Cognitive behavioral treatment of insomnia in school-aged children with autism spectrum disorder: A pilot feasibility study.
Eight short CBT-CI sessions cut sleep onset by about 20 minutes for school-aged kids with autism and the gains last.
01Research in Context
What this study did
Hutchins et al. (2020) ran an 8-session sleep package for school-aged kids with autism. Parents and kids met in person and learned new bedtime habits.
The team checked sleep logs and parent stress before, after, and one month later. No control group was used.
What they found
Kids fell asleep about 20 minutes faster. Parents fell asleep about 12 minutes faster. Night-wakings and challenging behaviors also dropped.
Most gains stayed in place one month later.
How this fits with other research
Ip et al. (2024) extends this idea. They moved the same sleep tools online and used them with preschoolers. Their telehealth program also cut sleep problems and lowered parent stress.
McLay et al. (2020) show why this matters. Parents usually try six different sleep fixes, mostly melatonin, and skip proven behavior plans. The S et al. package gives them a clear, short option that works.
Sivertsen et al. (2012) remind us the stakes are high. In a long-term study, only 8 % of autistic children outgrew chronic insomnia versus 52 % of typical peers. Quick, solid sleep tools are needed.
Why it matters
You now have an 8-session script that shaves serious minutes off bedtime for school-aged clients. Pair it with telehealth tricks from Ip et al. (2024) to reach younger kids or busy families. Start with a brief parent meeting, share the CBT-CI steps, and track sleep logs. Better nights for the child mean better days for everyone.
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02At a glance
03Original abstract
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 2020, 13: 167-176. © 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.
Autism research : official journal of the International Society for Autism Research, 2020 · doi:10.1002/aur.2204