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Your ATN@Work: Exploring the links between autism, sleep and behavior

Researchers at Missouri’s Thompson Center explore the association between autism-related sleep disturbances and daytime behavior challenges

By child psychologist Micah Mazurek, of the University of Missouri’s Thompson Center for Autism and Neurodevelopmental Disabilities, in Columbia. The Thompson Center is one of 14 sites in the Autism Speaks Autism Treatment Network.

I am really happy for this opportunity to tell you about the results of our recent sleep and behavior study. The study appears in the Journal of Autism and Developmental Disorders. It was supported by and conducted through the Autism Speaks Autism Treatment Network (ATN).

Editor’s note: See our news story on the study here.

In this study, neurodevelopmental pediatrician Kristin Sohl and I explored the suspected relationship between sleep and behavior problems among children with autism.

Why focus on sleep?
Through my work as a psychologist at the Thompson Center, I get to know many children with autism and their families. Sleep problems clearly rank among the biggest stressors for these families. Earlier research revealed that sleep problems are very common among children with autism, and that they can really interfere with a child’s day-to-day activities.

I know that when I don’t get a good night’s sleep, I’m not at my best the next day!

This research likewise showed that sleep difficulties among children with autism affect the whole family. Many parents described feeling they could not sleep for worrying about the safety of children who routinely woke up and got out of bed in the middle of the night. Other parents described routinely losing sleep because their wakeful children needed comfort and help getting back to sleep.

One of the questions we wanted to answer in our study was whether sleep problems are linked to daytime behavior problems among children with autism. We know that many children with autism struggle with aggression, irritability, hyperactivity and attention problems. We wanted to know whether these problems are more common or worse in children who routinely have trouble sleeping.

Why would sleep be related to behavior?
We know that disrupted sleep can make it harder for even typically developing children to regulate their behavior the next day. They tend to be more impulsive and have trouble paying attention. We wondered whether this might be an even greater issue children affected by autism – as they are at even greater risk for both sleep and behavioral problems.

How did we test our ideas?
Funding from the Autism Speaks ATN made it possible for us to test these ideas in a study we conducted at the University of Missouri. Our study included 81 parents of children with autism. They answered questions about their children’s sleep patterns and daytime behavior. They told us how often their children had problems falling asleep and staying asleep, and whether their children had any other types of sleep problems. They answered questions about physical aggression, irritability (being grouchy or quick to anger), attention problems and hyperactivity (being overly active or fidgety).

What did we find?
As we expected, the results showed that sleep and behavior problems are highly related among children with autism. In other words, children who have trouble sleeping at night are more likely to show difficulties regulating their behavior during the day. One interesting finding was that waking up during the night had the strongest relationship with daytime behavior problems. These results highlight the importance of interventions that improve sleep, particularly night awakening.

What does this mean?
Our study can’t tell us whether sleep problems cause behavioral problems or vice versa. However, the results suggest that these problems are closely associated. When children with autism are having problems with aggression or other behavioral difficulties, it’s important for parents and clinicians to look for and address sleep disturbances. It’s quite possible that addressing underlying sleep problems will help improve children’s daytime behavior. We need further research to confirm that we’re correct in this.

What are the next steps?
We hope to follow more children with autism over longer periods of time to learn more about what is causing sleep difficulties. Our team is also getting ready to launch a study to test a new intervention for sleep problems in children with autism. Through this work, we hope to learn more about whether improving sleep difficulties can also have positive effects on behavior and family functioning.

The good news is that families don’t need to wait for the results. Thanks to research by ATN neurologist Beth Malow at Vanderbilt University, Autism Speaks has published three age-appropriate ATN/AIR-P Sleep Tool Kits. You can download them free of charge from the Autism Speaks website – along with the ATN/AIR-P Challenging Behaviors Tool Kit here.

Also see the Autism Speaks Challenging Behavior Tool Kit (right) for related strategies and resources that can help support you and your loved one with autism during these difficult situations. It too can be download it free of charge from the Autism Speaks website, here.

I would like to thank all the families who helped us with this study. We are also grateful for the support of the Autism Speaks community and the Autism Treatment Network. We hope this work can make a difference in the lives of children with autism and their families.

* Learn more about the Autism Speaks Autism Treatment Network here.
* Find the ATN center nearest you 
* Explore our archive of ATN expert-advice blogs and news stories 


The Autism Speaks blog features opinions from people throughout the autism community. Each blog represents the point of view of the author and does not necessarily reflect Autism Speaks' beliefs or point of view.