An investigation into the primary and secondary effects of functional behavioural assessment based interventions for sleep problems in six children with autism.

Abstract

Sleep problems, including co-sleeping, are highly prevalent in children with autism spectrum disorder (ASD). Given the negative secondary effects associated with sleep problems, it is essential that effective treatments for sleep problems are identified. An evidence-based approach to treating challenging behaviours in children with ASD is the use of functional behavioural assessment (FBA). However, there is limited research into using this tool to formulate treatments for sleep problems in this population. This thesis is comprised of two studies. Study 1 was a single-case pilot study that included a 6-year-old boy with ASD, which investigated the impact of sleep interventions on his sleep outcomes and parents wellbeing. Study 2 was a single-case multiple baseline across participants design which included five 2-6 year old children with ASD. Children in both studies demonstrated multiple sleep problems, including co-sleeping. Study 2 built upon the experimental design and methodology of the pilot study, and explored the collateral effects of improved sleep outcomes on children’s daytime functioning, ASD symptomatology, and parent’s sleep and partner relationship quality. FBA was used to inform individualised and function-based multicomponent interventions for all children in both studies. One participant withdrew from the study before completing intervention, and another was still involved in intervention at the time of submission of this thesis. In response to treatment, parental presence during sleep onset was eliminated for all six children, and co-sleeping following a night waking was eliminated for all children who completed intervention. For the families who completed intervention, improvements were seen in other sleep outcomes, with reductions in sleep onset latency and night wakings for all children. Results of the Depression Anxiety and Stress Scales (DASS-21), Pittsburgh Sleep Quality Index (PSQI), and Relationship Quality Index (RQI) demonstrated improvements in sleep quality for all parents, some improvements in levels of depression, and mixed outcomes for relationship quality. Results on the Child Behaviour Checklist (CBCL) and Gilliam Autism Rating Scale (GARS-3) suggested improvements in the children’s externalising behaviours, specifically attention, aggression and ADHD characteristics, as well as improvements in their overall ASD symptomatology, in particular their restricted/repetitive behaviours. The findings have important implications for the use of FBA to inform treatments for sleep problems that include co-sleeping, in children with ASD. Findings add to the scarcity of literature experimentally investigating pre- and post- measures of secondary problems associated with sleep disturbances.