Beyond challenging behaviors, sleep maintenance problems in autistic youth at the time of hospitalization are associated with increased caregiver strain.

purposeAutistic children are at increased risk for psychiatric hospitalization for challenging behaviors. Sleep problems may increase this risk due to the added strain they place on caregivers and their ability to maintain safety at home. We evaluate if caregiver-reported sleep problems in autistic children at the time of the child's hospital admission predict caregiver reported stress and self-efficacy, above and beyond the severity of the child's challenging behaviors.

methodsParticipants included 598 autistic children (ages 4-20) admitted to specialized psychiatric inpatient units and a primary caregiver. Caregivers reported if their child had sleep initiation and/or sleep maintenance problems. Caregivers completed the Parenting Stress Index-Short Form and Difficult Behavior Self-Efficacy Scale. Hierarchical linear regression models examined associations between sleep problems and caregiver outcomes, controlling for child irritability, and both household- and child-level characteristics.

resultsFifty-nine percent of children had a caregiver-reported sleep problem. Sleep maintenance problems were significantly associated with increased parental distress, more dysfunctional parent-child interactions, and greater perception of the child as difficult to manage, above and beyond challenging behavior severity and other covariates. Sleep initiation problems were unrelated to caregiver outcomes. Self-efficacy in single caregivers and those in lower-income households was more negatively impacted by sleep problems than other caregivers.

conclusionsSleep maintenance problems may independently contribute to caregiver strain above and beyond challenging behaviors. Social and financial resources may buffer against the negative effect of sleep problems. Preventative interventions targeting sleep may provide needed support for vulnerable families.