Poor Sleep Quality Among Adolescents With ASD Is Associated With Depressive Symptoms, Problem Behaviors, and Conflicted Family Relationships

Abstract

To better understand correlates of sleep issues for adolescents with autism spectrum disorder (ASD), we conducted two related studies of sleep quality in association with adolescent well-being and family relationships. In Study 1, 28 adolescents with ASD, 27 typically developing (TD) adolescents, and their mothers, participated. Mothers and adolescents independently completed questionnaires about sleep and adolescent functioning. In Study 2, 20 adolescents with ASD and their mothers participated, and actigraphy was used to measure sleep quality. Regression results from Study 1 indicated more daytime sleepiness was associated with more depressive symptoms and more discordant mother–adolescent relationships in the ASD sample. More sleep–wake problems were associated with more depressive symptoms in TD adolescents. In Study 2, more time asleep and poorer sleep efficiency were associated with more depressive symptoms and discordant sibling relationships. These findings suggest that helping adolescents with ASD with their sleep issues may confer benefits in other parts of their lives.

A systematic review of the rates of depression in autistic children and adolescents without intellectual disability

“…Other assessment of autism included parent report measured by the ADI‐R and evaluation of documentation of diagnosis by the study team (Lopata et al., 2010), prior diagnosis by an experienced clinician, confirmed using the ADOS‐G (Mazzone et al., 2013), or prior diagnosis confirmed by the ADOS and ADI‐R with autism determined based on all diagnostic information available and on consensus of the multidisciplinary team that included psychologists and psychiatrists (Montazeri et al., 2020). Prior diagnosis of autism was noted in another study and confirmed by the ADOS‐2 and/or the Social Communication Questionnaire (SCQ; Phung et al., 2019) or the ADI‐R (Witwer & Lecavalier, 2010) with autism determined by prior diagnosis and confirmation by the DISCO in one study (Vickerstaff et al., 2007). Prior diagnosis of autism by experienced child neurology professionals and/or multidisciplinary teams confirmed by medical records and the ADI‐R was noted in one study (Reinvall et al., 2016) or noted as diagnosis by Module 3 or 4 of the ADOS and according to best clinical judgement in another (Orinstein et al., 2015).…”

“…Ghaziuddin, Weidmer‐Mikhail, and Ghaziuddin (1998) reported an age range of 8–51 years, with a mean age of 15.1 years old. A mixture of cross‐sectional (Demirkaya, Tutkunkardas, & Mukaddes, 2016; Mattila et al., 2010; Mazefsky, Kao, & Oswald, 2011; Montazeri, de Bildt, Dekker, & Anderson, 2020; Mukaddes & Fateh, 2010; Phung, Abdullah, & Goldberg, 2019; Vickerstaff, Heriot, Wong, Lopes, & Dossetor, 2007; Witwer & Lecavalier, 2010), prospective designs (Bitsika, Sharpely, Andronicos, & Agnew, 2016; Ghaziuddin et al., 1998; Salazar et al., 2015), and case‐control (case controls, unless comprised of an autistic group, are not reported in this review, please see individual papers for details) studies were included. Six studies were conducted in United States (Ghaziuddin et al., 1998; Joshi et al., 2018; Lopata et al., 2010; Mazefsky et al., 2011; Phung et al., 2019; Witwer & Lecavalier, 2010), three in Turkey (Demirkaya et al., 2016; Mukaddes & Fateh, 2010; Şahin, Bozkurt, & Karabekiroğlu, 2019), three in Australia (Bitsika et al., 2016; Bitsika & Sharpley, 2015; Vickerstaff et al., 2007), two in the United Kingdom (Green, Gilchrist, Burton, & Cox, 2000; Salazar et al., 2015), two in Finland (Mattila et al., 2010; Reinvall et al., 2016), one in Canada (Orinstein et al., 2015), one in the Netherlands (Montazeri et al., 2020), and one in Italy (Mazzone et al., 2013).…”

“…Of the remaining six, one aimed to assess autism and suicidality (Demirkaya et al., 2016); one aimed to explore the relations among generalized anxiety, depression symptoms, and social competence (Lopata et al., 2010); one explored autism and the psychometric properties of four self‐report measures that screen for depression, anxiety, attention deficit hyperactivity disorder, and obsessive compulsive disorder (Mazefsky et al., 2011); and one aimed to investigate the associations among self‐perceived social competence, intellectual ability, and depressive symptomatology (Vickerstaff et al., 2007). Another aimed to investigate pre‐pubertal risk factors in developing developmental disorders (Şahin et al., 2019) and one aimed to explore correlates of sleep difficulties in ASD (Phung et al., 2019).…”

“…The measurement of depression in autism varied across the included studies (see Table 4). Depression was determined by interview (Demirkaya et al., 2016; Green et al., 2000; Joshi et al., 2018; Mattila et al., 2010; Mazefsky et al., 2011; Mazzone et al., 2013; Mukaddes & Fateh, 2010; Orinstein et al., 2015; Reinvall et al., 2016; Şahin et al., 2019; Salazar et al., 2015; Witwer & Lecavalier, 2010), questionnaire‐based measures (Bitsika et al., 2016; Bitsika & Sharpley, 2015; Lopata et al., 2010; Mazzone et al., 2013; Montazeri et al., 2020; Phung et al., 2019; Vickerstaff et al., 2007), and a mix of multiple pulled methods (Ghaziuddin et al., 1998). Multiple pulled methods included psychiatric examinations based on DSM criteria, psychiatric, school, and social services records, the Kiddie Schedule for Affective Disorders and Schizophrenia–Epidemiological Version, and supplemented telephone interviews to determine diagnosis (Ghaziuddin et al., 1998).…”

“…Three studies employed multiple measures of depression; this included parent and self‐report on the Child and Adolescent Symptom Inventory which measures DSM‐V criteria for MDD (Bitsika et al., 2016), parent and self‐report on The Revised Children’s Anxiety and Depression Scale (RCADS) measuring DSM‐IV criteria for MDD (Montazeri et al., 2020), and self‐report on the Italian version of Children’s Depression Inventory, in addition to an interview measure, as described above (Mazzone et al., 2013). Three studies used self‐report questionnaires as their measure of depression rates; the Child and Adolescent Symptom Inventory’s MDD subscale (Bitsika & Sharpley, 2015), the Children’s Depression Inventory (Vickerstaff et al., 2007), and the Center for Epidemiological Studies Depression Scale (Phung et al., 2019). One used a parent report questionnaire as their measure of depression in their sample; Lopata et al.…”