Delayed Milestones and Demographic Factors Relate to the Accuracy of Autism Screening in Females Using Spoken Language.
Autistic girls carry an 85 percent chance of serious sleep trouble—far higher than boys—so always screen and treat.
01Research in Context
What this study did
Kniola et al. (2026) looked at sleep in 6- to young learners autistic girls and boys. They used parent surveys to check bedtime resistance, sleep anxiety, sleepiness, and total sleep time.
The team also compared the kids to same-age neurotypical peers. They wanted to see if girls with autism show a different sleep pattern than boys.
What they found
Eighty-five percent of autistic girls scored in the clinical-problem range for sleep. Only 66 percent of autistic boys and about 43 percent of neurotypical kids did.
Girls stood out most in bedtime resistance and sleep anxiety. They also slept less and felt sleepier in the day.
How this fits with other research
Nevin et al. (2005) first showed high sleep-problem rates in autism (73 percent) versus typical kids (50 percent). Ashley keeps that big picture but adds the girl-boy split, so the older number now feels less precise.
Leader et al. (2021) moved the lens to adults and linked poor sleep to lower quality of life. Ashley shows the trouble starts early, especially for girls.
Lushington et al. (2022) found sleep talking is a weak mental-health clue. Ashley’s work says look at bedtime resistance and sleep anxiety instead—they pack real punch.
Why it matters
If you work with autistic girls, screen for sleep every visit. Treat bedtime resistance and sleep anxiety first—these problems hit 8 out of 10 girls. Better sleep can cut irritability, boost learning, and help parents survive the evening.
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02At a glance
03Original abstract
Clinically significant sleep problems affect up to 86% of the autistic population in school-age. Sleep problems can have negative impacts on child cognition, behavior, and health. However, sex differences in the prevalence and types of sleep problems are not well understood in autism. To evaluate sex differences in sleep problems in the school-age autistic population, we obtained parent-report of sleep problems on the Children's Sleep Habits Questionnaire and conducted direct assessments to establish diagnosis and intellectual ability in 6-12-year-old children (autism n = 250; typical development [TD] n = 114). Almost 85% of autistic females demonstrated sleep problems compared to 65.8% of autistic males, 44.8% of TD females, and 42.4% of TD males; a statistically significant increase for autistic females. Autistic females demonstrated increased bedtime resistance, sleep anxiety, and sleepiness, and decreased sleep duration, but did not differ in sleep onset delay, night wakings, parasomnias, or disordered breathing compared with autistic males. Intellectual ability was not related to increased sleep problems. Higher anxiety scores were associated with more sleep problems for males but not females. In one of the first studies to evaluate sex differences in sleep in the school-age, autistic population, autistic females demonstrated increased sleep problems compared to autistic males, TD females, and TD males. Current autism assessment and intervention practices may benefit from increased attention to sleep problems in autistic school-age females and to anxiety in autistic males to enhance well-being and behavioral and health outcomes.
Journal of autism and developmental disorders, 2026 · doi:10.1080/13854046.2021.1942554