Sleep problems in children with autism spectrum disorder: a multicenter survey.
Most Chinese preschoolers with ASD fight bedtime, wake at night, and drag through the day—each lost hour links to sharper autism traits.
01Research in Context
What this study did
Cheng et al. (2021) asked parents of preschoolers across China to fill out two short checklists. One listed autism traits. The other listed common sleep problems.
They compared 2- to 7-year-old children with ASD to same-age peers without ASD.
What they found
Two out of every three children with ASD had serious sleep trouble. Only half of the typical children did.
Bedtime battles, long time to fall asleep, night fears, and next-day sleepiness were the biggest gaps.
More sleep problems went hand in hand with higher autism symptom scores.
How this fits with other research
Paavonen et al. (2008) saw the same pattern years earlier in older kids with Asperger syndrome. The new study shows the trouble starts even earlier.
Laposa et al. (2017) add a clue: stomach pain, reflux, or constipation raises the odds of sleep disorders by 70%. Ask about GI issues when sleep is rough.
Udhnani et al. (2025) looks like a contradiction. In adults, autism alone did not predict poor sleep once anxiety and depression were counted. The difference is age: little kids can’t tell us they feel worried; their sleep simply breaks down.
Why it matters
If a preschool client melts down at bedtime, treat the sleep first. Better rest often softens next-day irritability and repetitive behaviors. Add a GI check and brief parent coaching on dark, quiet routines. You may see gains in both sleep and daytime learning without extra teaching trials.
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02At a glance
03Original abstract
High prevalence of sleep problems have been reported in children with Autism Spectrum Disorder (ASD). This study aims to investigate the sleep conditions of ASD children in China, and explore the relationship between the common sleep problems and core symptoms and developmental levels. Using a cross-sectional design, we included 2 to 7-year-old children from 13 cities in China: 1310 with ASD and 1158 with typically-developing (TD) children. The neurodevelopmental level was evaluated with the revised Children Neuropsychological and Behavior Scale (CNBS-R2016). ASD were diagnosed with DSM-5 and Child Autism Rating Scale (CARS). the Social Responsiveness Scale (SRS), the Autism Behavior Checklist (ABC) and the communication warning behavior sub-scale in CNBS-R2016 valued autism behaviors. The children’ s sleep habits questionnaire (CSHQ) assessed sleep conditions. The prevalence of sleep disorders in ASD children was significantly higher than that in TD (67.4% vs. 51%, p < 0.01), and among them the four dimensions with the highest prevalence of sleep problems were bedtime resistance (25.6%), sleep anxiety (22.7%), sleep onset delay (17.9%) and daytime sleepiness (14.7%). ASD children with sleep onset delay or sleep anxiety had higher ABC, SRS scores and higher scores on communication warning behavior with sleep anxiety, with daytime sleepiness had higher ABC, SRS and CARS scores, and with bedtime resistance had higher SRS total scores. Differences in the neurodevelopmental level were not significant. Children with ASD have a higher prevalence of sleep problems. Bedtime resistance, anxiety, sleep onset delay and daytime sleepiness may be related to the core symptoms, but not be related to the developmental level in ASD children. In the clinic, sleep assessment should be included in the routine of ASD visits, and during the intervention, sleep hygiene education is as important as the treatment of biological factors. The study was approved by the ethics committee of the Children’s Hospital of Chongqing Medical University, Approval Number: (2018) IRB (STUDY) NO. 121, and registered in the Chinese Clinical Trial Registry (Registration number: ChiCTR2000031194). The online version contains supplementary material available at 10.1186/s12888-021-03405-w.
BMC Psychiatry, 2021 · doi:10.1186/s12888-021-03405-w