0841 Discrepancies between Parent-Reported and Observed Sleep Disturbance in Hospitalized Children with Autism Spectrum Disorder (ASD)

Abstract

Introduction

Parent-reported sleep disturbance in children with autism spectrum disorder (ASD) is a strong predictor of psychiatric hospitalization. However, it is unknown if parent-reported sleep disturbance persists in hospital settings, which are characterized by highly structured daily routines and low-distraction sleep environments. We examined if parent-reported sleep disturbance at home predicted observed sleep disturbance in the hospital and examined predictors of discrepancy between home and hospital settings.

Methods

Children with ASD and their parents (N=172) were recruited at the time of admission to one of six inpatient units, as part of the Autism Inpatient Collection (AIC). Parents reported on their child’s difficulty maintaining sleep and completed self-report measures of parental-strain. Sleep was measured observationally by hospital staff in 15 minute increments for 24.1 ± 21.3 nights. An observed sleep maintenance problem was defined as a nightly average of ≥30 minutes spent awake after sleep onset. Logistic regression and multivariate models evaluated associations between parent-reported and observed sleep disturbance and parental-strain variables as predictors of discrepancy between observed and parent-reported sleep disturbance.

Results

Parent-reported sleep disturbance (n=68; 39.5%) did not predict observed sleep disturbance (n=44; 25.6%) within the hospital. Parent-reported sleep disturbance was associated with greater parental-distress (F=4.20, p<.05), greater dysfunction in parent-child interactions (F=6.699, p<.01), greater perception of the child as difficult (F=10.86, p<.001), and lower parental self-efficacy (F=5.23, p<.05). Children with a parent-reported sleep problem that was not observed in the hospital were perceived as more difficult (F=4.87, p<.01) and had greater dysfunction in parent-child interactions (F=2.84, p<.05).

Conclusion

Parent-reported sleep disturbance at home was unrelated to observed sleep disturbance during hospitalization for children with ASD. Parental-strain was strongly related to parent-reported sleep disturbance, but not sleep disturbance within the hospital. Longitudinal and experimental studies are needed to determine directionality of associations between child sleep disturbances and parental-strain, evaluate if sleep improves within the hospital setting, and if so, identify key factors that contribute to improvement.

Support (If Any)

Funding for the AIC is provided by the Simons Foundation and the Nancy Lurie Marks Family Foundation.