Chapter 9: Behavioral Strategies to Promote Sleep in Individuals with Autism Spectrum Disorder

Sleeping problems are more prevalent in individuals with autism spectrum disorder (ASD) than in typically developing individuals or individuals with intellectual disability (ID; Schreck & Mulick, 2000; see Chapter 1). For example, in a study by Couturier et al. (2005) 23 children with ASD (without ID) were matched to typically developing children between 5 and 12 years of age and data on sleep-related behaviors were collected using the Child’s Sleep Habits Questionnaire (CSHQ; Owens, Spirito, & McGuinn, 2000). Results showed that the prevalence and severity of sleep problems was higher in children with ASD than in children from the control group. More specifically, children with ASD showed more bedtime resistance, longer sleep onset delay, longer sleep duration, more sleep anxiety, more nighttime wakings, and more parasomnias (e.g., abnormal behavior during sleep). In another study, Cotton and Richdale (2006) compared the prevalence of sleep problems in children with ASD and ID to that in children with Down syndrome, Prader-Willi syndrome, nonspecific ID, and typically developing children aged between 2 and 18 years. The prevalence of sleep problems was highest in the ASD group. Children with ASD presented with more than one type of sleep problem and settling, sleep maintenance problems and co-sleeping were most commonly reported. The sleep problems observed may also include bedtime tantrums, disruptive night waking, and sleep terrors.