OARacle Newsletter

Sleep difficulties are highly prevalent in autistic youth, often contributing to negative child and family outcomes. Behavioral sleep interventions have been shown to reduce those difficulties, yet few studies have examined how they would work for autistic youth. In 2024, co-investigators Cameron Neece, Ph.D., and Tori Van Dyk, Ph.D., conducted a two-year, OAR-funded study to evaluate Malow’s Sleep Education Manual (SEM), a behavioral sleep intervention for parents. 

Dr. Neece, Ph.D., is a professor of psychology at Loma Linda University, California, and a licensed clinical psychologist. Dr. Van Dyk, Ph.D., is an associate professor at Loma Linda University and a licensed clinical psychologist, certified pediatric behavioral sleep medicine provider, and supervising psychologist in the university’s pediatric sleep clinic. 

Their goals were to: 

• Determine the effectiveness of the intervention in improving sleep problems in an ethnically, socioeconomically, and linguistically diverse sample of autistic children. 
• Investigate the impact of parental consistency in implementing intervention techniques. 
• Examine how parental stress impacts the effectiveness of the intervention in reducing the child’s sleep problems.

Methodology

In Phase 1, the researchers conducted focus groups with families and behavioral sleep interventionists to inform study procedures and intervention components. Drs. Neece and Van Dyk used the feedback to tailor the intervention to better meet the needs of participants and providers. They also ensured that the intervention would suit the needs of the community’s diverse residents.

In Phase 2, the researchers recruited 42 primary caregivers and their autistic children, ages 3 to 10, with sleep problems, including difficulty falling asleep, maintaining sleep, early morning wakening, or insufficient sleep. Two families who spoke Spanish also participated to evaluate the intervention delivered in Spanish. The families were randomly assigned to either the SEM intervention or the control group with a diet and physical activity intervention.

Both interventions included three online sessions over the course of six weeks. The SEM intervention covered general sleep education (e.g., sleep hygiene, bedtime routines, improving bedtime resistance, night awakenings, and addressing co-sleeping), and provided families with specific guidance and resources for developing and implementing a bedtime routine with a visual schedule. In subsequent sessions, parents received additional guidance on specific sleep problems their child experienced and how to implement strategies to resolve them.

Outcomes

Goal 1: Analysis over the course of the intervention revealed that there was no significant change in sleep efficiency or total sleep time and no differences in rate of change between treatment groups. However, the researchers noted in their final report that total disturbance problems decreased, and decreased more, on average, for those in the sleep intervention group. The team found the same results for sleep initiation and duration problems and for sleep anxiety and co-sleeping problems.

Goal 2: The researchers found that parents did have a high level of understanding, implementation of, and comfort with the intervention. However, their hypothesis that parent understanding, comfort level, and accuracy in implementing the SEM intervention techniques would result in changes in child sleep problems was not supported. 

Goal 3: Parental stress did not moderate the impact of the interventions in improving child sleep problems, contrary to what the researchers anticipated. They noted that parental stress significantly increased over the course of the interventions in both the SEM and the control group.

Practical Findings

Most important, the study showed that it is possible to significantly reduce sleep problems through a brief and cost-effective, online intervention, which benefits the autistic child and can help improve family well-being. The unexpected finding that parental stress significantly increased over the course of the intervention indicates the need to address parental mental health, in line with other studies that showed parental stress increased when delivering behavioral interventions.

The researchers plan to replicate the results of the study with a larger sample that includes a third “treatment as usual” comparison condition and larger Spanish-speaking population. 

Sherri Alms is the freelance editor of The OARacle, a role she took on in 2007. She has been a freelance writer and editor for more than 20 years.