Sleep Disturbances: Why Children With Autism Spectrum Disorder May Have Trouble Sleeping At Night FanT C., Keramati C., Tomberlin C., Bisson J.

The purpose of our study was to explain the difference between nighttime waking between children with and without ASD. In a cross sectional study, parents were recruited, voluntarily, through social media advertisement and were asked to complete an online survey. Twenty-four parents whose children met the age restrictions of our study were included in the final dataset (13 parents of children with ASD and 11 parents of children without ASD). An independent t-test was used to compare individuals with ASD and typically developing (TD) individuals. Our results show a trend; the ASD group woke up more often in the first five months of life (M = 3.92) compared to the TD group (M = 2.55), t(22) = 2.00, p = 0.058. Our team will recruit more participants to further explore our research hypothesis.

Autism spectrum disorder (ASD) is a neurodevelopmental disorder characterized by severe challenges with social interaction, repetitive behaviors, speech and nonverbal communication.

In the United States today, 1 in 68 children are diagnosed with an autism spectrum disorder.
Two-thirds of children with autism have some kind of sleeping problem, with prevalence rates ranging from 53% to 84%. Sleeping problems can effect cognition, mood, and behavior [5].
Sleep disorders are defined as sleeping patterns which may be severe enough to interfere with a person’s normal physical, mental and emotional functioning.
The severity of sleeping problems and sleep disorders in children with autism is of particular concern due to the potentially adverse effects that insufficient sleep has on daytime behavior and functioning.



  • Early detection and treatment of autism is important for optimal outcomes.
  • A delayed diagnosis could eventually lead to life long deficits and developmental delays which could impair daily living.
  • Because there are very few markers of autism in children before 12-18 months of age, treatment is often delayed by a failure to diagnose the disorder early in infancy.
  • While researchers continue to try and understand the full etiology of the disorder, recognized causes of autism include genetic factors, prenatal factors, environmental factors, and/or a combination of these.
  • Although causal factors of autism have been researched for many decades, there seems to be limited research on potential differences in lifestyle behaviors between young children with and without autism.

Literature Review

  • Previous research has shown that sleep disturbances are not uncommon in individuals with autism (Cohen, Conduit, Lockley, Rajaratnam, 2014).
  • Several aspects of sleeplessness (extreme difficulty getting to sleep, long periods of night waking, short duration sleep at night, early morning waking and consequent daytime sleepiness) are consistently the most commonly reported (Wiggs & Stores, 2004).
  • Several other forms of sleep disturbances are also prevalent, including parasomnias and other inconsistencies in sleep patterns (Ming, Sun, Nachajon, Brimacombe, & Walters, 2009).

The purpose of this study is to explore the differences in sleeping positions and nighttime waking between typically developing infants and infants who go on to develop Autism Spectrum Disorder.

If documented, this could be another early marker for Autism Spectrum Disorder.


A retrospective, cross sectional research design was used to gather and analyze data on infant’s sleeping behaviors. Using a cross sectional design allows researchers to observe patterns, trends or relationships between variables.

Participants. Participants were recruited through advertisement posts on social media web pages including Facebook and Twitter. All participants were parents, 18 years or older, who had a child over the age of 3. The child did not have to be biologically related to the caregiver. The final sample size consisted of 24 parents (13 parents of children with ASD and 11 parents of children without ASD).

Measures. The Baby and Infant Screen for Children with Autism Traits (BISCUIT) is a tool that measures severity of autism symptoms for children aged 17-37 months. Part 1 of the BISCUIT has three distinct factors that relate to the core symptoms of Autism Spectrum Disorder: issues with socialization, repetitive behaviors, and communication. For this study, a modified (14 question) version of the BISCUIT was used. Internal consistency was high for all factors (α=INSERT RANGE OF ALPHAS).


The information presented below was taken from a larger study exploring early lifestyle differences in children with autism and children without autism.

Our research team contacted well-known organizations (e.g., Autism Speaks, Autism Awareness, etc.) through their social media pages (i.e., Facebook and Twitter) to ask if they were willing to post our survey link on their webpage. If an organization agreed, the survey link was posted on their webpage for viewers to see.

Following the BISCUIT questionnaire, participants were asked to recall what percentage of time their infant slept in specific positions (i.e., back, side, stomach or “other”). Parents were asked to report their child's sleeping positions for different age /developmental time points. They were also asked to report how many times per night their child awoke in the first five months. Finally, parents were asked to report whether or not their child had been diagnosed with an autism spectrum disorder.

Each participant who provided contact information and answered the survey completely and honestly received their choice of either a $5 Starbucks or Dunkin’ Donuts gift card. Participants were also entered into a drawing to win a $100 Amazon gift card and at the end of the research study,



Pearson Product Moment correlations were conducted to examine the relationships among the three sub scales of the BISCUIT (i.e., socialization, repetitive behaviors, and communication), the average number of times the child awoke at night in the first five months of life, the average amount of nightly sleep, and the percent of time the child was placed in certain sleeping positions (back, stomach, side, other).

There was marginal significance for the relationship between repetitive behaviors and the percent of time mother’s placed their child on his/her stomach in the first year of life, r=-.328, p=0.077. Infants who were placed on their backs for higher percentages of the time were less likely to exhibit repetitive behaviors. A trend was also observed between repetitive behaviors and the percent of time children were placed in “other” sleeping positions during the first year of life, r=-.347, p=0.060. The more repetitive behaviors a child engaged in, the lower the percent of time he/she was placed in “other” sleeping positions. A statistically significant relationship was found between social behaviors and the percent of time children were placed in “other” sleeping positions in the first year of life, r=-.410, p=0.024. Communicative behaviors were also significantly correlated with “other” sleeping positions as well, r=-4.01, p=0.028. The more communicative and social behaviors a child engaged in, the less time they were placed in “other” sleeping positions.

There were no other significant correlations between the BISCUIT sub scales and the other variables assessed in this study, ps>0.05.


Independent t-tests were conducted to explore differences between those with autism and those without autism for the average number of times awoken at night in the first five months of life, the average amount of nightly sleep, and the percent of time the child was placed in certain sleeping positions (back, stomach, side, other).

There was marginal significance for the differences between those who have autism and those who don’t have autism regarding the number of times the child woke up per night during the first five months of life, t(22)=2.00, p=0.058. Children with autism woke up marginally more times per night compared to children without autism (Figure 1). There was also marginal significance for the difference between the two groups for the number of hours the child slept at night. Based on this observed trend, t(28)=-1.81, p=0.081, children with autism slept fewer hours per night compared to children without autism (see Figure 2).

No other significant differences were observed between variables assessed in this study, p’s>0.05.

Figure 1. Children with autism woke up more times per night compared to children without autism.
Figure 2. Children with autism slept fewer hours per night compared to children without autism.



  • In the past sleeping disturbances have been observed in individuals with autism.
  • This is the first study to document differences in sleeping patterns of infants with autism in the first five months of life.
  • Specifically, trends in the data suggest that infants with autism wake up more frequently than typically developing infants.
  • One possible reason for the correlation between sleep disturbances and children with autism is the presence of a defective ASMT gene, which is responsible for the coding of the last enzyme in the anabolic pathway of melatonin synthesis. This defect in melatonin synthesis could either be responsible for ineffectual melatonin, or perhaps lower levels of melatonin. Melatonin is the hormone responsible for maintaining an individuals sleep cycle, and if this hormone is not functioning correctly, it could affect a child's sleep-wake cycle. However, more research is needed to further support this relation between the ASMT gene, autism, and sleep disturbance (Melke, Botros, Chaste, Betancur, Nygren, Anckarsäter, & Chabane, 2008)
  • Another explanation for this waking phenomenon is that children with autism, being more susceptible to over-stimulus, are more prone to being woken by environmental factors. The significance here being that the confirmation of infants experiencing greater rates of sleep disturbance and subsequently experiencing autism diagnosis later life, then autism symptoms may display themselves earlier than initially recognized (Malow & McGrew, 2008).

Moving forward the team is looking to begin a longitudinal study, to track infants through development to observe any correlation with sleeping position and symptoms typically displayed by those with autism.


In conclusion, our study supports the theory that children with autism experience less sleep than their non-diagnosed counterparts, and that sleep disturbance may be an early presenting autism symptom.

Undergraduate Researchers at Clemson University


Cohen, S., Conduit, R., Lockley, S. W., Rajaratnam, S. M., & Cornish, K. M. (2014). The relationship between sleep and behavior in autism spectrum disorder (ASD): a review. Journal of Neurodevelopmental Disorders, 6(1), 44.

Ming, X., Sun, Y., Nachajon, R. V., Brimacombe, M., & Walters, A. S. (2009). Prevalence of Parasomnia in Autistic Children with Sleep Disorders. Retrieved March 28, 2017, from

Wiggs, L., & Stores, G. (2004). Sleep patterns and sleep disorders in children with autistic spectrum disorders: Insights using parent report and actigraphy. Developmental Medicine & Child Neurology, 46(6), 372-380. doi:10.1017/S0012162204000611

Melke, J., Botros, H. G., Chaste, P., Betancur, C., Nygren, G., Anckarsäter, H., ... & Chabane, N. (2008). Abnormal melatonin synthesis in autism spectrum disorders. Molecular psychiatry, 13(1), 90-98.

Malow, B. A., & McGrew, S. G. (2008). Sleep disturbances and autism. Sleep Medicine Clinics, 3(3), 479-488.


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