Family management of common sleep disturbances among children with autism: Implications for pediatric nursing research and practice

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BACKGROUND: Sleep disturbances are common among children with autism spectrum disorder (ASD) and can negatively impact the health and wellbeing of the child, caregiver, and family. Nurses are well-positioned to support families of children with ASD to improve sleep. DESIGN & PURPOSE: In this mixed methods study, we leveraged an existing dataset to 1) characterize qualitative descriptions of sleep disturbances experienced by children (4-10y) with ASD, 2) examine the convergence of qualitative descriptions of sleep disturbances with quantitative scores on the Children's Sleep Habits Questionnaire (CSHQ), and 3) explore strategies used to manage bedtime and sleep disturbances. RESULTS: In this sample (n = 30), 70 % of caregivers described that their child had one or more sleep disturbances, with night wakings (43.3 %), bedtime resistance (30 %), and sleep anxiety (30 %) being most common. Qualitative descriptions largely converged with the CSHQ scores; however, in 20 % of cases, the caregiver reported no concerns about sleep while the CSHQ score indicated a clinically significant sleep problem. Management of bedtime and sleep disturbances required significant effort and balancing of multiple domains, including the child's sleep needs, the sleep needs of the caregiver and other family members, the child's sleep environment preferences and daytime activities that promote or disrupt sleep. CONCLUSION & IMPLICATIONS TO PRACTICE: Sleep disturbances are prevalent, despite efforts to implement bedtime routines and manage sleep disturbances. Pediatric nurses play an integral role in screening for sleep disturbances, educating families, and providing guidance for implementing behavioral and environmental interventions. Implications for clinical practice and future research are discussed.

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