

Study Goals

In her 2013 study, Whitney Loring Psy.D., assistant professor of pediatrics and psychiatry/licensed clinical psychologist at Vanderbilt University Medical Center, implemented a brief education-based program and assessed the impact of the program on nighttime sleep and daytime functioning for adolescents with ASD.  The goals of the study, Sleep Education Program for Adolescents and Young Adults with Autism Spectrum Disorders, were to:

• Determine if a sleep education program for adolescents with ASD would improve nighttime sleep. Dr. Loring and her research team hoped that the program would shorten the length of time it took participants to fall asleep, improve sleep initiation, reduce night wakings, and improve sleep duration.

• See if daytime functioning would improve, specifically reducing hyperactivity and repetitive behaviors and improving attention span.

Study Format

Eighteen participants with ASD, between the ages of 11 and 21, participated in the study. Participants were eligible only if they had problems falling asleep and staying asleep.  They and their parents attended two individual sleep education sessions, approximately one week apart, conducted by Dr. Loring. The sessions were based on strategies that had been shown to be successful for children with ASD ages 2 to 10 in a 2014 study published in the Journal of Autism and Developmental Disorders.

During the first session, Dr. Loring discussed sleep challenges and described day and night behaviors that promote successful sleep, sleep environment, and bedtime routine. Sessions were tailored to each adolescent’s cognitive level and degree of parental involvement in sleep behaviors. She also recommended modifications to the adolescent’s routine, sleep environment, and/or sleep behaviors and asked the adolescent and parents to record the adolescent’s completion of the recommendations discussed during the session in the interim until the next session.

The second session began with a discussion of how the recommendations went since the last appointment. Dr. Loring asked about challenges and offered suggestions to help. She also discussed distraction and relaxation techniques to help with sleep onset delay and/or night wakings.

For four weeks after the second session, Dr. Loring made weekly calls to follow up while participants and their parents continued to follow her recommendations. At the end of the four weeks, the participants were asked to wear an actigraphy watch that recorded changes in sleep quality and quantity for 10 to 14 days (they had also worn an actigraphy watch at the beginning of the study). They came back for one more session to retake the behavioral and sleep measures they had taken at the beginning of the study. Three months later, they were contacted by phone and asked how things were going with their sleep.

Study Results

Dr. Loring’s study shows that a brief behavioral sleep education intervention does result in changes to sleep-related behavior that have perceived benefits on the child’s sleep and subsequent daytime behavior. Both the adolescents and the parents who participated reported improvements in sleep quality, and stability, cognitive and behavioral changes, and sleep environment and hygiene.

Dr. Loring and her team found statistically significant improvements in sleep behaviors as reported by both the adolescents and parents, specifically in sleep quality Specifically, overall parent and adolescent report results were statistically significant related to changes in sleep hygiene and in the specific subscales of cognitive and behavioral changes, sleep environment, and sleep stability.

Because poor sleep is generally more of an issue for adolescents than it is for younger children, the results of this study offer a needed intervention for adolescents with ASD and their parents looking for ways to improve sleep quality.