Behaviour, cognition, and autism symptoms and their relationship with sleep problem severity in young children with autism spectrum disorder.

In autism, poor sleep begins in early childhood, varies in severity and is associated with behavioural difficulties. We examined relationships between sleep and behaviour in young children with autism and no, mild/typical or severe/atypical sleep problems to determine behavioural profiles that may differentiate sleep problem severity. Method: Parents of children with autism aged 2- to 5-years reported on their child's sleep behaviour (CSHQ), including additional written descriptions of sleep behaviours. Children were then classified as good sleepers or as having mild/typical or severe/atypical sleep problems using National Sleep Foundation guidelines and current sleep literature. The three sleep groups were compared on autistic severity (ADOS), cognition (Mullen Scales of Early Leaning) and behaviour (BASC-3). Results: Parents of 46 children aged 24- to 71-months participated. The severe/atypical sleep group were more likely to have multiple severe sleep difficulties. The sleep groups did not differ on autism severity or cognition. The BASC-3 withdrawal subscale differentiated severe problem sleepers from the other groups, while BASC-3 inattention differentiated problem sleepers from good sleepers. The severe/atypical sleep problem group also had more overall behaviour problems than good sleepers Conclusions: Social withdrawal and multiple, severe sleep difficulties may underlie difficulties in treating poor sleep in some autistic children, suggesting that an individualised approach to treatment is needed to address severe sleep concerns. Early detection and intervention for poor sleep may reduce or prevent significant sleep and behavioural concerns continuing into later childhood. Sleep interventions that include targeting attention and withdrawal behaviours may assist in in this regard.