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Background Sleep problems are common in autistic children and adversely impact daytime functioning. The Children's Sleep Habits Questionnaire (CSHQ) [39] was developed from a community-based sample of children and has validated a cut-off score of 41. Katz et al. [50] developed an abbreviated 23-item four-factor version of the CSHQ, which may be useful when assessing sleep in autistic children. However, a cut-off value has not yet been developed. Objective: Our objective was to develop and validate a cut-off for the CSHQ-autism total score in order to identify sleep problems among autistic children. We hypothesized that the derived cut-off value for the CSHQ-autism would perform better than the original CSHQ cut at 41 on validation in a sample of autistic children. Methods Age-specific cut-off values were developed and validated using receiver operating characteristic analysis. Results The derived cut-off values for the CSHQ-autism total score were 34, 35, 33, and 35 for the 2–3, 4–10, 11–17, and 2–17 years age groups, respectively. On validation, all cut-off values performed with moderate to high sensitivity (76.6–82.4%) and moderate specificity (69.1–75.5%), while the original CSHQ cut at 41 had high sensitivity (89.9–93.0%) but low specificity (42.6–57.7%). Using McNemar's tests, the CSHQ-autism had significantly higher specificity but lower sensitivity than the original CSHQ cut at 41 in all age groups. Conclusions The CSHQ-autism cut-off values performed better overall than the original CSHQ cut at 41 in a sample of autistic children. The CSHQ-autism cut-off can help identify sleep problems among autistic children.

Background Insomnia and low iron stores are common in children with autism spectrum disorders, and low iron stores have been associated with sleep disturbance. Methods We performed a randomized placebo-controlled trial of oral ferrous sulfate to treat insomnia in children with autism spectrum disorders and low normal ferritin levels. Twenty participants who met inclusion criteria and whose insomnia did not respond to sleep education were randomized to 3 mg/kg/day of ferrous sulfate (n = 9) or placebo (n = 11) for three months. Results Iron supplementation was well tolerated, and no serious adverse events were reported. Iron supplementation improved iron status (+18.4 ng/mL active versus −1.6 ng/mL placebo, P = 0.044) but did not significantly improve the primary outcome measures of sleep onset latency (−11.0 minutes versus placebo, 95% confidence interval −28.4 to 6.4 minutes, P = 0.22) and wake time after sleep onset (−7.7 minutes versus placebo, 95% confidence interval −22.1 to 6.6 min, P = 0.29) as measured by actigraphy. Iron supplementation was associated with improvement in the overall severity score from the Sleep Clinical Global Impression Scale (−1.5 points versus placebo, P = 0.047). Changes in measures of daytime behavior did not differ between groups. Conclusion This trial demonstrated no improvement in primary outcome measures of insomnia in subjects treated with ferrous sulfate compared with placebo. Interpretation was limited by low enrollment.

Background In autism, poor sleep begins in early childhood, varies in severity and is associated with behavioural difficulties. We examined relationships between sleep and behaviour in young children with autism and no, mild/typical or severe/atypical sleep problems to determine behavioural profiles that may differentiate sleep problem severity. Method Parents of children with autism aged 2- to 5-years reported on their child’s sleep behaviour (CSHQ), including additional written descriptions of sleep behaviours. Children were then classified as good sleepers or as having mild/typical or severe/atypical sleep problems using National Sleep Foundation guidelines and current sleep literature. The three sleep groups were compared on autistic severity (ADOS), cognition (Mullen Scales of Early Leaning) and behaviour (BASC-3). Results Parents of 46 children aged 24- to 71-months participated. The severe/atypical sleep group were more likely to have multiple severe sleep difficulties. The sleep groups did not differ on autism severity or cognition. The BASC-3 withdrawal subscale differentiated severe problem sleepers from the other groups, while BASC-3 inattention differentiated problem sleepers from good sleepers. The severe/atypical sleep problem group also had more overall behaviour problems than good sleepers Conclusions Social withdrawal and multiple, severe sleep difficulties may underlie difficulties in treating poor sleep in some autistic children, suggesting that an individualised approach to treatment is needed to address severe sleep concerns. Early detection and intervention for poor sleep may reduce or prevent significant sleep and behavioural concerns continuing into later childhood. Sleep interventions that include targeting attention and withdrawal behaviours may assist in in this regard.

Background Sleep problems are common in individuals with ASD. This study examined the relationships between bedtime consistency, cognitive functioning, comorbid diagnoses, intervention, demographics and sleep duration in children with ASD. Method Cross-sectional data from 1683 children with ASD in the 2016 and 2017 National Survey of Children's Health were analyzed. The sample was 80 % male, 46 % non-Hispanic white, and mean age was 10.5 (SD 4.1) years. All data were parent report. Multiple linear regression was performed. Results ASD severity was associated with shorter sleep duration, and bedtime consistency was associated with longer sleep duration. Age moderated the effects of both bedtime consistency and ADD/ADHD on sleep duration. Both the positive effect of bedtime consistency and the negative effect of ADD/ADHD on sleep duration became less pronounced with age. Conclusion Although the challenges related to sleep and behavior may differ by age of the child, bedtime consistency could be a good target to improve sleep duration for all children with ASD. Future studies, especially longitudinal studies, on sleep habits and sleep hygiene, in conjunction with other measures of sleep patterns (e.g., night wakings) and correlates of sleep problems, may provide further evidence for the importance of good sleep practices and guide sleep treatment in children with ASD.