News and Knowledge

A good night’s sleep refreshes us physically and emotionally. Who hasn’t woken up after a night of deep sleep, feeling like a new person? Even more critical for children, a good night’s sleep is often an elusive goal for many children with autism. More than half of parents of children with autism report a sleep disturbance in their children, including difficulty falling asleep, waking during the night, awaking early in the morning, short total sleep time, and nightmares.

That statistic led Susan Mayes, Ph.D., a professor and researcher at the Penn State College of Medicine, to apply to OAR to fund a study on sleep disturbance. “I am looking at the relationship between sleep and daytime functioning, such as academic performance, mood, behavior, and neuropsychological functioning. The goal of the study is to determine the frequency, type, and severity of sleep problems in children with autism, then to determine how characteristics such as age, IQ, gender, and severity of autism might affect sleep. I’m also examining how comorbid conditions, like mental retardation, anxiety, and depression, affect sleep in children with autism,” Dr. Mayes explains.

She hopes that the study’s results will advance knowledge of how sleep is related to daytime functioning, information that she believes will help parents, clinicians, and educators in how they work with children. “My team and I have collected information on more than 500 children through questionnaires filled out by their parents,” she explains. The data from her study can also help identify which children are at risk for sleep problems, allowing an early diagnosis and treatment. “By examining the factors related to sleep, the study can help target areas for intervention to improve sleep, thereby improving sleep and daytime functioning.”

How the Study Works

Mayes and her team are analyzing clinical data on more than 500 children with autism, 6 to 15 years of age with Full Scale IQs of 40 to 143. Parents rated their children on a 4-point scale from “not at all a problem” to “very often a problem” on the nine sleep problem items on the Pediatric Behavior Scale (PBS).

The PBS yields five sleep problem scores:

1. Sleep disturbance (difficulty falling and staying asleep)
2. Sleeps less than the norm
3. Parasomnias (nightmares and walking and talking in sleep)
4. Daytime sleepiness
5. A total sleep-problems score based on norms for the child’s age and gender.

The PBS also yielded scores on several subscales, including five to be used in the proposed study:

1. Behavior problems (e.g., opposition and aggression)
2. Mood disturbance (e.g., irritability and explosiveness)
3. Inattention, impulsivity, and hyperactivity
4. Anxiety
5. Depression

The PBS was chosen as the primary sleep measure because it yields a norm referenced standard score, unlike other sleep scales.

The severity of autistic symptoms is indicated by scores on the PBS autism items and the total score on the Checklist for Autism in Young Children. The Checklist for Autism is completed by a clinician based on a parent interview and other information, such as observations of the child, teacher report, previous evaluations, and school records. Children also completed reading, math, and written expression subtests from the Wechsler Individual Achievement Test. In addition, the children were administered tests that measure neuropsychological functions, including attention, executive function, working memory, response inhibition, processing speed, and graphomotor skills. Children also completed the WISC-III or WISC-IV verbal and nonverbal IQ subtests measuring verbal reasoning, abstract and conceptual thinking, vocabulary, comprehension, social reasoning, visual logic, and visual-motor skills.

Disseminating the Results

Mayes says that preliminary results have already been presented at one conference and submitted for publication. She will be presenting further results at a conference in June and a symposium in the fall. In addition, Mayes notes, the department of psychiatry where she works has a mental health training program for community practitioners. “We recently did a teleconference on sleep disorders in children and children with autism were a big focus. Providing program like this and posting study results on our department’s autism Web site are other ways for us to disseminate the findings.”

“Preliminary results show that children with autism have more sleep problems than typical children,” Mayes says, “and more sleep problems than children in other diagnostic groups, including children with ADHD, anxiety, depression, and brain injuries.”