Peer-reviewed article
The impact of sleep habits on emotional and behavioral problems, quality of life, caregiver depression, and burnout in children with autism spectrum disorder.
Arici Gürbüz A, Cömertoğlu Arslan S, Bozduman Çelebi S, Binokay H, Altun H ·
Summary
Written by AI, not yet AICS's view · claude-haiku-4-5-20251001This study examined how sleep problems affect children with autism spectrum disorder and their families. Researchers compared 101 children with autism aged 6-12 years to 81 typically developing children, measuring their sleep quality, behavior, quality of life, and parental mental health. Children with autism had more sleep difficulties despite sleeping longer overall, and their parents reported higher rates of depression and burnout. Sleep quality significantly influenced how behavioral problems and parental stress affected children's overall quality of life.
Key points
- 40-80% of children with autism experience sleep disturbances
- Children with autism showed poorer sleep quality across multiple measures (bedtime resistance, night wakings, parasomnias) compared to typically developing peers
- Maternal depression and burnout were substantially higher in families of children with autism
- Sleep quality mediated between child behavioral difficulties and quality of life (23.1% of association), maternal depression and quality of life (51.4%), and maternal burnout and quality of life (36.6%)
- Autism diagnosis, behavioral difficulties, sleep disturbance severity, and maternal burnout independently predicted lower quality of life
Limitations
This is a cross-sectional study, so it cannot establish causality or direction of effects between sleep, behavior, and outcomes. The sample is limited to mothers as primary caregivers and children aged 6-12 years, which may not represent all caregivers or the full age range of children with autism.
Abstract
Background Sleep disturbances affect 40-80% of children with autism spectrum disorder (ASD), yet their concurrent associations with neurobehavioral functioning, health-related quality of life (HRQoL), and primary caregiver mental health remain insufficiently characterized within an integrated multivariate framework that includes typically developing controls. This limits clinicians' ability to position sleep disturbance within the broader family burden associated with ASD. Methods This cross-sectional case-control study included 101 children aged 6-12 years with DSM-5-confirmed ASD and 81 typically developing controls, together with their primary caregiving mothers. Sleep was assessed using the Children's Sleep Habits Questionnaire (CSHQ), child behavior using the Strengths and Difficulties Questionnaire (SDQ), HRQoL using the KINDL, and maternal psychiatric morbidity using the Beck Depression Inventory (BDI) and Maslach Burnout Inventory (MBI). Multiple linear regression and bootstrap mediation analyses were performed. Results Despite significantly longer total daily sleep duration, children with ASD had poorer scores across most CSHQ subscales, including bedtime resistance, night wakings, and parasomnias (p < 0.05), whereas daytime sleepiness was not significantly different (p = 0.075). Maternal depression and burnout were substantially higher in the ASD group (p < 0.001). In multivariable analysis, ASD diagnosis (B = -6.124, p = 0.001), SDQ total difficulties (B = -0.533, p < 0.001), sleep disturbance severity (B = -0.523, p < 0.001), and maternal burnout (B = -0.146, p = 0.016) independently predicted lower HRQoL. Sleep quality significantly mediated the associations of child behavioral difficulties (23.1%, p = 0.016), maternal depression (51.4%, p = 0.002), and maternal burnout (36.6%, p = 0.027) with HRQoL. Conclusion Sleep disturbances in children with ASD were associated with greater behavioral difficulties, lower HRQoL, and poorer maternal mental health. Sleep quality also mediated the associations between child behavioral difficulties, maternal psychological well-being, and HRQoL. These findings highlight the importance of assessing sleep as part of comprehensive, family-centered care for children with ASD.