The Relationship Between Sensory-Processing Disorders and Sleep Disturbances in School-Aged Autistic Children in Shiraz, 2015

AUTHORS

Sahar Ghanbari 1 , * , Amin Rezaei 2

1 Department of Occupational Therapy, School of Rehabilitation Sciences, Shiraz University of Medical Sciences, Shiraz, IR Iran

2 School of Rehabilitation Sciences, Shiraz University of Medical Sciences, Shiraz, IR Iran

How to Cite: Ghanbari S, Rezaei A. The Relationship Between Sensory-Processing Disorders and Sleep Disturbances in School-Aged Autistic Children in Shiraz, 2015, Jundishapur J Chronic Dis Care. 2016 ; 5(2):e32337. doi: 10.17795/jjcdc-32337.

ARTICLE INFORMATION

Jundishapur Journal of Chronic Disease Care: 5 (2); e32337
Published Online: April 2, 2016
Article Type: Research Article
Received: September 5, 2015
Revised: November 19, 2015
Accepted: December 19, 2015
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Abstract

Background: Autism is a neurological disorder that limits communication, socialization, and participation of children in symbolic play. Sensory processing disorders are common characteristics (45% to 96%) of children with pervasive development disorders, including. Sleep disorders are also more prevalent in autistic children than in normal children.

Objectives: This study aimed to investigate the relationship between sensory processing disorders and sleep disturbances in school-aged autistic children.

Patients and Methods: This study is quantitative, observational, and cross-sectional. 35 school-aged autistic children in Shiraz, Iran were selected using cluster sampling. A demographic questionnaire, short sensory profile (SSP), and the sleep disturbance scale for children (SDSC) were used. The Pearson correlation coefficient and Pearson chi-square were used during data analysis.

Results: Results shows that autistic children show clear differences from normal function (74.3%), possible differences with normal function (20%), and normal function (5.7%) in their total sensory processing scores. 95.3% of autistic children had some degrees of abnormal sensory processing disorder. Also, 68.6% of the participants suffered from sleep disorders. However, there was no relationship between sensory processing disorders and sleep disturbances in children with autism (P value = 0.83). Also, there was no correlation between the subscales of sensory processing disorders and the subscales of sleep disturbances.

Conclusions: The results showed that despite the simultaneous high prevalence of sleep disturbances and sensory processing disorders in children with autism, there isn’t a significant relationship between the two conditions among these children.

Keywords

Child Pervasive Development Disorders Sensory Processing Disorder Sleep Disorders Autism

Copyright © 2016, Ahvaz Jundishapur University of Medical Sciences. This is an open-access article distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 International License (http://creativecommons.org/licenses/by-nc/4.0/) which permits copy and redistribute the material just in noncommercial usages, provided the original work is properly cited.

1. Background

Autism is a neurological disorder that limits communication, and participation of children in symbolic play (1). In the fourth edition of the Diagnostic and Statistical Manual (DSM-IV-TR), among the extensive collection of abnormal behavior seen in autism spectrum disorder (ASD), three key characteristics are introduced: qualitative impairment in social interaction, serious damage to communication, and repetitive, limited, and stereotyped behavioral disorder. Symptoms of the disorder appear before age three (2). According to the results, of every thousand people, 2 to 6 people have been diagnosed with the disorder (1). It is believed that autism is spreading. The disorder is four to five times more common in boys, and autistic girls suffer severe mental retardation (3). Biological factors are involved in the pathogenesis of this disorder, because seizure disorders and mental retardation are more common (4). The common view of most researchers in the field is that genetic factors play an effective role in the incidence of autism (2).

Sensory integration is a natural, neurological, and developmental process that begins in prenatal ages and continues throughout life and, but the most effective development occurs during the first 7 years of life. A sensory processing pattern is a bio-psychosocial phenomenon that is probably associated with genetic or biological factors (5). The evidence suggests that sensory processing patterns remain constant during the life (6). The successful completion of every activity in the life requires substantial sensory processing or sensory integration. Sensory processing disorder (SPD) or sensory integration dysfunction is a condition in which the sensory messages are not organizing the appropriate responses (7). The ability to process sensory information, including registration and modulation and the internal organization of this information, is necessary for successful behavior based on environmental demands, and ultimately results in meaningful participation in daily activities (8). While most people use this ability normally, some people also show extreme sensory patterns that can increase or decrease sensitivity to stimuli. Increased sensitivity to sensory stimuli prompts some behavioral characteristics: discomfort in the face of sensory stimuli, cognitive and emotional tension, irritability, moodiness, anxiety, and hyper alertness (9-11).

Sleep disorders in children include insomnia, sleepiness, sleep-related breathing disorders, nightmares, waking disorders, rhythmic movement disorders, and urinary incontinence (12). The main sleep problems in children include daytime sleepiness, insomnia, difficulty falling asleep, difficulty staying asleep, and snoring (13). If sleep disorders in children are left untreated, they can lead to complications such as impaired attention and concentration, memory problems, and learning and behavioral disorders (12). For families with children and/or adolescents, sleep disorders can likewise influence social, emotional, and academic abilities (14).

Sleep disorders are particularly important in children with autism. First, children with autism who have worse nighttime sleep quality exhibit more behavioral problems. In addition, daytime sleepiness can affect children’s behavior in training programs. Finally, the children’s sleep problems disrupt the entire family’s sleep, and can increase family stress and irritability during the day (15). The prevalence of sleep disorders in healthy children estimated between 25 and 40 percent (16), but during the investigations, the prevalence of sleep disorders in children with autism is estimated to be 44% to 83% (17).

One of the features of autism spectrum disorders is sensory processing disorder, the inability to maintain the integrity of sensory information and to respond appropriately to sensory stimuli. Various studies show that 45% - 96% of children with autism spectrum disorders suffer from these sensory problems (18). To extend a study conducted by Batya Engel-Yeger and Tamar Shochat to examine the relationship between sensory processing disorders and sleep quality in healthy adult subjects, we decided to examine this relationship in children with autism.

2. Objectives

The aim of this study was to determine the relationship between sensory processing disorders with common sleep disturbances in autistic children. To achieve this goal, we identified a variety of sensory processing disorders and sleep problems in autistic children.

3. Patients and Methods

This study is quantitative, observational, and cross-sectional. The data in this study were obtained through questionnaires completed by the parents of 35 school-aged autistic children (28 boys and 7 girls) in Shiraz, Iran. To collect the data, the cluster sampling method was used. Data were collected almost equally from four schools in different parts of the city. To do this research, we established some inclusion and exclusion criteria. Inclusion criteria were age from 3 to 12 years, parental consent to participate in the research, having medical records with a diagnosis of autism at school, and having no change in sleep-related prescription drugs in the past three months. Children with autism who also suffered from other psychiatric disorders, children with complex neurological disorders such as cerebral palsy and PKU, and children who had unstable medical condition, such as asthma, diabetes, and heart disease were excluded from the study. Some ethical considerations in this research included reassuring the studied families of their confidentiality, and taking into account and respecting their beliefs and traditions.

To collect background information, the researcher wrote a demographic questionnaire that asked the age and gender of the children, the number and ages of children in the family, and the occupation of the parents. To determine the presence of a sensory processing disorder, the short sensory profile (SSP) was used. The SSP is a questionnaire with 38 questions for caregivers, covering information on seven areas of sensory information processing (subscales), including tactile sensitivity, smell-taste sensitivity, sensitivity to movement, sensory seeking, auditory processing, weakness-low energy, and visual-auditory sensitivity. Three score estimate categories were established: clear difference with normal, possible difference with normal, and normal function, based on the total scores of each subscale and the sum of all subscales. The reliability of the original form of the questionnaire 95%, and a validity of 0.90 was obtained. Through Cronbach’s alpha, a reliability of 0.74 was obtained for the Persian form of the questionnaire (19).

To measure sleep disorders in children with autism, the sleep disturbance scale for children (SDSC) questionnaire was used. The SDSC is a questionnaire completed by parents or caregivers. It investigates the occurrence of sleep disorders during the previous 6 months, and contains 26 items in a Likert type scale with values of 1 - 5 (higher numerical values reflect a higher frequency of symptoms). The sum of the scores provides a total sleep score with a possible range of 26 to 130. The subsets are disorders of initiating and maintaining sleep (DIMS); sleep breathing disorders (SBD); disorders of arousal (e.g. sleepwalking, sleep terrors, or nightmares) (DA); sleep-wake transition disorders (e.g. hypnic jerks, rhythmic movement disorders, hypnagogic hallucinations, nocturnal hyperkinesia, or bruxism) (SWTD); disorders of excessive somnolence (DOES); and sleep hyperhydrosis (SHY). The reliability and validity of the questionnaire were estimated to be 0.71 and 0.79, respectively (20). SPSS16 with descriptive and analytic statistics (chi square and Pearson correlation) was used for analyzing data with a significance level under 0.05.

4. Results

The participants’ mean age was 9 ± 2.301 years old. Results show that the participants’ sensory processing scores had clear differences with normal (74.3%), possible differences with normal (20%), and normal function (5.7%). Thus, 95.3% of the children had some degree of abnormal sensory processing disorder. 68.6% of the participants suffered from sleep disturbances. To investigate the relationship between the qualitative elements of sleep disturbances and sensory processing disorders among the participants, a contingency table (Table 1) was drawn.

Table 1. The Relationship Between Sleep Disturbance and Sensory Processing Disorder Items in Autistic Children
Sensory Processing Disorder Normal FunctionPossible DifferencesClear Differences
Sleep Disturbances
No Problem0 (0)4 (36.4)7 (63.6)
Problem2 (8.3)3 (12.5)19 (79.2)

To find a significant relationship among these items, a Pearson chi square test was used to correlate sensory processing disorder and sleep disturbances (Table 2).

Table 2. Correlation of Qualitative Sensory Processing Disorder and Sleep Disturbance Items
CorrelationSignificant LevelDFValue
Pearson Chi Square0.19123.309

According to the results in the table, there is no significant relationship between sleep disturbances and sensory processing disorder.

To determine the relationship between subscales of sleep disturbances and SPDs, Pearson’s correlation coefficient was used (Table 3).

Table 3. The Relationship Between Subscales of Sleep Disturbances and Subscales of Sensory Processing Disorders in Autistic Childrena
VariableDIMSSBDDASWTDDOESSHYSleep Disturbances
Tactile Sensitivity(0.504) 0.12(0.11) 0.28(0.21) 0.22(0.71) - 0.65(0.8) - 0.048(0.568) - 0.08(0.604) 0.08
Smell-Taste Sensitivity(0.67) - 0.07(0.39) 0.15(0.12) 0.27(0.362) - 0.16(0.55) 0.104(0.56) - 0.1(0.93) 0.016
Sensitivity to Movement(0.7) - 0.07(0.94) 0.013(0.47) 0.13(0.6) - 0.101(0.99) - 0.003(0.145) - 0.25(0.756) 0.054
Sensory Seeking(0.473) - 0.13(0.84) - 0.03(0.51) - 0.12(0.13) - 0.26(0.7) - 0.63(0.78) - 0.05(0.41) - 0.14
Auditory Processing(0.67) - 0.07(0.89) 0.024(0.95) - 0.012(0.64) - 0.08(0.79) - 0.05(0.45) 0.133(0.86) - 0.031
Weakness- Low Energy(0.71) - 0.07(0.56) 0.103(0.34) 0.17(0.58) 0.09(0.89) 0.024(0.4) - 0.15(0.69) 0.07
Visual- Auditory Sensitivity(0.24) - 0.21(0.83) - 0.04(0.62) - 0.09(0.11) - 0.28(0.31) - 0.18(0.15) - 0.25(0.22) 0.214
Sensory Processing Disorders(0.75) - 0.06(0.49) 0.12(0.45) 0.13(0.36) - 0.16(0.92) - 0.017(0.37) - 0.16(0.83) - 0.39

a(P value)-correlation coefficient.

According to the results of these correlation tests, there is no significant relationship between sleep disturbances and sensory processing disorders.

5. Discussion

According to the results of this study, the overall prevalence of sleep disturbances among 35 school-aged children with autism in Shiraz was 68.6%, on the basis of the SDSC. Previous studies that have reported similar results. Najafi et al. (21) (2013) reported that 70% of 55 autistic children in the Isfahan autism center had sleep disorders, as measured by the children’s sleep habits questionnaire (CSHQ) and Actigraph. Similarly, a study by Souders et al. (22) (2009) estimated that the prevalence of sleep disorders in children with autism was 62.5%. Liu et al. (23) (2006) estimated that 86% of children with autism had sleep disorders based on the CSHQ. However, some other studies reported a considerably lower prevalence of sleep disorders in children with autism. In a study by Sivertsen et al. (24) (2012), the prevalence of chronic sleep disorders in 28 children with autism was reported at 39.6%. In another study, which was conducted by Goodline-Jones (2008), the prevalence of sleep disorders in a similar group of children was 41% (25). In explaining such inconsistencies, it can be pointed out that in some studies, autistic children are classified into high and low function groups. Additionally, there are differences in research implementation and questionnaires used and the age range of the studies. The present study also found that 95.3% of autistic children had some degree of abnormal sensory processing disorder. Tomchek and Dunn reported a similar prevalence of sensory processing disorders, 95%, based on an investigation of 281 children with autism spectrum disorders (26).

The results of this study showed that there is no significant relationship between sensory processing disorders and sleep disturbances in children with autism. A previous study conducted by Mazurek and Petroski on 1374 children with autism spectrum disorders used the CSHQ and the SSP, and found a correlation between sensory over-responsiveness and sleep problems in these children (27). In explaining this discrepancy, it can be noted that Mazurek and Petroski (27) used the high/low function division (we did not), had a larger sample size, used a different sleep questionnaire, and surveyed a different age range. A study by Engel-Yeger and coworkers on healthy adults showed that sensory processing disorders that are characterized by hypersensitivity were associated with sleep quality. In fact, there was a correlation between sleep quality and a low sensory threshold. It is possible that the parents in our research may have ignored their children’s sleep behaviors, or they may not be aware enough of the importance of sleep and its impact on the daily functioning of these children (28). In another study conducted by Roth on 22 infants aged 1.7 to 12.9 months, the results indicated that infants’ looking behavior decreases as sleep problems increase. Roth suggested that by providing age-appropriate sensory stimulation through a sensory diet, the sleep problems would be reduced (29).

This study is the first research designed to investigate the relationship between sensory processing disorders and sleep disturbances in autistic children. Limitations in this study included a lack of enough Persian and English research resources, difficulty in coordinating the survey responses, bureaucratic delays, and incomplete or missing questionnaires. We do suggest using a larger sample size for future studies of this relationship. IQ tests and categorizing autistic children as high and low function before collecting the data could also help produce more accurate results.

Acknowledgements

Footnote

References

  • 1.

    Robledo SJ, Ham-Kucharski D. The autism book: Answers to your most pressing questions [in Persian]. 2005;

  • 2.

    Kendal FC. Abnormal Child Psychology [In Persian]. 2010; : 177 -200

  • 3.

    Authors IG, Sarason BR. Abnormal psychology: the problem of maladaptive behavior [in Persian]. 2005; : 643 -72

  • 4.

    Sodock B, Kaplan B, Arjmand J. Pocket handbook of clinical psychiatry [in Persian]. 2009; : 397 -402

  • 5.

    Dunn W. The sensations of everyday life: empirical, theoretical, and pragmatic considerations. Am J Occup Ther. 2001; 55(6) : 608 -20 [PubMed]

  • 6.

    Zukerman M. Behavioral expression and biosocial bases of sensation seeking. 1994;

  • 7.

    Samani S. Comparsion sensory processing pattern in children using hearing aid and normal children in 3 to 6 years [In Persian]. 2010;

  • 8.

    Humphry R. Young children's occupations: explicating the dynamics of developmental processes. Am J Occup Ther. 2002; 56(2) : 171 -9 [PubMed]

  • 9.

    Pfeiffer B, Kinnealey M, Reed C, Herzberg G. Sensory modulation and affective disorders in children and adolescents with Asperger's disorder. Am J Occup Ther. 2005; 59(3) : 335 -45 [PubMed]

  • 10.

    Kinnealey M, Fuiek M. The relationship between sensory defensiveness, anxiety, depression and perception of pain in adults. Occup Ther Inter. 1999; 6(3) : 195 -206

  • 11.

    Shochat T, Tzischinsky O, Engel-Yeger B. Sensory hypersensitivity as a contributing factor in the relation between sleep and behavioral disorders in normal schoolchildren. Behav Sleep Med. 2009; 7(1) : 53 -62 [DOI][PubMed]

  • 12.

    Fricke-Oerkermann L, Pluck J, Schredl M, Heinz K, Mitschke A, Wiater A, et al. Prevalence and course of sleep problems in childhood. Sleep. 2007; 30(10) : 1371 -7 [PubMed]

  • 13.

    Chokroverty S. Overview of sleep & sleep disorders. Indian J Med Res. 2010; 131 : 126 -40 [PubMed]

  • 14.

    Silva FG, Silva CR, Braga LB, Neto AS. Portuguese Children's Sleep Habits Questionnaire - validation and cross-cultural comparison. J Pediatr (Rio J). 2014; 90(1) : 78 -84 [DOI][PubMed]

  • 15.

    Honomichl RD, Goodlin-Jones BL, Burnham M, Gaylor E, Anders TF. Sleep patterns of children with pervasive developmental disorders. J Autism Dev Disord. 2002; 32(6) : 553 -61 [PubMed]

  • 16.

    Owens JA, Dalzell V. Use of the 'BEARS' sleep screening tool in a pediatric residents' continuity clinic: a pilot study. Sleep Med. 2005; 6(1) : 63 -9 [DOI][PubMed]

  • 17.

    Richdale AL. Sleep problems in autism: prevalence, cause, and intervention. Dev Med Child Neurol. 1999; 41(1) : 60 -6 [PubMed]

  • 18.

    Ben-Sasson A, Hen L, Fluss R, Cermak SA, Engel-Yeger B, Gal E. A meta-analysis of sensory modulation symptoms in individuals with autism spectrum disorders. J Autism Dev Disord. 2009; 39(1) : 1 -11 [DOI][PubMed]

  • 19.

    Ghanbari S, Amiri M. Comparison of sensory processing between Hearings impaired children using hearing aids with Normal children (3-6 years) [in Persian]. Psychology of Exceptional Individuals . 2015; 5(18)

  • 20.

    Bruni O, Ottaviano S, Guidetti V, Romoli M, Innocenzi M, Cortesi F, et al. The Sleep Disturbance Scale for Children (SDSC). Construction and validation of an instrument to evaluate sleep disturbances in childhood and adolescence. J Sleep Res. 1996; 5(4) : 251 -61 [PubMed]

  • 21.

    Najafi M, Gashol M, Saeidi N. Sleep Problems in Autistic Children. 6th International Congress on Child and Adolescent Psychiatry. 2013;

  • 22.

    Souders MC, Mason TB, Valladares O, Bucan M, Levy SE, Mandell DS, et al. Sleep behaviors and sleep quality in children with autism spectrum disorders. Sleep. 2009; 32(12) : 1566 -78 [PubMed]

  • 23.

    Liu X, Hubbard JA, Fabes RA, Adam JB. Sleep disturbances and correlates of children with autism spectrum disorders. Child Psychiatry Hum Dev. 2006; 37(2) : 179 -91 [DOI][PubMed]

  • 24.

    Sivertsen B, Posserud MB, Gillberg C, Lundervold AJ, Hysing M. Sleep problems in children with autism spectrum problems: a longitudinal population-based study. Autism. 2012; 16(2) : 139 -50 [DOI][PubMed]

  • 25.

    Goodlin-Jones BL, Tang K, Liu J, Anders TF. Sleep patterns in preschool-age children with autism, developmental delay, and typical development. J Am Acad Child Adolesc Psychiatry. 2008; 47(8) : 930 -8 [DOI][PubMed]

  • 26.

    Tomchek SD, Dunn W. Sensory processing in children with and without autism: a comparative study using the short sensory profile. Am J Occup Ther. 2007; 61(2) : 190 -200 [PubMed]

  • 27.

    Mazurek MO, Petroski GF. Sleep problems in children with autism spectrum disorder: examining the contributions of sensory over-responsivity and anxiety. Sleep Med. 2015; 16(2) : 270 -9 [DOI][PubMed]

  • 28.

    Engel-Yeger B, Shochat T. The relationship between sensory processing patterns and sleep quality in healthy adults. Can J Occup Ther. 2012; 79(3) : 134 -41 [PubMed]

  • 29.

    Ott K, Blank S, Becker K, Langer R, Weichert W, Roth W, et al. Factors predicting prognosis and recurrence in patients with esophago-gastric adenocarcinoma and histopathological response with less than 10 % residual tumor. Langenbecks Arch Surg. 2013; 398(2) : 239 -49 [DOI][PubMed]

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