Treatment of Sleep Disturbances in Young Children With Autism

• Modified Simond & Parraga Sleep Questionnaire (MSPSQ) [ Time Frame: Baseline, Week 4, and Week 8 ] [ Designated as safety issue: No ]
  The MSPSQ used by Wiggs and colleagues (Wiggs & Stores, 1996 ; Wiggs & Stores, 1999 : Wiggs & Stores, 2004) will be used. It will be completed by the primary caregiver for both groups. The questionnaire consists of two parts. Part 1 includes items related to the quantity and quality of sleep, while Part 2 asks more detailed questions specific to sleep disorders. A composite sleep index score is used by assigning a score to the frequency of sleep problems targeted: bedtime resistance, night waking, early morning waking and sleeping in places other than bed.
  
  

• Actigraphy [ Time Frame: After the Home Visit, After the Week 4 Assessment, After the Week 8 Assessment ] [ Designated as safety issue: No ]
  Each child will wear an actigraph for five consecutive weeknights. An actigraph is a small watch-like device that collects activity data. The processor samples physical motion and translates it to numerical digital data. It summarizes and stores the frequency of motions into epochs of specified time duration. It is a reliable method of objective data collection for sleep-wake patterns including timing, continuity, and duration of sleep. We will determine when the child is down for sleep (lights off after any bedtime routine) from a sleep diary that the primary caregiver will complete.
  
  

Autism Spectrum Disorders (Autistic Disorder, Pervasive Developmental Disorder, Asperger Disorder) are severe developmental disorders of early childhood onset affecting as many as 1 in 150 children (Center for Disease Control & Prevention, 2007). They characterized by deficits in social interaction and communication, as well as repetitive behavior and restricted interests (American Psychiatric Association, 2000). Given the severity and the prevalence, autism is a significant public health issue. Recent years have seen both an increase in the prevalence of autism and an improved ability to diagnose the disorder much earlier (Fombonne, 2003). It is during the child's early years when it is generally agreed that intensive interventions are most likely to improve long term prognosis (National Research Council, 2001). While not a core feature of autism, it is widely accepted that a large percentage children with autism spectrum disorders (autism) present with significant sleep issues (Honomichl, Goodlin-Jones, Burnham, Gaylor & Anders, 2002; Johnson, 1996; Wiggs & Stores, 2004). Sleep problems in typically developing children are known to adversely impact daytime functioning, learning acquisition, as well as parenting and family functioning (Dahl, 1996; Ebert & Drake, 2004; Sadeh, Gruber, & Raviv; 2002; Sadeh, Raviv, & Gruber, 2000). For young children with autism whose development is already compromised by a range of deficits, the detrimental impact of sleep disturbances may be even more significant. However, the impact of sleep disturbances on optimal performance in behavioral and education interventions have not been systematically explored.

This study will conduct a randomized clinical trial to evaluate the efficacy of a behavioral parent training program in the amelioration of sleep disturbances in young children with autism. This work will be used to examine the feasibility, acceptability and efficacy of a behavior training program for sleep disturbance in children with autism. It represents a low cost and rapid clinical approach to the problem in this younger age group.