Cognitive behavioral treatment of insomnia in school-aged children with autism spectrum disorder: A pilot feasibility study

被引:30
|
作者
McCrae, Christina S. [1 ,2 ]
Chan, Wai Sze [3 ]
Curtis, Ashley F. [1 ]
Deroche, Chelsea B. [4 ]
Munoz, Melissa [5 ]
Takamatsu, Stephanie [6 ]
Muckerman, Julie E. [2 ]
Takahashi, Nicole [2 ]
McCann, Dillon [7 ]
McGovney, Kevin [8 ]
Sahota, Pradeep [9 ]
Mazurek, Micah O. [10 ]
机构
[1] Univ Missouri, Dept Psychiat, One Hosp Dr,PC 3009, Columbia, MO 65212 USA
[2] Univ Missouri, Thompson Ctr Autism & Neurodev Disorders, Columbia, MO USA
[3] Univ Hong Kong, Dept Psychol, Pok Fu Lam, Hong Kong, Peoples R China
[4] Univ Missouri, Sch Med, Biostat & Res Design Unit, Columbia, MO USA
[5] Univ Missouri, Dept Educ Sch & Counseling Psychol, Columbia, MO USA
[6] Childrens Hosp Colorado, Aurora, CO USA
[7] Univ Missouri, Dept Hlth Sci, Columbia, MO USA
[8] Univ Missouri, Dept Chem & Biol Sci, Columbia, MO USA
[9] Univ Missouri, Dept Neurol, Columbia, MO USA
[10] Univ Virginia, Curry Sch Educ & Human Dev, Charlottesville, VA USA
关键词
autism; insomnia; child; parent; cognitive behavioral therapy; behavior; SLEEP PROBLEMS; REPETITIVE BEHAVIORS; INTERVENTION; QUESTIONNAIRE; DISTURBANCE; MANAGEMENT; SEVERITY; THERAPY; MOTHERS; IMPACT;
D O I
10.1002/aur.2204
中图分类号
B84 [心理学]; C [社会科学总论]; Q98 [人类学];
学科分类号
03 ; 0303 ; 030303 ; 04 ; 0402 ;
摘要
Insomnia is common in autism and associated with challenging behavior and worse parent sleep. Cognitive behavioral treatment for childhood insomnia (CBT-CI) is efficacious in typically developing children, but not yet tested in school-aged children with autism. This single arm pilot tested 8-session CBT-CI in 17 children with autism and insomnia (M age = 8.76 years, SD = 1.99) and their parent(s) (M age = 39.50 years, SD = 4.83). Treatment integrity was assessed for each session [delivery (by therapist), receipt (participant understanding), and enactment (home practice)]. Children and parents wore actigraphs and completed electronic diaries for 2-weeks to obtain objective and subjective sleep onset latency (SOL), total sleep/wake times (TST/TWT), and sleep efficiency (SE) at pre/post/1-month follow-up. Parents also completed the Aberrant Behavior Checklist [irritability, lethargy, stereotypy, hyperactivity, inappropriate speech (e.g., excessive/repetitive, loud self-talk)] at pre/post/1-month. Fifteen children completed all sessions. Average integrity scores were high [90%-delivery/receipt, 87.5%-enactment]. Parents found CBT-CI helpful, age-appropriate, and autism-friendly. Paired samples t-tests (family-wise error controlled) found CBT-CI improved child sleep (objective SOL-18 min, TWT- 34 min, SE-5%; subjective SOL-29 min, TST-63 min, TWT-45 min, SE-8%), and decreased irritability, lethargy, stereotypy, and hyperactivity. At 1-month, objective TST improved, inappropriate speech decreased, but hyperactivity was no longer decreased. Other gains were maintained. Parent sleep (objective SOL-12 min, TST-35 min, TWT-21 min, SE-4%; subjective SOL-11 min, TWT- 31min, SE-11%) and fatigue also improved. At 1-month, gains were maintained. This pilot shows CBT-CI is a feasible treatment that holds promise for improving child and parent sleep and functioning and suggests a randomized controlled trial in school-aged children with autism is worth conducting. Autism Res 2019. (c) 2019 International Society for Autism Research, Wiley Periodicals, Inc. Lay Summary Insomnia is common in autism and associated with challenging behaviors and poor parent sleep and stress. Cognitive behavioral treatment for childhood insomnia (CBT-CI) has not been tested in school-aged children with autism. This pilot study shows therapists, parents, and children were able to use CBT-CI to improve child and parent sleep, child behavior, and parent fatigue. Parents found CBT-CI helpful, age-appropriate, and autism-friendly. CBT-CI holds promise for treating insomnia in school-aged children with autism and deserves further testing.
引用
收藏
页码:167 / 176
页数:10
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