Sleep problems in autism: Sex differences in the school-age population.
Annette Estes, Jeffrey Munson, Tanya St John and 5 others
PMID 36341856WHAT IT FOUND
Autistic girls had the highest rates of sleep problems, affecting 84.4% compared to 65.8% of autistic boys and about 43% of typically developing children.
Anxiety predicted poor sleep in boys, but not in girls.
Key findings
01Autistic females had the highest prevalence of sleep problems (84.4%) compared to autistic males (65.8%), TD females (44.8%), and TD males (42.4%).
02Anxiety was strongly associated with sleep problems in autistic males, but not in autistic females.
03Autistic females showed significantly more impairment than autistic males in bedtime resistance, sleep duration, sleep anxiety, and daytime sleepiness.
STILL TO COME
How it was doneWhat they foundWhat it means for PTsWhat it means for OTsWhat it means for SLPs
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What it does not show
Sleep was assessed only via parent report (CSHQ), which has low to moderate concordance with objective measures like polysomnography. The study was cross-sectional, so it cannot determine causality or track changes over time. The sample was finalized in 2015, before autism-specific CSHQ cutoffs were established, potentially affecting the sensitivity of the screening tool for this population. The sample had a lower proportion of BIPOC participants than the surrounding community, limiting generalizability. The number of autistic females was relatively small compared to males, which may affect the stability of the sex difference findings.
Declared interests
The study was supported by the National Institute of Mental Health (NIMH). The authors declared no other conflicts of interest.
The easy way to misread this
Do not assume that treating anxiety will improve sleep in autistic girls. The study found that anxiety levels did not predict sleep problems in females, whereas they did in males. Sleep issues in autistic girls appear to be pervasive and independent of anxiety severity.