Journal of Autism and Developmental Disorders

, Volume 48, Issue 11, pp 3720–3726 | Cite as

Sleep Problems and Their Relationship to Maladaptive Behavior Severity in Psychiatrically Hospitalized Children with Autism Spectrum Disorder (ASD)

  • Elise M. SannarEmail author
  • Tamara Palka
  • Carol Beresford
  • Christine Peura
  • Desmond Kaplan
  • Mary Verdi
  • Matthew Siegel
  • Shir Kaplan
  • Marco Grados
  • For the Autism and Developmental Disorders Inpatient Research Collaborative (ADDIRC)
S.I. : Autism Inpatient Collection - Studying the Severely Affected


We examined the relationship between sleep duration and awakenings to Aberrant Behavior Checklist-Community (ABC-C) and Autism Diagnostic Observation Schedule (ADOS-2) scores in hospitalized youth with ASD and behavioral disturbance. Participants included 106 patients with a stay of at least 10 nights. Sleep in the hospital was recorded by staff observation. Higher scores on the ABC-C (irritability, stereotypy, and hyperactivity subscales) at admission were significantly associated with fewer minutes slept during the last five nights of hospitalization. There was no association between total awakenings and ABC-C scores or ADOS-2 comparison scores. Improved understanding of the relationship between sleep quality and maladaptive behavior in this challenging cohort of patients with ASD is vital to the definition and design of future effective interventions.


Autism spectrum disorder Sleep Behavior problems Children and adolescents 



The ADDIRC is made up of the co-investigators: Matthew Siegel, M.D. (P.I.) (Maine Medical Center Research Institute; Tufts University), Craig Erickson, M.D. (Cincinnati Children’s Hospital; University of Cincinnati), Robin L. Gabriels, Psy.D. (Children’s Hospital Colorado; University of Colorado), Desmond Kaplan, M.D. (Sheppard Pratt Health System), Carla Mazefsky, Ph.D. (Western Psychiatric Institute and Clinics; University of Pittsburgh), Eric M. Morrow, M.D., Ph.D. (Bradley Hospital; Brown University), Giulia Righi, Ph.D. (Bradley Hospital; Brown University), Susan L. Santangelo, Sc.D. (Maine Medical Center Research Institute; Tufts University), and Logan Wink, M.D. (Cincinnati Children’s Hospital; University of Cincinnati). Collaborating investigators and staff: Jill Benevides, B.S., Carol Beresford, M.D., Carrie Best, M.P.H., Katie Bowen, L.C.S.W., Briar Dechant, B.S., Tom Flis, B.C.B.A., L.C.P.C., Holly Gastgeb, Ph.D., Angela Geer, B.S., Louis Hagopian, Ph.D., Benjamin Handen, Ph.D., B.C.B.A.-D., Adam Klever, B.S., Martin Lubetsky, M.D., Kristen MacKenzie, B.S., Zenoa Meservy, M.D., John McGonigle, Ph.D., Kelly McGuire, M.D., Faith McNeill, B.S., Tamara Palka, M.D., Ernest Pedapati, M.D., Christine Peura, B.A., Joseph Pierri, M.D., Christie Rogers, M.S., C.C.C.-S.L.P., Brad Rossman, M.A., Jennifer Ruberg, L.I.S.W., Elise M. Sannar, M.D., Cathleen Small, Ph.D., Kahsi A. Smith, Ph.D., Nicole Stuckey, M.S.N., R.N., Brittany Troen, M.A., R.-D.M.T., Barbara Tylenda, Ph.D., Mary Verdi, M.A., Jessica Vezzoli, B.S., Deanna Williams, B.A., and Diane Williams, Ph.D., C.C.C.-S.L.P. We gratefully acknowledge the contributions of the coordinating site advisory group: Donald L. St. Germain, M.D. and Girard Robinson, M.D., and our scientific advisory group: Connie Kasari, Ph.D., Bryan King, M.D., James McCracken, M.D., Christopher McDougle, M.D., Lawrence Scahill, M.S.N., Ph.D., Robert Schultz, Ph.D. and Helen Tager-Flusberg, Ph.D., the input of the funding organizations and the families and children who participated.

Author Contributions

ES conceived of the study, participated in its design, and drafted the manuscript; TP participated in the design and interpretation of the data; CB conceived of the study and participated in its design and interpretation of the data, CP participated in the design, coordination of the study and interpretation of the data; DK participated in the design and interpretation of the data; MV participated in the design, coordination of the study and interpretation of the data; MS conceived of the study and participated in its design, SK performed the statistical analysis; MG participated in the design and performed the statistical analysis. All authors read and approved the final manuscript.


The Autism Inpatient Collection (AIC) phenotypic database and biorepository is supported by a grant from the Simons Foundation Autism Research Initiative and the Nancy Lurie Marks Family Foundation, (SFARI #296318 to M.S.).

Compliance with Ethical Standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. This article does not contain any studies with animals performed by any of the authors.

Informed Consent

Informed consent was obtained from all individual participants when they enrolled in the AIC. As the current study involved retrospective review, formal consent was not required.


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Copyright information

© Springer Science+Business Media, LLC 2017

Authors and Affiliations

  • Elise M. Sannar
    • 1
    Email author
  • Tamara Palka
    • 2
  • Carol Beresford
    • 1
  • Christine Peura
    • 2
  • Desmond Kaplan
    • 3
    • 4
  • Mary Verdi
    • 2
  • Matthew Siegel
    • 2
    • 5
  • Shir Kaplan
    • 6
  • Marco Grados
    • 4
  • For the Autism and Developmental Disorders Inpatient Research Collaborative (ADDIRC)
  1. 1.Children’s Hospital ColoradoAuroraUSA
  2. 2.Spring Harbor HospitalWestbrookUSA
  3. 3.Sheppard Pratt Health SystemTowsonUSA
  4. 4.Johns Hopkins University School of MedicineBaltimoreUSA
  5. 5.Tufts University School of MedicineBostonUSA
  6. 6.University of MarylandCollege ParkUSA

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