Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2024 Apr 1:10.1007/s10803-024-06309-2.
doi: 10.1007/s10803-024-06309-2. Online ahead of print.

The Impact of Cognitive Behavioral Therapy on Sleep Problems in Autistic Children with Co-occurring Anxiety

Holly K Harris  1   2 , Minjee Kook  3 , Peter Boedeker  3   4 , Andrew G Gusick  5 , Ariel M Lyons-Warren  6   7 , Robin P Goin-Kochel  6   8 , Chaya Murali  9 , Leandra N Berry  6   8 , Eric A Storch  3
Affiliations

The Impact of Cognitive Behavioral Therapy on Sleep Problems in Autistic Children with Co-occurring Anxiety

Holly K Harris et al. J Autism Dev Disord. .

Abstract

Purpose: This study seeks to examine the relationship between anxiety-symptom severity and sleep behaviors in autistic children receiving cognitive behavioral therapy (CBT).

Methods: We conducted a secondary-data analysis from a sample of 93 autistic youth, 4 to 14 years, participating in 24 weeks of CBT. Clinicians completed the Pediatric Anxiety Rating Scale (PARS) and parents completed the Children's Sleep Habits Questionnaire, Abbreviated/Short Form (CSHQ-SF) at baseline, mid-treatment, post-treatment and 3 months post-treatment. Mediation analysis evaluated the role of anxiety symptoms in mediating the effect of time in treatment on sleep.

Results: There was a negative association between time in treatment and scores on the CSHQ-SF (b = - 3.23, SE = 0.493, t = - 6.553, p < 0.001). Increased time in treatment was associated with decreased anxiety (b = - 4.66, SE = 0.405, t = - 11.507, p < 0.001), and anxiety symptoms decreased with CSHQ-SF scores (b = 0.322, SE = 0.112, t = 2.869, p = 0.005). The indirect effect of time in treatment on CSHQ-SF scores through PARS reduction was negative, but not statistically significant.

Conclusion: Increased time in CBT was associated with decreased anxiety severity and improved sleep behaviors. Reductions in anxiety symptoms may mediate improvements in sleep problems, but larger sample sizes are necessary to explore this further.

Keywords: Anxiety; Autism; Children; Sleep; Treatment.

PubMed Disclaimer

Conflict of interest statement

Dr. Storch reports receiving research funding to his institution from the Ream Foundation, International OCD Foundation, and NIH. He was formerly a consultant for Brainsway and Biohaven Pharmaceuticals in the past 12 months. He owns stock less than $5000 in NView. He receives book royalties from Elsevier, Wiley, Oxford, American Psychological Association, Guildford, Springer, Routledge, and Jessica Kingsley.

Figures

Figure 1:
Figure 1:. Consort Diagram
*Note: Excluded/Dropout rate refers to participating in entirety of treatment, and does not necessarily reflect those that completed the measures of interest in this secondary analysis
Figure 2:
Figure 2:. Mediation Model
The mediation model shown as a path diagram. The a path connecting Time to PARS inidicates the associated effect between time in treatment on PARS. The b path connecting PARS to CSHQ-SF indicates the consistent associated effect of PARS on CSHQ-SF. The remaining path from Time to CSHQ-SF is the remaining direct effect after controlling for the mediating pathway. *p < 0.05; **p < 0.01, ***p < 0.001.
See this image and copyright information in PMC

References

    1. Alvaro PK, Roberts RM, & Harris JK (2013). A Systematic Review Assessing Bidirectionality between Sleep Disturbances, Anxiety, and Depression. Sleep, 36(7), 1059–1068. 10.5665/sleep.2810. - DOI - PMC - PubMed
    1. Astill RG, Van der Heijden KB, Van Ijzendoorn MH, & Van Someren EJ (2012). Sleep, cognition, and behavioral problems in school-age children: a century of research meta-analyzed. Psychological bulletin, 138(6), 1109–1138. 10.1037/a0028204 - DOI - PubMed
    1. Bates D, Maechler M, Bolker B, Walker S. (2015). Fitting Linear Mixed-Effects Models Using lme4. Journal of Statistical Software, 67(1), 1–48. doi: 10.18637/jss.v067.i01. - DOI
    1. Beran TN (2007). Elliott CD. (2007). Differential Ability Scales (2nd ed.). San Antonio, TX: Harcourt Assessment. Canadian Journal of School Psychology, 22(1), 128–132. 10.1177/0829573507302967 - DOI
    1. Boedeker P. (2017). Hierarchical linear modeling with maximum likelihood, restricted maximum likelihood, and fully Bayesian estimation. Practical Assessment, Research and Evaluation, 22. 1–19.

LinkOut - more resources