0749 Behavioral Sleep Education in Children with Autism and Insomnia: Partnership with Community Practices

Abstract

Introduction: Insomnia is common in children with autism spectrum disorder (ASD). Due to time constraints, pediatricians may impart only limited information to parents on sleep education. Building the capacity of community therapists to provide sleep education within the context of their ongoing care is practical and time-effective for families. We describe a collaborative program whereby academic sleep physicians and psychologists provide training to community therapists in behavioral sleep interventions. These therapists then deliver education to parents of children with ASD and insomnia, who, in turn, implement behavioral strategies with their children. Methods: Pilot pre/post behavioral study examining the effectiveness of providing sleep education to parents of children with ASD with sleep onset delay (30 minutes or longer). Pediatricians referred families to community therapists we had trained in sleep education. The intervention consisted of a 90-minute in-person session followed by two shorter weekly sessions conducted in-person or by phone. Parents completed baseline and post-intervention surveys including the Children's Sleep Habits Questionnaire (CSHQ; standard and four-factor modified for ASD) and the Family Inventory of Sleep Habits (FISH). Children wore actigraphy at baseline and post-intervention. Wilcoxon signed rank tests were performed to determine change with the intervention. Results: 31 children completed the intervention (mean age = 6.6 years; standard deviation, SD = 2.7). FISH improved from 46.1 (SD = 5.6) to 50.0 (SD = 3.7; p =0.000). Standard CSHQ showed improvements in sleep onset delay (p = 0.000), bedtime resistance (p = 0.001), night wakings (p= 0.002) and sleep duration (p= 0.007). Four-factor CSHQ showed improvements in sleep initiation and duration (p = 0.000) and sleep anxiety and co-sleeping (p = 0.001). Sleep latency (minutes) measured by actigraphy improved from 55.9 (SD = 19.9) to 44.8 (SD = 16.9; p = 0.04). Conclusion: Improvements were documented in sleep habits and parent-reported and objective measures of sleep in children with ASD after receiving sleep education. This work demonstrates a successful partnership among parents, community pediatricians, community therapists, and academic sleep physicians and psychologists.