Examination of the Relationship Between Sleep Problems and Behaviour Problems in Autism Spectrum Disorder in Early Childhood

Background and Objective Sleep problems are common in children with autism spectrum disorder (ASD) and may contribute to behavioural difficulties. In this study, sleep problems were examined to determine whether they predict behavioural symptoms independently of autism severity.Methods This retrospective study included children with ASD followed at a child and adolescent psychiatry outpatient clinic. Sleep problems were assessed using the Children’s Sleep Habits Questionnaire (CSHQ), autism related behavioural symptoms using the Krug’s Autism Behavior Checklist (ABC), and autism severity using the Childhood Autism Rating Scale (CARS). Multiple linear regression and correlation analyses were performed.Results Significant differences were observed between ASD severity groups in ABC sensory, relating, and total scores (all p<0.05). CARS scores were positively correlated with CSHQ total scores (r=0.243, p=0.018). CSHQ total scores were also positively correlated with ABC subscale scores (all p<0.05). In hierarchical regression analyses, autism severity significantly predicted behavioural symptoms in the first model (β=0.426, p<0.001). After adding CSHQ total scores, both autism severity (β=0.385, p<0.001) and sleep problems (β=0.354, p=0.001) remained significant predictors of behavioural symptoms.Conclusions Sleep problems were associated with both autism severity and behavioural symptoms in children with ASD. Furthermore, sleep disturbances remained an independent predictor of behavioural symptoms after controlling for autism severity. In children with ASD, identifying and addressing sleep problems may be important.