Sleep and stereotypy in children with autism: effectiveness of function-based behavioral treatment

Jolene E Hunter; Laurie K McLay; Karyn G France; Neville M Blampied

doi:10.1016/j.sleep.2021.01.062

Sleep and stereotypy in children with autism: effectiveness of function-based behavioral treatment

Sleep Med. 2021 Apr:80:301-304. doi: 10.1016/j.sleep.2021.01.062. Epub 2021 Feb 2.

Authors

Jolene E Hunter¹, Laurie K McLay², Karyn G France³, Neville M Blampied⁴

Affiliations

¹ School of Health Sciences, University of Canterbury, Te Kura Mātai Hauora, Te Whare Wānanga o Waitaha, Private Bag 4800, Christchurch, NZ, USA. Electronic address: jolene.hunter@pg.canterbury.ac.nz.
² School of Health Sciences, University of Canterbury, Te Kura Mātai Hauora, Te Whare Wānanga o Waitaha, Private Bag 4800, Christchurch, NZ, USA.
³ School of Health Sciences, University of Canterbury, Te Kura Mātai Hauora, Te Whare Wānanga o Waitaha, Private Bag 4800, Christchurch, NZ, USA. Electronic address: laurie.mclay@canterbury.ac.nz.
⁴ School of Psychology, Speech & Hearing, University of Canterbury, Te Kura Mahi ā-Hirikapo, Te Whare Wānanga o Waitaha, Private Bag 4800, Christchurch, NZ, USA. Electronic address: neville.blampied@canterbury.ac.nz.

PMID: 33610955
DOI: 10.1016/j.sleep.2021.01.062

Abstract

Objectives: Children with autism spectrum disorder (ASD) experience high rates of sleep problems, which exacerbate the core symptoms of ASD, including stereotypy (restricted and repetitive behaviors). Conversely, stereotypy can interfere with sleep by actively competing with sleep-facilitative behaviors (eg, lying down quietly). Behavioral interventions informed by functional behavioral assessment (FBA) significantly reduce sleep problems in children with ASD, however, their impact on sleep-interfering stereotypy is not clear. This study investigated the effectiveness of function-based behavioral treatments for sleep problems, including sleep-interfering stereotypy, in children with ASD, the maintenance of these effects, and parents' satisfaction with the treatment process.

Methods: A non-concurrent multiple baselines across participants design was used to evaluate the effectiveness of function-based, individualized treatments for sleep problems and sleep-interfering stereotypy in three children with ASD. For each participant, stereotypy was automatically maintained and interfered with the initiation and/or re-initiation of sleep. Parents implemented multi-component treatments that included a faded bedtime procedure.

Results: Treatment reduced sleep problems in 2/3 participants, and the duration of stereotypy was reduced in all participants. Treatment effects were largely maintained at follow-up, and parent-reported satisfaction was high.

Conclusion: These results support prior research demonstrating the effectiveness of FBA-informed behavioral treatments for sleep problems in children with ASD. Further, this study shows that these treatments may be effective in reducing sleep-interfering stereotypy. Future research should more thoroughly investigate the bidirectional relationships between sleep and core symptoms of ASD, and address how these relationships are assessed and treated in the sleep context.

Keywords: Autism spectrum disorder; Faded bedtime procedure; Functional behavioral assessment; Sleep; Stereotypy; Treatment.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Autism Spectrum Disorder* / complications
Autism Spectrum Disorder* / therapy
Autistic Disorder* / complications
Autistic Disorder* / therapy
Behavior Therapy
Child
Humans
Sleep
Sleep Wake Disorders* / complications
Sleep Wake Disorders* / therapy