Beyond Coincidence: The Temporal Course of Inter-Relationship Between Sleep and Challenging Behaviors Across Four Weeks in Children With Autism

Abstract

BACKGROUND: Previous research has supported a relationship between sleep problems and challenging behavior. However, the relationship may be inflated due to shared method variance and longitudinal coupling. Therefore, our main goal was to clarify any potential connections between behavior problems and sleep disturbances.METHODS: We examined the temporal relationship between sleep difficulties and behavioral problems among 80 children with mild-moderate and severe autism aged 2-10 years with the cross-lagged panel model.RESULTS: The results suggest that some sets of sleep difficulties establish behavioral problems. In addition, distinct types of behavioral problems worsen a range of sleep difficulties. Accordingly, parasomnia had the most significant positive correlation with irritability as the time lagged (r=0.393) and with the composite score of the Aberrant Behavior Checklist (AbBC) (r=0.348) in the next week. Stereotypical behaviors also preceded bedtime resistance in the next week (r=0.324). The relationships became stronger in mild-moderate autism. The other cross-correlations were negligible since their correlation coefficient was r<0.30. In general, the temporal relationship between sleep difficulties and behavioral problems seemed only to matter for the subsequent week; the causality was lost in broader time lags.CONCLUSIONS: This study emphasizes the importance to take the type of preceding sleep problems into account when trying to comprehend challenging behavior in autism. Treatment for parasomnia may have a favorable impact on behavior problems. Furthermore, interventions aiming at stereotypical behaviors may lessen certain sleep disturbances. The underlying processes that cause these symptoms may be in common.