Sleep problems in autistic children and adolescents: an age-stratified approach

Sleep disorders are common in autistic children and adolescents. However, the associations between children's age and clinical features remain underexplored. This study investigates age-specific relationships between sleep difficulties and autism symptomatology, behavioral/emotional problems, cognitive development, and parenting stress. A total of 218 autistic participants were divided into three age groups: 6-36 months, 3-6 years, and 6-18 years. Sleep was assessed using the <i>Sleep Disturbance Scale for Children</i> (SDSC); behavioral and emotional difficulties were measured using the <i>Child Behavior Checklist</i> (CBCL); autism severity was assessed using the <i>Autism Diagnostic Observation Schedule - Second Edition</i> (ADOS2), cognitive development was assessed using the Intelligence Quotient (IQ)/Developmental Quotient (DQ) scores, and parenting stress was assessed using the <i>Parenting Stress Index</i> (PSI). Results demonstrate age-specific variations in the relationship between sleep disturbances and clinical features in autistic children. In the 6-36 months group, sleep difficulties were influenced by autism severity, cognitive level, and emotional-behavioral factors. In the 3-6-year-old group, behavioral and emotional regulation issues were associated with sleep problems. In children aged 6-18 years, autism severity, adaptive functioning, and parenting stress emerged as key factors contributing to sleep disturbances. These findings underscore the dynamic and evolving nature of sleep problems in autism, highlighting the need for age-tailored interventions.