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

Figures & data

Table 1 Demographic variables and clinical characteristics of the sample

		ASD patients, N=112	Controls, N=112
Age (mean, SD)	In years	8.06 (3.22)	9.01 (3.12)
Gender (N, %)	Male	81 (72.3)	74 (66.1)
Intellectual capacity (N, %)	Normal Intellectual disability	46 (41.1) 66 (58.9)	100 (100) –
ASD severity (N, %)	Mild-to-moderate Severe	52 (46.4) 60 (53.6)	–

Abbreviation: ASD, autism spectrum disorder.

Table 2 The comparison of CSHQ scores between the patient and control groups

CSHQ	ASD patients, N=112 mean (SD)	Controls, N=112 mean (SD)	Cohen’s d	P-value
Total score	53.01 (7.59)	50.63 (7.44)	0.316	0.026
Bedtime resistance	10.98 (2.26)	10.34 (2.17)	0.288	0.043
Sleep onset delay	6.15 (1.32)	6.27 (1.38)	−0.088	0.532
Sleep anxiety	6.30 (2.15)	5.60 (1.80)	0.353	0.014
Night waking	4.08 (1.46)	3.90 (1.19)	0.135	0.343
Daytime sleepiness	13.35 (3.55)	13.37 (3.17)	−0.005	0.967
Parasomnias	9.15 (2.85)	8.63 (2.50)	0.193	0.173
Sleep-disordered breathing	3.55 (1.20)	3.46 (1.14)	0.076	0.589

Abbreviations: ASD, autism spectrum disorder; CSHQ, Children’s Sleep Habits Questionnaire.

Table 3 The comparison of CSHQ scores between ASD patients with normal intellectual capacity and intellectual disability

CSHQ	Normal intellectual capacity, N=46 mean (SD)	Intellectual disability, N=66 mean (SD)	Cohen’s d	P-value
Total score	52.30 (8.28)	53.51 (7.07)	0.157	0.435
Bedtime resistance	10.61 (2.20)	11.24 (2.29)	0.280	0.177
Sleep onset delay	6.40 (1.25)	5.96 (1.36)	−0.336	0.103
Sleep anxiety	6.30 (2.18)	6.29 (2.16)	−0.004	0.970
Night waking	3.76 (1.20)	4.31 (1.60)	0.388	0.065
Daytime sleepiness	13.35 (3.46)	13.34 (3.64)	−0.002	0.986
Parasomnias	8.50 (2.66)	9.62 (2.92)	0.400	0.052
Sleep-disordered breathing	3.64 (1.47)	3.48 (0.95)	−0.129	0.513

Abbreviations: ASD, autism spectrum disorder; CSHQ, Children’s Sleep Habits Questionnaire.

Table 4 The comparison of CSHQ scores between patients with mild-to-moderate ASD and severe ASD

CSHQ	Mild-to-moderate ASD, N=52, mean (SD)	Severe ASD, N=60, mean (SD)	Cohen’s d	P-value
Total score	51.70 (7.91)	54.32 (7.09)	0.348	0.084
Bedtime resistance	10.60 (2.23)	11.36 (2.26)	0.338	0.094
Sleep onset delay	6.30 (1.18)	6.00 (1.45)	−0.226	0.261
Sleep anxiety	6.06 (2.10)	6.54 (2.20)	0.223	0.268
Night waking	3.80 (1.22)	4.36 (1.63)	0.388	0.056
Daytime sleepiness	13.14 (3.39)	13.56 (3.72)	0.118	0.557
Parasomnias	8.62 (2.78)	9.68 (2.86)	0.375	0.063
Sleep-disordered breathing	3.62 (1.38)	3.48 (0.99)	−0.116	0.563

Abbreviations: ASD, autism spectrum disorder; CSHQ, Children’s Sleep Habits Questionnaire.

Figure 1 The correlation between bedtime resistance subscore and CARS total score in ASD patients. The Pearson product-moment correlation coefficient between bedtime resistance subscore and CARS total score was calculated in 112 ASD patients (r=0.19, P=0.048).

Abbreviations: ASD, autism spectrum disorder; CARS, Childhood Autism Rating Scale.

Table 5 The correlations between CSHQ scores and CARS, AuBC, and AbBC total scores

CSHQ	CARS		AuBC		AbBC
	r	P-value	r	P-value	r	P-value
Total score	0.107	0.291	0.069	0.503	−0.031	0.763
Bedtime resistance	0.198	0.048	0.068	0.510	0.150	0.143
Sleep onset delay	−0.148	0.140	−0.086	0.401	−0.147	0.152
Sleep anxiety	0.079	0.435	0.111	0.278	0.045	0.662
Night waking	0.201	0.045	0.160	0.118	0.085	0.406
Daytime sleepiness	−0.018	0.857	0.060	0.561	−0.009	0.928
Parasomnias	0.183	0.068	0.161	0.114	0.080	0.437
Sleep-disordered breathing	−0.097	0.335	−0.131	0.202	−0.117	0.253

Abbreviations: CSHQ, Children’s Sleep Habits Questionnaire; CARS, Childhood Autism Rating Scale; AuBC, Autism Behavior Checklist; AbBC, Aberrant Behavior Checklist.

Figure 2 The correlation between night waking subscore and CARS total score in ASD patients. The Pearson product-moment correlation coefficient between night waking subscore and CARS total score was calculated in 112 ASD patients (r=0.20, P=0.045).

Abbreviations: ASD, autism spectrum disorder; CARS, Childhood Autism Rating Scale.

Table 6 The comparison of clinical symptoms between ASD patients with CSHQ <56 and CSHQ >56

	CSHQ <56, N=58 mean (SD)	CSHQ >56, N=54 mean (SD)	Cohen’s d	P-value
Parent T-DSM-IV-S  Total	31.03 (18.39)	35.62 (21.40)	0.230	0.263
Inattentiveness	11.89 (6.89)	14.82 (7.33)	0.411	0.045
Hyperactivity	12.04 (6.69)	13.25 (7.70)	0.167	0.415
CARS total	37.66 (6.55)	37.70 (7.16)	0.005	0.978
AuBC total	55.45 (21.17)	55.54 (23.09)	0.004	0.985
AbBC total	58.45 (18.23)	60.70 (18.24)	0.123	0.561

Abbreviations: ASD, autism spectrum disorder; CSHQ, Children’s Sleep Habits Questionnaire; T-DSM-IV-S, Turgay DSM-IV Disruptive Behavior Disorders Rating Scale; CARS, Childhood Autism Rating Scale; AuBC, Autism Behavior Checklist; AbBC, Aberrant Behavior Checklist.