Researchers studied 103 young children with autism to understand why some have trouble sleeping at night. They found that about one-third of the children had significant sleep problems. The study discovered that children who had difficult behaviors during meals, were hyperactive, or took dietary supplements were more likely to have sleep troubles. This research helps doctors understand what might be causing sleep problems in autistic children so they can help them sleep better. The findings suggest that looking at eating behaviors and activity levels might help identify which children need extra help with sleep.

The Quick Take

  • What they studied: What causes sleep problems in young children with autism and which behaviors or habits are connected to difficulty sleeping
  • Who participated: 103 children with autism, average age 5.8 years old (ranging from 2 to 10 years), mostly boys (77.7%). All children were seen at an autism clinic for regular checkups.
  • Key finding: About one-third of the children had significant sleep problems. Children who had trouble with eating behaviors, were very active or didn’t listen well, and took dietary supplements were more likely to have sleep difficulties. The study was quite accurate at predicting sleep problems using these three factors (84% accuracy).
  • What it means for you: If your autistic child struggles with sleep, doctors should ask about eating behaviors and activity levels, as these may be connected. This could help identify children who need sleep support earlier. However, this is one study, so more research is needed before making major changes to treatment.

The Research Details

Researchers looked at 103 children with autism who came to a clinic for regular care. They asked parents questions about their child’s sleep using a special survey called the Pediatric Autism Insomnia Rating Scale (PAIRS). They also collected information about the child’s behavior, eating habits, quality of life, and family situation using other surveys. The doctors measured each child’s height and weight. Then they compared children who had high sleep problem scores with those who had low scores to see what was different between the two groups.

This approach is important because it looks at real children in real clinic settings, not just in research labs. By asking parents directly about sleep and behavior, researchers get honest information about what families actually experience. This helps doctors understand the real-world connections between sleep problems and other behaviors in autistic children.

The study included a good number of children (103) and used well-known, trusted surveys to measure sleep and behavior. The researchers adjusted their results to account for other factors that might affect sleep. The study was accurate at predicting sleep problems (84% accuracy), which is a good sign. However, this was a single study at one clinic, so the results may not apply to all autistic children everywhere. The study was cross-sectional, meaning it looked at children at one point in time rather than following them over months or years.

What the Results Show

The average sleep problem score was 18.4 out of a possible scale, with scores ranging from 0 to 58. About one-third (33%) of children scored above 22, which indicates significant sleep problems. When researchers looked at what predicted sleep problems, three main factors stood out: hyperactivity and not listening to instructions, difficult behaviors during meals, and taking dietary supplements. These three factors together were very good at predicting which children had sleep problems (84% accuracy). The study found that children with higher hyperactivity scores and more mealtime behavior problems were significantly more likely to have sleep difficulties. Interestingly, taking dietary supplements was also connected to sleep problems, though the reason for this connection isn’t clear from this study.

The study found no differences in height, weight, or constipation between children with and without sleep problems. There were also no differences based on age, gender, or other family background factors. This suggests that sleep problems in autistic children may be more related to behavior and activity level than to physical size or digestive issues. The connection between dietary supplements and sleep problems was unexpected and may deserve further investigation.

Previous research has suggested that children with autism often have sleep problems, but this study helps explain why. Earlier studies found that behavior problems and autism severity are connected to sleep issues, and this research supports that finding. The focus on mealtime behaviors as a predictor is somewhat new and suggests that eating-related stress or difficulty might be an overlooked factor in sleep problems. The dietary supplement finding is interesting because it hasn’t been emphasized in previous research.

This study only looked at children at one point in time, so we can’t tell if the behaviors cause sleep problems or if sleep problems cause the behaviors. The study included mostly boys (77.7%), so the results might not apply equally to girls with autism. All children came from one clinic, so they might be different from autistic children in other areas or countries. The study didn’t look at other possible causes of sleep problems like medical conditions or medications. The researchers relied on parent reports, which might not always be completely accurate. Finally, this is one study, so the findings need to be confirmed by other researchers before making big changes to how doctors treat sleep problems.

The Bottom Line

If your child with autism has sleep problems, talk to your doctor about your child’s behavior during meals and activity level, as these may be connected. A doctor can use tools like the PAIRS survey to measure sleep problems and help create a plan. Consider whether dietary supplements might be affecting sleep and discuss this with your healthcare provider. These recommendations are based on one study, so work with your child’s doctor to find the best approach for your specific situation. (Confidence level: Moderate - this is helpful information but needs confirmation from additional studies.)

Parents of young children with autism who struggle with sleep should pay attention to this research. Doctors and specialists who work with autistic children may find this helpful for understanding sleep problems. Teachers and caregivers might also benefit from understanding these connections. This research is less relevant for children without autism or for older teenagers and adults with autism, though some findings might apply.

Changes in sleep don’t happen overnight. If you make changes based on this research (like addressing mealtime stress or activity levels), give it at least 2-4 weeks to see improvements. Some children may improve faster, while others need more time. Work with your doctor to track progress and adjust your approach as needed.

Want to Apply This Research?

  • Track your child’s sleep using a simple daily log: record bedtime, wake time, number of night wakings, and rate sleep quality on a scale of 1-10. Also note mealtime behavior that day (smooth vs. difficult) and activity level (calm vs. very active). Look for patterns over 2-4 weeks.
  • Start a mealtime behavior improvement plan: reduce distractions during meals, use consistent routines, offer preferred foods alongside new foods, and keep mealtimes calm and positive. Track how mealtime stress changes and whether sleep improves alongside it.
  • Create a weekly summary showing: average sleep quality, number of difficult mealtimes, activity level rating, and any dietary supplements given. Review monthly to see if improvements in mealtime behavior or activity level connect with better sleep. Share this data with your child’s doctor at appointments.

This research provides helpful information about connections between behavior and sleep in autistic children, but it is not medical advice. Every child is unique, and sleep problems can have many different causes. Always consult with your child’s doctor or pediatrician before making changes to your child’s sleep routine, diet, supplements, or treatment plan. If your child has severe sleep problems, ask your doctor about a referral to a sleep specialist. This study was conducted at one clinic and needs to be confirmed by additional research before being applied universally.