Sleep Disturbances and Associated Factors in Thai Children with Autism Spectrum Disorder
Objectives : This study aimed to explore sleep patterns, sleep disturbances, and their
associated factors in Thai children with ASD.
Methods : Data from 102 children aged 4-12 years at Yuwaprasart Waithayopathum Child and
Adolescent Psychiatric Hospital, Samut Prakan, Thailand were collected for this cross-sectional,
analytic study. Participants were children diagnosed with ASD who visited the outpatient
department during March and May 2018. Sleep disturbances were examined using the
children’s sleep habits questionnaire (CSHQ)- Thai version, reported by parents. Associated
factors studied included sleep practices and environment, emotional and behavioral problems,
using the strengths and difficulties questionnaire (SDQ), autism severity, comorbidities, and
medication. Pearson’s correlations and stepwise linear regression analysis were used to
determine predictors for overall sleep disturbances.
Results : Of the total 102 participants, 86.3% were male, with autism severity level ranging
from mild (50.0%), moderate (30.0%), to severe (20.0%), based on DSM-5. Most children had
disturbed sleep, with overall disturbances rates of 89.2%. Most common sleep domains were
bedtime resistance (57.0%), sleep anxiety (37.0%), and sleep disordered breathing (35.0%).
Results showed that younger parental age, absence of bedtime routine, higher SDQ difficulties
scores, and severe autism significantly associated with increased overall sleep disturbances.
Lower sleep disturbances were found in primary school children and methylphenidate users.
After stepwise linear regression analysis, total SDQ difficulties remained the strongest predictor
of overall sleep disturbances.
Conclusions : A large portion of autistic children were affected by sleep disturbances. Treatment
for ASD should always include management of sleep practices and factors that contribute to
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