Sleep problems and the occurrence of dangerous behavior within autistic people: A retrospective community-based sample

Sleep disturbances affect 50%-80% of autistic individuals and are linked to heightened risk for psychiatric comorbidities and dangerous behaviors, including self-injury, suicidal ideation, and aggression. While previous studies have identified correlational relationships, few have examined whether sleep problems predict dangerous behaviors in large, real-world samples. This study used retrospective clinical data from a behavioral health nonprofit to investigate whether sleep problems predict dangerous behaviors among autistic individuals, accounting for age and adaptive functioning. The sample included 8,375 autistic individuals (mean age = 8.35 years). Sleep problems, dangerous behaviors, and adaptive functioning were measured at intake and every 6 months. Binary logistic regressions assessed whether sleep problems predicted current and historical suicidal ideation, self-injury, and aggression. Results showed that sleep problems significantly increased the odds of a history of suicidal ideation and suicidal ideation at intake (odds ratio = 2.29, 2.46, respectively), a history of self-injury and self-injury at intake (odds ratio = 1.95, 2.20, respectively), and aggression at intake (odds ratio = 1.58), even after adjusting for age, sex, and adaptive functioning. Age and adaptive behavior were also independently associated with dangerous behaviors. These findings underscore the importance of routinely assessing and treating sleep problems in autistic individuals as a potential pathway to reducing dangerous behaviors and improving overall wellbeing.Lay AbstractSleep problems are very common among autistic children and adults, affecting between half and three-quarters of individuals. Poor sleep is linked to higher risks for serious behaviors such as self-injury, suicidal thoughts, and aggression, but it is not well understood whether sleep problems actually predict these behaviors. This study looked at real-world clinical data from over 8,000 autistic individuals, ages 2 to 21, who received services from a large behavioral health organization. We examined whether having sleep problems increased the likelihood of dangerous behaviors, even after taking into account a person's age, daily living skills, and sex. We found that individuals with sleep problems were more than twice as likely to show self-injury or suicidal thoughts and were also more likely to show aggression. These findings highlight how important it is for providers and families to regularly assess and address sleep difficulties as part of autism care. Improving sleep may be an important step toward reducing the risk of dangerous behaviors and supporting overall wellbeing for autistic individuals and their families.