Telehealth-delivered parent-based sleep-focused intervention for insomnia in preschool children with autism spectrum disorder: A randomized controlled study

Abstract

Sleep problems are common in children with autism spectrum disorder. Although previous research has shown the positive effects of parent-based sleep intervention, it was mainly focused on face-to-face modality, which might limit accessibility. This study aimed to examine the efficacy of a telehealth-delivered parent-based sleep-focused intervention in treating insomnia in preschool children with autism spectrum disorder. A total of 62 parents/caregivers with a child with autism spectrum disorder and comorbid insomnia (aged 3–6 years) were randomized to receive either three weekly group sessions of sleep-focused intervention via Zoom with telephone support ( n = 30) or treatment as usual ( n = 32). The intervention group had significantly greater improvements in overall sleep problems (Children’s Sleep Habit Questionnaire total score; p < 0.05), bedtime resistance ( p < 0.05), and sleep-onset delay ( p < 0.05) at post-treatment as compared to the treatment as usual group. The intervention group also showed significant improvements in overall behavioral and emotional problems ( p < 0.05), especially externalizing problems ( p < 0.05) as measured by Strengths and Difficulties Questionnaire, and parental stress level ( p < 0.05) as measured by Depression, Anxiety and Stress Scale-21 as compared to the treatment as usual group (partial η2 = 0.081–0.101). The findings supported the feasibility and promising effects of a brief parent-based sleep intervention delivered via telehealth. Lay abstract Sleep problems are common in children with autism spectrum disorder. Although the effects of parent-based sleep intervention were shown to be promising, previous research was limited to the face-to-face service model, which might limit accessibility. This study examined a sleep-focused parent training group delivered via telehealth for treating insomnia in preschool children with autism spectrum disorder, which allowed parents to join the intervention remotely. Results showed that children in the intervention group had greater improvements in sleep and insomnia symptoms after treatment, as compared to those who only received care as usual. This sleep-focused treatment also led to improved daytime behaviors, especially externalizing problems such as hyperactivity and conduct problems, in children with autism spectrum disorder. Parents who had attended the training also reported reduced parental stress level after treatment. The findings supported the feasibility and promising effects of a brief parent-based sleep intervention delivered via telehealth for preschooler with autism spectrum disorder.