Including children and adolescents with autism spectrum disorder in functional behavioural assessment-informed interventions for sleep disturbance

Abstract

Sleep disturbances are a significant problem for individuals with autism spectrum disorder (ASD) across the lifespan and are associated with numerous detrimental impacts to the individual and their whānau/family. The aetiology of ASD-related sleep problems is complex and likely multifactorial. Functional behavioural assessment (FBA) is increasingly being utilised to identify environment-behaviour contingencies underlying sleep disturbance and inform targeted treatment. Parent-implemented behavioural sleep interventions for young children with ASD are well supported by research, but few studies have evaluated such interventions for older children and adolescents, nor has research investigated the feasibility or effectiveness of young person-implemented interventions. Using single-case experimental designs (multiple-baseline design or AB design with replication across participants and behaviours), the three empirical studies included in this thesis evaluated the efficacy of FBA- informed parent- and young person-implemented sleep interventions with 12 verbally communicative 9- to 15-year-olds with ASD (11 males, 1 female). The results illustrated intervention was generally effective in reducing or resolving participant sleep disturbance and improvements tended to be maintained at short- and long-term follow-up. Further, the secondary outcomes of resolving sleep disturbance appeared to include a significant reduction in participant internalising (e.g., anxiety, depressive symptoms) behaviour, without significant improvements to participant externalising behaviour, or in parent sleep, mental health, or marital relationship quality. Overall, findings indicate the feasibility, effectiveness, and acceptability of FBA-informed interventions involving input from the young person and their parents.