Methods Data were collected at AS ATN enrollment Primary Measures: Demographic Information Child Behavior Checklist (CBCL) Anxiety Problems Scale Short Sensory Profile (Sensory Over-Responsivity [SOR] created score) Childrens Sleep Habits Questionnaire (CSHQ) subscales Full Scale IQ score (various measures)

Sleep Problems in Children with Autism Spectrum Disorder: Examining the Role of Anxiety and Sensory

Over-Responsivity Micah Mazurek, PhD1,2 & Gregory Petroski, PhD1

1University of Missouri, 2Thompson Center for Autism & Neurodevelopmental Disorders

Background Sleep problems are common among children with autism spectrum

disorder (ASD) (Richdale & Schreck, 2009) and can have significant detrimental effects on daytime functioning (Schreck, Mulick & Smith, 2004; Goldman et al., 2012; Delahaye et al., 2014).

The etiology of sleep problems in ASD is thought to be multifactorial, including possible disruption in circadian rhythms and melatonin regulation, medical problems, or medication effects (Malow & McGrew, 2008; Johnson & Malow, 2008).

Hyperarousal is often associated with insomnia in the general population (Riemann et al., 2010) and may also underlie sleep difficulties for children with ASD, particularly given their increased risk for arousal-related symptoms.

Emerging evidence suggests that arousal-related symptoms, specifically sensory over-responsivity and anxiety, may be related to the development and maintenance of sleep problems in children with ASD.

Collaborating with the ATN

To obtain access to the ATN Custom Forms or for information on collaborative research activities, please go to: www.asatn.org

Participants 1347 children (2 17.6 years) with ASD enrolled

in the Autism Speaks Autism Treatment Network (AS ATN) clinical registry database

Majority male (84.8%) and Caucasian (90.6%)

Acknowledgements This project is/was supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) under cooperative agreement UA3 MC11054 Autism Intervention Research Network on Physical Health. This information or content and conclusions are those of the author and should not be construed as the official position or policy of, nor should any endorsements be inferred by HRSA, HHS or the U.S. Government. This work was conducted through the Autism Speaks Autism Treatment Network serving as the Autism Intervention Research Network on Physical Health.

Working collaboratively across North America, to address the physical health of

children and adolescents with autism.

Final Path Model: Ages 2-5

Correlations by Age Group Anxiety SOR

Ages 2-5 Ages 6-18 Ages 2-5 Ages 6-18

SOR -.46*** -.39*** -- --

Bedtime Resistance .31*** .24*** -.12** -.18***

Sleep Onset Delay .21*** .15*** -.17** -.16***

Sleep Duration .29*** .23*** -.25*** -.19***

Sleep Anxiety .42*** .36*** -.23*** -.29***

Night Wakings .29*** .14*** -.21*** -.09**

*p < .05, **p < .01, ***p < .001

Objectives To examine the bivariate and multivariate

relations among anxiety, sensory over-responsivity, and specific sleep problems in children and adolescents with ASD

Chi-sq DF PR>Chi-sq CFI RMSEA RMSEA LL RMSEA UL

12.9 13

0.46 1.00 0.00 0.00 0.05

Final Path Model: Ages 6-18

Chi-sq DF PR>Chi-sq CFI RMSEA RMSEA LL RMSEA UL

6.29 8

0.62 1.00 0.00 0.00 0.03

Data Analyses Data Analysis Plan Pearsons correlation coefficients Bivariate relationships between anxiety, SOR & sleep problems

Path modeling techniques (fitting a single model) CSHQ subscales as dependent variables SOR and anxiety as independent variables IQ, age and gender as covariates

Conclusions Children with ASD who have anxiety and SOR

are at increased risk for sleep problems. These results support the idea that

hyperarousal may underlie sleep problems for many children with ASD.

Future research is needed, including: Physiological measures of arousal Objective measures of sleep Longitudinal designs Treatment studies focusing on arousal

Continued research on this topic is essential to inform understanding of etiology and targeted treatments.

Note: Displayed paths are the statistically significant (p < 0.05) regression relationships. Covariance terms are suppressed for simplicity.