781 - Assessing Links between Sleep Problems and Attention and Behavioral Regulation Difficulties in Preschoolers with Autism Spectrum Disorder - Cross-sectional and Longitudinal Approaches

Publication Number: 781.3772

Thea Bregman, UC Davis, Sacramento, CA, United States; Bibiana Restrepo, University of California, Davis, School of Medicine, Sacramento, CA, United States; Kathleen Angkustsiri, UC Davis MIND Institute, Sacramento, CA, United States; Zainab A. Akinjobi, University of California, Davis, Sacramento, CA, United States; Danielle Harvey, University of California, Davis, Davis, CA, United States; Temitayo Oyegbile-Chidi, University of California, Davis, School of Medicine, Sacramento, CA, United States; Meghan Miller, University of California, Davis, School of Medicine, Sacramento, CA, United States; Wu Nordahl, UC Davis, Sacramento, CA, United States

Background: Sleep problems are common in children with autism spectrum disorder (ASD). Sleep difficulties in early childhood may contribute to development of difficulties with attention and behavioral regulation. Prior literature has focused primarily on a cross-sectional approach, while less is known about longitudinal relationships.

Objective: We aim to evaluate differences in sleep between preschoolers with ASD and typical development (TD) and whether higher levels of sleep problems in preschoolers with ASD are related to development of attention and behavioral regulation difficulties in middle childhood.

Design/Methods: This is a secondary analysis of data collected by the UC Davis MIND Institute Autism Phenome Project. Two-sample t-tests and linear regression with adjustment for covariates and potential confounders that met a p< 0.1 threshold in simpler models were used first to compare sleep in preschoolers with ASD and TD using the Children’s Sleep Habit Questionnaire (CSHQ) Autism Factor Score derived by Hatch et al. (2020) (n= 279 ASD, mean age 37.2 mo; 128 TD, mean age 36.2 mo). Similar analytic methods were used to evaluate for concurrent associations between sleep problems (CSHQ total score) and ADHD symptoms (Child Behavior Checklist DSM-oriented ADHD subscale) in the preschoolers with ASD (n= 262, mean age 37.3 mo) and then for longitudinal associations in middle childhood (n= 75, mean age 37 mo and mean age at follow up 139.9 mo).

Results: Preschoolers with ASD had more sleep difficulties than TD peers (CSHQ Autism Factor Score ASD mean (SD): 11.9 (3.2); TD: 9.9 (2.0), p< 0.001). Sleep problems were significantly associated with attention and behavioral challenges for preschoolers with ASD (r=0.26, p< 0.001), but this effect was not significant after accounting for covariates (ethnicity, parental income, Social Responsiveness Scale).

Within ASD, sleep problems in preschool were not associated with later attention and behavioral challenges in middle childhood (r=-0.01, p=0.91). However, levels of attention and behavioral challenges in preschool were associated with higher levels of these challenges in middle childhood (p < 0.01).

Conclusion(s): Preschoolers with ASD had significantly more sleep problems than the TD group. After adjusting for covariates, sleep problems in preschoolers with ASD were not associated with elevated levels of attention and behavioral regulation challenges cross-sectionally or longitudinally when reassessed in middle childhood. Further research is needed to examine this relationship.

Table 1: Linear regression results for CSHQ Autism Factor Score comparing TD to ASD in preschoolers with adjustment for covariates and potential confounders that met a p<0.1 threshold


Table 2: Linear regression results between CSHQ total score and Child Behavior Checklist DSM-oriented ADHD subscale in preschoolers with ASD with adjustment for covariates and potential confounders that met a p<0.1 threshold


Table 3: Linear regression results for CSHQ total score in preschoolers with ASD and Child Behavior Checklist DSM-oriented ADHD subscale in middle childhood with adjustment for covariates and potential confounders that met a p<0.1 threshold