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Sleep problems in children with autism spectrum disorder: clinical correlates and the impact of attention deficit hyperactivity disorder

Authors Gunes S, Ekinci O, Feyzioglu A, Ekinci N, Kalinli M

Received 23 November 2018

Accepted for publication 18 February 2019

Published 2 April 2019 Volume 2019:15 Pages 763—771


Checked for plagiarism Yes

Review by Single anonymous peer review

Peer reviewer comments 3

Editor who approved publication: Dr Roger Pinder

Serkan Gunes,1 Ozalp Ekinci,2 Aynur Feyzioglu,3 Nuran Ekinci,4 Merve Kalinli5

1Child and Adolescent Psychiatry Department, Hatay State Hospital, Hatay, Turkey; 2Child and Adolescent Psychiatry Department, Medical Faculty, University of Health Sciences, Istanbul, Turkey; 3Clinical Psychology Department, Institute of Health Sciences, Istanbul, Turkey; 4Child and Adolescent Psychiatry Department, Erenkoy Research and Training Hospital, Istanbul, Turkey; 5Child and Adolescent Psychiatry Department, Faculty of Medicine, Mersin University, Mersin, Turkey

Purpose: High prevalence of sleep problems has been reported in children with autism spectrum disorder (ASD). However, there is limited literature about the types and clinical correlates of sleep problems. This study aims to compare sleep disturbances between children with ASD and healthy children and investigate the relationship between sleep difficulties and clinical symptoms of ASD.
Materials and methods: The sample consisted of 112 children in ASD patient group and 112 healthy controls, with an age range of 2–18 years. The Children’s Sleep Habits Questionnaire (CSHQ) was used for sleep problems; Turgay DSM-IV Disruptive Behavior Disorders Rating Scale parent form (T-DSM-IV-S) was used to assess hyperactivity/impulsivity and inattentiveness; Childhood Autism Rating Scale (CARS), Autism Behavior Checklist, and Aberrant Behavior Checklist were used to evaluate the severity of autistic symptoms and behavioral problems.
Results: Total score, bedtime resistance, and sleep anxiety subscores of CSHQ were significantly higher in children with ASD than the control group. Among ASD children, intellectual capacity was not found to be associated with CSHQ scores. Bedtime resistance and night waking subscores of CSHQ were found to be positively correlated with CARS total score. Inattentiveness subscore of Parent T-DSM-IV-S was significantly higher in children with moderate-to-severe sleep problems.
Conclusion: Sleep difficulties in ASD patients may occur independently of intellectual disability. Bedtime resistance and night waking appear to be linked with ASD symptoms. Inattentiveness in ASD children may be associated with moderate-to-severe sleep problems.

Keywords: ADHD, ASD, autism, sleep, sleep problems

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