Current Issues in Sleep in Children with Neurodisability

Introduction: Autistic children experience sleep disturbances at a higher rate than do neurotypical children. It has been argued that sleep disturbances negatively impact behavior, exacerbate learning difficulties, and decrease the quality of life among autistic children. Increasing exercise has been proposed to address sleep disturbances, however, little is known about how exercise might best be promoted for autistic children in Aotearoa New Zealand. Here, we explored caregivers' lived experiences of their autistic child's sleep disturbances and participation in exercise.

Methods: Semi-structured interviews were conducted with 15 mothers of autistic children aged between 5 and 10. Mothers also completed the Sleep Disturbances Scale for Children (SDSC).

Results: Scores on the SDSC indicated that there was considerable variation in sleep disturbance severity. Eight themes were identified from the interviews: sleep disturbances, the impact of exercise on sleep, exercise activities, whānau involvement in exercise, barriers for participation in exercise, support for participation in exercise, sensory considerations for participation in exercise, and activities specifically for children with special needs.

Conclusions: Our findings highlight how challenging sleep disturbances can be for autistic children and their families and how participation in exercise can be promoted to potentially minimize their negative impact.

Objective: Pediatric insomnia is one of the most commonly reported disorders, especially in children with neurodevelopmental disorders. Better Nights, Better Days for Children with Neurodevelopmental Disorders (BNBD-NDD) is a transdiagnostic, self-guided, eHealth behavioral sleep intervention developed for parents of children with NDDs ages 4–12 years with insomnia. After usability testing, a randomized controlled trial (RCT) was conducted to evaluate the effectiveness of the BNBD-NDD program. By interviewing RCT participants after their outcome measures were collected, we sought to determine the barriers and facilitators that affect the reach, effectiveness, adoption, implementation, and maintenance of the BNBD-NDD intervention, as well as to assess whether barriers and facilitators differ across levels of engagement with the program and NDD groups.

Method: Twenty parents who had been randomized to the treatment condition of the RCT participated in this study. These parents participated in virtual semi-structured qualitative interviews about their experiences with the BNBD-NDD program. Rapid analysis was used, in which one researcher facilitated the interview, and another simultaneously coded the interview using the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework.

Results: Overall, more facilitators than barriers were identified for Reach, Effectiveness, Implementation, and Maintenance, whereas for Adoption more barriers emerged. Participants who were engaged reported more facilitators about the BNBD-NDD program design and behavior change, while unengaged participants mentioned needing more support to help facilitate their use of the program. Lastly, parents of children with ASD reported more facilitators and more barriers than did parents of children with ADHD.

Conclusion: With this feedback from participants, we can optimize BNBD-NDD for large-scale implementation, by modifying the program to better support parents, helping them implement the strategies effectively at home, and increasing the accessibility of this evidence-based treatment.