The Relation Among Sleep, Routines, and Behavior in Children With an Autism Spectrum Disorder
Children with an ASD have a propensity for routines and reportedly have a greater incidence of sleep disturbance and externalizing behaviors than typical children. In addition, significant relations have been identified among routines, sleep behavior, and externalizing behavior in a community sample of children, suggesting that a lack of routines may be related to sleep disturbance and externalizing behaviors. However, to date, no known studies have thoroughly examined the relation between these variables in children with an ASD. The primary purpose of the present investigation was to examine relations among routines, sleep, and behavior in children with an ASD. Primary caregivers of 58 children with an ASD and 57 non-ASD children ages 6-12 participated in the study (ASD M = 9.0, SD = 2.09; Non-ASD M = 8.25, SD = 1.98). Most participants were recruited and completed the surveys on-line. Several significant relations were found, including correlations between bedtime routines and general routines, sleep hygiene, and sleep quality; general routines and sleep hygiene; and all pairings of sleep hygiene, sleep quality, and externalizing behavior. Other predicted relations were not supported. Diagnostic status significantly moderated the relation between general routines and externalizing behavior, but not between bedtime routines and either sleep quality or externalizing behavior. These results support relations between the variables of interest and indicate a need for additional research to further clarify the exact nature of the relations. Further research may be most pertinent within children with ASD who experience less consistent routines and children with ASD who exhibit sleep disturbance. In addition, the observed relation between bedtime routines and sleep behavior indicates implementation of consistent bedtime routines may be an appropriate intervention strategy for children with an ASD who experience sleep disturbance.