Journal of Autism and Developmental Disorders

, Volume 49, Issue 4, pp 1410–1422 | Cite as

Comparison of Online and Face-to-Face Parent Education for Children with Autism and Sleep Problems

  • Cristine A. RobertsEmail author
  • Kevin C. Smith
  • Ashley K. Sherman
Original Paper


Many children with autism spectrum disorder (ASD) have sleep disorders. Face-to-face (F2F) sessions have empowered parents to help their child sleep. Our goal was whether online technologies could provide similar improvements in children’s sleep while also improving parents’ quality of life. Identical programs were taught in two sessions to F2F and online parents. Measurements were compared from baseline to 4 and 8 weeks post teaching sessions. Twenty-three participants completed the program. Parent quality of life improved for both groups. Parent fatigue scores were improved and sustained for the online group. The total sleep score improved for both groups, while the online group had sustained decreases in night wakings. Online methods can conveniently help improve sleep for children with ASD.


Autism Children’s sleep disorders Online teaching Parents’ quality of life Actigraphy Parents’ fatigue 



Financial support for this study was provided by the Organization for Autism Research and Children’s Mercy Hospital.

Author Contributions

CAR conceived of the study, designed the methods and educational sessions, recruited and consented participants, conducted the educational sessions, distributed the measurement tools, managed the data collection, and drafted the manuscript. KCS collaborated in the conception of the study, managed all of the data associated with actigraphy and interpretation, and helped to draft and revise the manuscript. AKS performed the statistical analysis, designed the statistical tables, and wrote much of the results section of the manuscript. All authors read and approved the final manuscript.

Compliance with Ethical Standards

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 the 1964 Helsinki declaration and its later amendments or comparable ethical standards.


  1. Adkins, K. W., Molloy, C., Weiss, S. K., Reynolds, A., Goldman, S. E., Burnette, C., et al. (2012). Effects of a standardized pamphlet on insomnia in children with autism spectrum disorders. Pediatrics, 130(2), S139–S144.CrossRefGoogle Scholar
  2. Ali, N., Rigney, G., Weiss, S. K., Brown, C. A., Constantin, E., Godbout, R., et al. (2018). Optimizing an eHealth insomnia intervention for children with neurodevelopmental disorders: A Delphi study. Sleep Health. Scholar
  3. Bastiaansen, D., Koot, H. M., Ferdinand, R. F., & Verhulst, F. C. (2004). Quality of life in children with psychiatric disorders: Self-, parent, and clinician report. Journal of the American Academy of Child and Adolescent Psychiatry, 43(2), 221–230.CrossRefGoogle Scholar
  4. Carter, I. (2009). Positive and negative experiences of parents involved in online self-help groups for autism. Journal on Developmental Disabilities, 15, 44–52.Google Scholar
  5. Centers for Disease Control and Prevention. (2018). Prevalence of autism spectrum disorder among children aged 8 years—Autism and Developmental Disabilities Monitoring Network, 11 Sites, United States, 2014. Morbidity and Mortality Weekly Report, 67(6), 1–23.Google Scholar
  6. Clifford, T., & Minnes, P. (2013). Logging on: Evaluating an online support group for parents of children with autism spectrum disorders. Journal of Autism and Developmental Disorders, 43, 1662–1675. Scholar
  7. Cohen, S., & Wills, T. A. (1985). Stress, social support and the buffering hypothesis. Psychological Bulletin, 98, 310–357.CrossRefGoogle Scholar
  8. Cortesi, F., Giannotti, F., Ivanenko, A., & Johnson, K. (2010). Sleep in children with autistic spectrum disorder. Sleep Medicine, 11(7), 659–664. Scholar
  9. Cuomo, B. M., Vaz, S., Lee, E. A. L., Thompson, C., Rogerson, J. M., & Falkmer, T. (2017). Effectiveness of sleep-based interventions for children with autism spectrum disorder: A meta-synthesis. Pharmacotherapy, 37(5), 555–578. Scholar
  10. Delahaye, J., Kovacs, E., Sikora, D., Hall, T. A., Orlich, F., Clemons, T. E., et al. (2014). The relationship between health-related quality of life and sleep problems in children with autism spectrum disorder. Research in Autism Spectrum Disorders, 8, 292–303. Scholar
  11. Eckerberg, B. (2004). Treatment of sleep problems in families with young children: Effects of treatment on family well-being. Acta Paediatrica, 93(1), 126–134. Scholar
  12. Giallo, R., Wood, C. E., Jellett, R., & Porter, R. (2011). Fatigue, wellbeing and parental self-efficacy in mothers of children with an autism spectrum disorder. Autism, 17(4), 1–16. Scholar
  13. Goodlin-Jones, B. L., Sitnick, S. L., Tang, K., Liu, J., & Anders, T. F. (2008). The Children’s Sleep Habits Questionnaire in toddlers and preschool children. Journal of Developmental and Behavioral Pediatrics, 29(2), 82–88. doi: 0.1097/DBP.0b013e318163c39a.CrossRefGoogle Scholar
  14. Gruber, R., Cassoff, J., Frenette, S., Wiebe, S., & Carrier, J. (2012). Impact of sleep extension and restriction on children’s emotional lability and impulsivity. Pediatrics, 130(5), e1155–e1161.CrossRefGoogle Scholar
  15. Heitzman-Powell, L. S., Buzhardt, J., Rusinko, L. C., & Miller, T. M. (2013). Formative evaluation of an ABA outreach training program for parents of children with autism in remote areas. Focus on Autism and Other Developmental Disabilities, 29(1), 23–38.CrossRefGoogle Scholar
  16. Hollway, J. A., & Aman, M. G. (2011). Sleep correlated of pervasive developmental disorders: A review of the literature. Research in Developmental Disabilities, 32, 1399–1421. Scholar
  17. Hollway, J. A., Aman, M. G., & Butter, E. (2013). Correlates and risk markers for sleep disturbance in participants of the autism treatment network. Journal of Autism and Developmental Disorders, 43, 2830–2843. Scholar
  18. Humphreys, J. S., Gringras, P., Blair, P. S., Scott, N., Henderson, J., Fleming, P. J., et al. (2014). Sleep patterns in children with autistic spectrum disorders: A prospective cohort study. Archives of Disease in Childhood, 99(2), 114–118. Scholar
  19. Hundley, R. J., Shui, A., & Malow, B. A. (2016). Relationship between subtypes of restricted and repetitive behaviors and sleep disturbance in autism spectrum disorder. Journal of Autism and Developmental Disorders, 46, 3448–3457. Scholar
  20. Jackson, J. B., Steward, S. R., Roper, S. O., & Muruthi, B. A. (2018). Support group value and design for parents of children with severe or profound intellectual and developmental disabilities. Journal of Autism and Developmental Disorders. Scholar
  21. Jeste, S. S. (2011). The neurology of autism spectrum disorders. Current Opinion in Neurology, 24(2), 132–139. Scholar
  22. Johnson, C. R., Turner, K. S., Foldes, E., Brooks, M. M., Kronk, R., & Wiggs, L. (2013). Behavioral parent training to address sleep disturbances in young children with autism spectrum disorders: A pilot trial. Sleep Medicine, 14, 995–1004. Scholar
  23. Katz, T., & Malow, B. (2014). Solving sleep problems in children with autism spectrum disorder: A guide for frazzled families. Bethesda: Woodbine House.Google Scholar
  24. Lopez-Wagner, M. C., Hoffman, C. D., Sweeney, D. P., Hodge, D., & Gilliam, J. E. (2008). Sleep problems of parents of typically developing children and parents of children with autism. Journal of Genetic Psychology, 169(3), 245–259. Scholar
  25. Malow, B. A., Adkins, K. W., Reynolds, A., Weiss, S. K., Loh, A., Fawkes, K., et al. (2014). Parent-based sleep education for children with autism spectrum disorders. Journal of Autism and Developmental Disorders, 44(1), 216–228. Scholar
  26. Markovich, A. N., Gendron, M. A., & Corkum, P. V. (2015). Validating the Children’s Sleep Habits Questionnaire against polysomnography and actigraphy in school-aged children. Frontiers in Psychiatry, 5, 188. Scholar
  27. Mayes, S. D., & Calhoun, S. L. (2009). Variables related to sleep problems in children with autism. Research in Autism Spectrum Disorders, 3, 931–941. Scholar
  28. Mazurek, M. O., & Petroski, G. F. (2015). Sleep problems in children with autism spectrum disorder: Examining the contributions of sensor over-responsivity and anxiety. Sleep Medicine, 16, 270–279. Scholar
  29. Michielsen, H. J., De Vries, J., & Van Heck, G. L. (2003). Psychometric qualities of a brief self-rated fatigue measure: The Fatigue Assessment Scale. Journal of Psychosomatic Research, 54, 345–352.CrossRefGoogle Scholar
  30. Mileva-Seitz, V. R., Bakermans-Kranenburg, M. J., Battaini, C., & Maartje, P. C. M., L (2017). Parent-child bed-sharing: The good, the bad, and the burden of evidence. Sleep Medicine Reviews, 32, 4–27. Scholar
  31. Morgenthaler, T., Alessi, C., Friedman, L., Owens, J., Kapur, V., Boehlecke, B., et al. (2007). Practice parameters for the use of actigraphy in the assessment of sleep and sleep disorders: An update for 2007. Sleep, 30(4), 519–529.CrossRefGoogle Scholar
  32. Owens, J. A., Spirito, A., & McGuinn, M. (2000). The Children’s Sleep Habits Questionnaire (CSHQ): Psychometric properties of a survey instrument for school-aged children. Sleep-New York, 23(8), 1043–1051.Google Scholar
  33. Reed, H. E., McGrew, S. G., Artibee, K., Surdkya, K., Goldman, S. E., Frank, K., et al. (2009). Parent-based sleep education workshops in autism. Journal of Child Neurology, 24(8), 936–945. Scholar
  34. Reid, M. J., Walter, A. L., & O’Leary, S. G. (1999). Treatment of young children’s bedtime refusal and nighttime wakings: A comparison of “standard” and graduated ignoring procedures. Journal of Abnormal Child Psychology, 27(1), 5–16.CrossRefGoogle Scholar
  35. Reynolds, S., Lane, S. J., & Thacker, L. (2012). Sensory processing, physiological stress, and sleep behaviors in children with and without autism spectrum disorders. OTJR: Occupation, Participation and Health, 32(1), 246–257. Scholar
  36. Sadeh, A. (2004). A brief screening questionnaire for infant sleep problems: Validation and findings for an Internet sample. Pediatrics, 113(6), e570–e577.CrossRefGoogle Scholar
  37. SAS Institute Inc. (2018). Cary, NC. Retrieved from
  38. Schreck, K. A., Mulick, J. A., & Smith, A. F. (2004). Sleep problems as possible predictors of intensified symptoms of autism. Research in Developmental Disabilities, 25, 57–66. Scholar
  39. Sivertsen, B., Posserud, M. B., Gillberg, C., Lundervold, A. J., & Hysing, M. (2012). Sleep problems in children with autism spectrum problems: A longitudinal population-based study. Autism, 16(2), 139–150. Scholar
  40. Souders, M. C., Savodny, S., Eriksen, W., Sinko, R., Connell, J., Kerns, C., et al. (2017). Sleep in children with ASD. Current Psychiatry Report, 19(6), 34.CrossRefGoogle Scholar
  41. Stokes, M. A., Kornienko, L., Scheeren, A. M., Koot, H. M., & Begeer, S. (2017). A comparison of children and adolescent’s self-report and parental report of the PedsQL among those with and without autism spectrum disorder. Quality of Life Research, 26, 611–624. Scholar
  42. Symon, J. B. (2001). Parent education for autism: Issues in providing services at a distance. Journal of Positive Behavior Interventions, 3(3), 160–174.CrossRefGoogle Scholar
  43. Taylor, M. A., Schreck, K. A., & Mulick, J. A. (2012). Sleep disruption as a correlate to cognitive and adaptive behavior problems in autism spectrum disorders. Research in Developmental Disabilities. 33(5), 1408–1417. Scholar
  44. Tudor, M. E., Hoffman, C. D., & Sweeney, D. P. (2012). Children with autism: Sleep problems and symptom severity. Focus on Autism and Other Developmental Disabilities., 27(4), 254–262. Scholar
  45. Varni, J. W., Sherman, S. A., Burwinkle, T. M., Dickinson, P. E., & Dixon, P. (2004). The PedQL™ Family Impact Module: Preliminary reliability and validity. Health and Quality Life Outcomes. Scholar
  46. Veatch, O. J., Reynolds, A., Katz, T., Weiss, S. K., Loh, A., Wang, L., & Malow, B. A. (2017). Sleep in children with autism spectrum disorders: How are measures of parent report and actigraphy related to and affected by sleep education? Behavioral Sleep Medicine. 14, 665–676.CrossRefGoogle Scholar
  47. Vismara, L. A., McCormick, C., Young, G. S., Nadham, A., & Monlux, K. (2013). Preliminary findings of a telehealth approach to parent training in autism. Journal of Autism and Developmental Disorders, 43, 2953–2969.CrossRefGoogle Scholar
  48. Vriend, J. L., Corkum, P. V., Moon, E. C., & Smith, I. M. (2011). Behavioral interventions for sleep problems in children with autism spectrum disorders: Current findings and future directions. Journal of Pediatric Psychology, 36(9), 1017–1029. Scholar
  49. Weiss, S. K. (n.d.). Strategies to improve sleep in children with autism spectrum disorders: A parents’ guide. Autism Speaks Autism Treatment Network. Retrieved from
  50. World Health Organization. (1995). The World Health Organization Quality of Life assessment (WHOQOL): Position paper from the World Health Organization. Social Science & Medicine, 41(10), 1403–1409.CrossRefGoogle Scholar
  51. Yu, X., Ham, L. S., Au, C. T., Chan, S. H. Y., Chan, D. F., & Li, A. M. (2015). Extended parent-based behavioural education improves sleep in children with autism spectrum disorder. Hong Kong Journal of Paediatrics, 20(4), 219–225.Google Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  1. 1.University of Missouri-Kansas CityKansas CityUSA
  2. 2.Patient Care Services ResearchChildren’s Mercy HospitalKansas CityUSA
  3. 3.Division of Developmental and Behavioral SciencesChildren’s Mercy Kansas CityKansas CityUSA
  4. 4.Department of Health Services and Outcomes ResearchChildren’s Mercy Kansas CityKansas CityUSA

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