Treatment of Sleep Disturbances in Children with Autistic Disorder: Utilization of Behavioral Intervention, Social Story, and Picture Activity Schedule

Autistic Disorder is defined by heterogeneous, diagnosable traits that reflect pervasive impairment across several areas of functioning and are abnormal relative to developmental or mental age, including social interaction skills, communication skills, and/or the presence of stereotyped behaviors/interests/activities. Children with autism may display other aberrations, including sleep-wake behaviors that reportedly occur more frequently than that of typically developing children. Research has shown that children benefit from interventions targeting such impairments in functioning, including behavioral intervention, social skill training, and language training using multimodal interventions and parental involvement. This study is the first known investigation to examine the outcome of a non-pharmacological, multimodal intervention for children with autism and sleep difficulties. A single-participant, within-series design was utilized to investigate the outcome related to participation in a prescribed, individualized intervention using parent psychoeducation, social storybook, and picture activity schedule. The impact on child sleep-wake and daytime behaviors, parental sleepiness, parent-child relationship dynamics, marital functioning, and parental compliance were examined. Eleven participants completed 6 weeks of treatment, and outcome data was collected before, during, and after treatment. Following treatment, problematic sleepwake nighttime behaviors reportedly decreased for 88% of the children, child daytime sleepiness declined (63%), and mothers reported an increase in self-esteem (89%) and sense of competence (100%) related to parenting abilities. Whereas, parental psychopathology and general life stress appeared to minimally impact treatment outcome, aspects of the marital relationship were positively affected. Several parents expressed a high amount of child-related stress before treatment, which remained for 55% of parents at the conclusion of the study. However, the intensity of stressful child-related behaviors decreased for 78% of parents. More mothers (78%) than fathers (44%) reported a decrease in their feelings of sleepiness at the end of the study. A short-term, multimodal method for treating sleep difficulties in children with autism appeared to be effective, as all families reported improvement in all child sleep-related behavioral goals targeted for intervention, which is consistent with current behavioral management theories. Overall, the findings provide preliminary support for the benefits of including autism-specific, multimodal treatments in conjunction with established parent-directed behavioral management techniques in treating sleep challenges in children with autism