Sleep Problems in Children with Autism Spectrum Disorder: Do ACEs play a role?

• In Event: Poster Session 13
  In Poster Session: PS 13 Topic - Developmental Disabilities

Abstract

Introduction: Recent research has suggested that children with autism are disproportionately exposed to adverse childhood experiences (ACEs) (Kerns, Newschaffer, Berkowitz, & Lee, 2017; Rigles, 2017). The impact of ACEs on problems associated with autism have been understudied. Children with autism have elevated rates of sleep disorders (Souders et al., 2009: Schreck, Mulick & Smith, 2004). Sleep problems in children with autism are associated with meaningful impacts on child and parent quality of life (Delahaye et al., 2014; Meltzer, 2011). Behavioral and pharmacological sleep treatments are partially effective, but there remains significant room for improvement (Malow et al., 2014; Schroder et al., 2019). Increased ACE exposure may contribute to sleep problems in children with autism, and screening for and considering the role of ACEs may help clinicians develop more comprehensive treatment plans. Methods: The 2016-2017 National Survey of Children’s health collects data on multiple health indicators for children (ages 0-17) across the United States (n=71,811), including ACE exposure, sleep measures, and parent reported diagnoses of developmental problems. Sleep data are coded to indicate whether average hours of sleep per night meet American Academy of Pediatrics recommended guidelines & whether the child has a consistent bedtime. Children were divided into a group of children with autism (n=1711) a group with Down syndrome or other intellectual disability (ID/DS), but no autism (n=445) and a group with none of these three diagnoses (n=68,807). Results: Children with autism were less likely to obtain recommended hours of sleep per night (63.7%, n=1072) compared to children with ID/DS (76.5%, n=332; OR=1.86, p<.001) and to children with neither diagnosis (70%, n=46, 893, OR=1.33, p<.001). Children with autism were similarly less likely to always or usually have a consistent bedtime (85.4%, n=1,452) compared to children with ID/DS (89.7%, n=394, OR=1.50, p=.02) or no diagnosis (90%, n=61,372, OR=1.54, p<.001). Children in both diagnostic groups had higher ACE scores (M (DS/IS)=1.46, SD=1.81; M (Autism)=1.28, SD=1.52) compared to children with neither diagnosis (M=0.76, SD=1.26), F=205.037 (2/69998), p.001. Among all children, ACEs were associated with increased likelihood of sleep problems. Children with 2+ ACEs were about half as likely (OR=0.54, p<.001) as children with no ACEs to obtain sufficient sleep and to have a consistent bedtime (OR=0.41, p<.001). There was a significant interaction between autism, ACE exposure and sleep, such that the association between ACEs and sleep is weaker among children with autism. Among children with autism, having 2+ ACEs is associated with lower likelihood of obtaining enough sleep (OR=0.62, p<.001) and of having a consistent bedtime (OR=0.49, p<.001). Conclusions: ACEs are associated with increased sleep problems for all children, and in a subsample of children with autism. There is a weaker association between ACEs and sleep in autism, likely due to higher baseline prevalence of sleep problems. However, children with autism are at particular risk of ACE exposure, while diagnostic overshadowing may lead clinicians to be less likely to screen for trauma in this group. Comprehensive assessment, including ACE assessment, may improve treatment planning for sleep problems in this population.

Authors

• Atara Siegel, State University of New York at Albany (SUNY Albany)
  Presenting Author

• Laura Welch, State University of New York at Albany (SUNY Albany)
  Non-Presenting Author

• Leslie F Halpern, State University of New York at Albany
  Non-Presenting Author