Parent Perceptions of Sleep-Related Stereotypy Within Sleep Problems in Children on the Autism Spectrum: Implications for Behavioral Treatment

Abstract

Objectives Sleep problems in children on the autism spectrum may be affected by core diagnostic characteristics, including stereotypy (restricted and repetitive behaviors). Little is known about the nature of sleep-related stereotypy and its role within sleep disturbance. This study aimed to improve our understanding of the types of sleep-related stereotypy, its potential role within sleep difficulties, and how parents manage night-time stereotypy, in children on the autism spectrum. Methods This qualitative study used thematic analysis to analyze clinical assessment reports obtained from 21 parents of children on the autism spectrum referred for behavioral sleep intervention. Five themes, including the types of stereotypy, timing within sleep problems, stereotypy as sleep-interfering, stereotypy as sleep-conducive, and parent-responses, were identified. A clinical case study illustrates the potential role of vocal stereotypy within night wakings, through functional assessment and treatment of sleep problems in a child on the autism spectrum. Results Stereotypy included vocal and motor behaviors and repetitive manipulation of objects. Parents perceived stereotypy as both problematic and as beneficial to sleep, which may differentially affect behavioral treatment. Parent responses to stereotypy were varied and included co-sleeping. The case study highlights the complexity of the sleep and stereotypy relationship and the difficulty in treating automatically maintained behavior in the sleep context. Conclusion The function that stereotypy serves in relation to sleep disturbance is unclear and may differ across and within children. It is important we seek to better understand the specific ways that stereotypy may affect sleep, and vice versa, to improve clinical management of sleep problems in children on the autism spectrum.