Encyclopedia of Autism Spectrum Disorders

Living Edition
| Editors: Fred R. Volkmar

Restricted and Repetitive Behaviors and Sleep Disturbances in ASD

Living reference work entry
DOI: https://doi.org/10.1007/978-1-4614-6435-8_102371-1


Sleep problems may contribute to, and be exacerbated by, specific behavioral challenges in individuals with ASD, including restricted and repetitive behaviors.

Historical Background

Sleep problems are common in childhood and throughout the lifespan. Approximately 20–30% of typically developing children experience sleep difficulties, with the most common problems including difficulty falling asleep and staying asleep. Among adolescents and adults, sleep problems are more often labeled as insomnia (Meltzer and Mindell 2014). Population-based studies of adults conducted around the world suggest that approximately 30% of adults experience one or more symptoms of insomnia. Sleep problems occur even more frequently in children and adults with neurodevelopmental and psychiatric comorbidities (Krakowiak et al. 2008; Richdale and Schreck 2009).

Most of the research on sleep disturbance in Autism Spectrum Disorder (ASD) has been conducted on child and adolescent populations. Children...

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References and Reading

  1. Abel, E. A., Schwichtenberg, A. J., Broadhead, M. T., & Christ, S. L. (2018). Sleep and challenging behaviors in the context of intensive behavioral intervention for children with autism. Journal of Autism and Developmental Disorders, 48, 3871–3884.CrossRefGoogle Scholar
  2. Baker, E., & Richdale, A. L. (2015). Sleep patterns in adults with a diagnosis of high-functioning autism spectrum disorder. Sleep, 28(11), 1765–1774.CrossRefGoogle Scholar
  3. Bellesheim, K. R., Cole, L., Coury, D. L., Yin, L., Levy, S. E., Guinnee, M. A., Klatka, K., Malow, B. A., Katz, T., Taylor, J., & Sohl, K. (2019). Family-driven goals to improve care for children with autism spectrum disorder. Pediatrics, 142(3), e20173225.CrossRefGoogle Scholar
  4. Corkum, P. V., Reid, G. J., Hall, W. A., Godbout, R., Stremler, R., Weiss, S. K., Gruber, R., Witmans, M., Chambers, C. T., Begum, E. A., Pantelis, A., & Rigney, G. (2018). Evaluation of an internet-based behavioral intervention to improve psychosocial health outcomes in children with insomnia (better nights, better days): Protocol for a randomized controlled trial. JMIR Research Protocols, 7(3), e76.CrossRefGoogle Scholar
  5. Couturier, J. L., Speechley, K. N., Steele, M., Norman, R., Stringer, B., & Nicholson, R. (2005). Parental perception of sleep problems in children of normal intelligence with pervasive developmental disorders: Prevalence, severity, and pattern. Journal of the American Academy of Child and Adolescent Psychiatry, 44, 815–822.CrossRefGoogle Scholar
  6. Giannotti, F., Cortesi, F., Cerquiglini, A., Miraglia, D., Vagnoni, C., Sebastiani, T., & Bernabei, P. (2008). An investigation of sleep characteristics, EEG abnormalities and epilepsy in developmentally regressed and non-regressed children with autism. Journal of Autism and Developmental Disorders, 38, 1888–1897.CrossRefGoogle Scholar
  7. Goldman, S. E., Surdyka, K., Cuevas, R., Adkins, K., Wang, L., & Malow, B. A. (2009). Defining the sleep phenotype in children with autism. Developmental Neuropsychology, 34, 560–573.CrossRefGoogle Scholar
  8. Goldman, S. E., Richdale, A. L., Clemons, T., & Malow, B. A. (2012). Parental sleep concerns in autism spectrum disorders: Variations from childhood into adolescence. Journal of Autism and Developmental Disorders, 42, 531–538.CrossRefGoogle Scholar
  9. 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, 82–88.CrossRefGoogle Scholar
  10. Hodge, D., Hoffman, C. D., Sweeney, D. P., & Riggs, M. L. (2013). Relationship between children’s sleep and mental health in mothers of children with and without autism. Journal of Autism and Developmental Disorders, 43, 956–963.CrossRefGoogle Scholar
  11. Hollway, J. A., & Aman, M. G. (2011). Sleep correlates of pervasive developmental disorders: A review of the literature. Research in Developmental Disabilities, 32, 1399–1421.CrossRefGoogle Scholar
  12. Hollway, J. A., & Aman, M. G. (2011b). Pharmacological treatment of sleep disturbance in developmental disabilities: A review of the literature. Research in Developmental Disabilities, 32, 939–962.CrossRefGoogle Scholar
  13. 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.CrossRefGoogle Scholar
  14. Humphreys, J. S., Gringras, P., Blair, P. S., Scott, N., Henderson, J., Fleming, P. J., & Emond, A. M. (2014). Sleep patterns in children with autistic spectrum disorders: A prospective cohort study. Archives of Disease in Childhood, 99(2), 114–118.CrossRefGoogle Scholar
  15. Hundley, R. J., Shui, A., & Malow, B. A. (2016). Relationship between subtype of restricted and repetitive behaviors and sleep disturbance in autism spectrum disorders. Journal of Autism and Developmental Disorders, 46, 3448–3457.CrossRefGoogle Scholar
  16. Katz, T., & Malow, B. A. (2014). Solving sleep problems in children with Autism Spectrum Disorders. Woodbine House: A Guide for Frazzled Families.Google Scholar
  17. Krakowiak, P., Goodlin-Jones, B., Hertz-Piccotto, I., Croen, L. A., & Hansen, R. L. (2008). Sleep problems in children with autism spectrum disorders, developmental delays, and typical development: A population-based study. Journal of Sleep Research, 17(2), 197–206.Google Scholar
  18. MacDonald, L. L., Loring, W., Wyatt, A., Fawkes, D. B., Gray, L., & Malow, B. A. (2019). Behavioral sleep education for children with autism and insomnia: Partnership with community practices. Presented at the Associated Professional Sleep Societies Annual Meeting, San Antonio.Google Scholar
  19. Malow, B. A., Crowe, C., Henderson, L., McGrew, S. G., Wang, L., Song, Y., et al. (2009). A sleep habits questionnaire for children with autism spectrum disorders. Journal of Child Neurology, 24(1), 19–24.CrossRefGoogle Scholar
  20. Malow, B. A., Byars, K., Johnson, K., Weiss, S., Bernal, P., Goldman, S. E., et al. (2012). A practice pathway for the identification, evaluation, and management of insomnia in children and adolescents with autism spectrum disorders. Pediatrics, 130(2), S106–S124.CrossRefGoogle Scholar
  21. Malow, B. A., Adkins, K. W., Reynolds, A., Weiss, S. K., Loh, A., Fawkes, D., Katz, T., Goldman, S. E., Madduri, N., Hundley, R. J., & Clemons, T. (2014). Parent-based sleep education for children with autism spectrum disorders. Journal of Autism and Developmental Disorders, 44(1), 216–228.CrossRefGoogle Scholar
  22. Malow, B. A., Katz, T., Reynolds, A. M., Shui, A., Carno, M., Connolly, H. V., Coury, D., & Bennett, A. E. (2016). Sleep difficulties and medications in children with autism spectrum disorders: A registry study. Pediatrics, 137(S2), S61.Google Scholar
  23. Mayes, S. D., & Calhoun, S. (2009). Variables related to sleep problems in children with autism. Research in Autism Spectrum Disorder, 3, 931–941.CrossRefGoogle Scholar
  24. Mazurek, M. O., & Petroski, G. F. (2015). Sleep problems in children with autism spectrum disorder: Examining the contributions of sensory over-responsivity and anxiety. Sleep Medicine, 16(2), 270–279.CrossRefGoogle Scholar
  25. Meltzer, L. J., & Mindell, J. A. (2014). Systematic review and meta-analysis of behavioral interventions for pediatric insomnia. Journal of Pediatric Psychology, 39(8), 932–948.CrossRefGoogle Scholar
  26. Meltzer, L. J., Montgomery-Downs, H. E., Insana, S. P., & Walsh, C. M. (2012). Use of actigraphy for assessment in pediatric sleep research. Sleep Medicine Reviews, 16, 463–475.CrossRefGoogle Scholar
  27. Moore, B. A., Friman, P. C., Fruzzetti, A. E., & MacAleese, K. (2007). Brief report: Evaluating the bedtime pass program for child resistance to bedtime – A randomized controlled trial. Journal of Pediatric Psychology, 32(3), 283–287.CrossRefGoogle Scholar
  28. 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, 23, 1043–1051.CrossRefGoogle Scholar
  29. Park, S., Cho, S., Cho, I., Kim, B., Kim, J., Shin, M., et al. (2012). Sleep problems and their correlates and comorbid psychopathology of children with autism spectrum disorders. Research in Autism Spectrum Disorders, 6, 1068–1072.CrossRefGoogle Scholar
  30. Phung, J. N., & Goldberg, W. A. (2017). Poor sleep quality is associated with discordant peer relationships among adolescent with autism spectrum disorder. Research in Autism Spectrum Disorders, 34, 10–18.CrossRefGoogle Scholar
  31. Richdale, A. L., & Schreck, K. A. (2009). Sleep problems in autism spectrum disorders: Prevalence, nature and possible biopsychosocial aetiologies. Sleep Medicine Reviews, 13, 403–411.CrossRefGoogle Scholar
  32. Richdale, A. L., Francis, A., Gavidia-Payne, S., & Cotton, S. (2009). Stress, behavior, and sleep problems in children with an intellectual disability. Journal of Intellectual and Developmental Disability, 25(2), 147–161.CrossRefGoogle Scholar
  33. Schreck, K. A., Mulick, J. A., & Rojahn, J. (2003). Development of the behavioral evaluation of disorders of sleep scale. Journal of Child and Family Studies, 12(32), 349–359.CrossRefGoogle Scholar
  34. 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(1), 57–66.CrossRefGoogle Scholar
  35. Souders, M. C., Zavodny, S., Eriksen, W., Sinko, R., Connell, J., Kerns, C., Schaaf, R., & Pinto-Martin, J. (2017). Sleep in children with autism spectrum disorder. Current Psychiatry Reports, 19(6), 34.CrossRefGoogle Scholar
  36. Veatch, O. J., Goldman, S. E., Adkins, K. W., & Malow, B. A. (2015). Melatonin in children with autism spectrum disorders: How does the evidence fit together? Journal of Nature and Science, 1(7), e125.PubMedPubMedCentralGoogle Scholar
  37. Veatch, O. J., Sutcliffe, J. S., Warren, Z. E., Keenan, B. T., Potter, M. H., & Malow, B. A. (2017). Shorter sleep duration is associated with social impairment and comorbidities in ASD. Autism Research, 10, 1221–1238.CrossRefGoogle Scholar

Authors and Affiliations

  1. 1.Division of Developmental Medicine, Department of PediatricsVanderbilt University Medical CenterNashvilleUSA
  2. 2.Sleep Disorders Division, Department of NeurologyVanderbilt University Medical CenterNashvilleUSA