Lewis Samantha, Papadopoulos Nicole, Mantilla Ana, Hiscock Harriet, Whelan Moira, McGillivray Jane, Rinehart Nicole
Krongold Clinic, School of Educational Psychology and Counselling, Faculty of Education, Monash University, 19 Ancora-Imparo Way, Clayton, Victoria 3800, Australia.
Murdoch Children's Research Institute, Royal Children's Hospital, Flemington Road, Parkville, Victoria 3052, Australia.
Res Autism Spectr Disord. 2023 Apr;102:102110. doi: 10.1016/j.rasd.2023.102110. Epub 2023 Jan 23.
Up to 80% of children with autism experience behavioural sleep problems, predominantly relating to bedtime resistance, sleep anxiety, sleep dysregulation, and shorter duration, which are associated with increased autistic symptom expression and emotional and behavioural difficulties. Researchers predicted the COVID-19 pandemic would worsen sleep and behavioural difficulties for autistic children, due to their need for routine and certainty. This systematic review is the first to focus on delineating the role of sleep disturbance in exacerbating autistic symptoms and internalising and externalising behaviours during the pandemic.
In this PROSPERO registered systematic review, we aggregated and synthesised findings from empirical studies from 2020 onwards that included children with autism and examined sleep outcomes, using narrative and framework synthesis due to the variety of methods and designs employed. We identified additional relevant themes through inductive thematic analysis.
Seventy-one studies met the search criteria, and we selected seventeen for review following screening and quality assessment. These studies reported mixed findings; with strongest support for worsening of sleep problems typically experienced by autistic children, including difficulties with sleep regulation and shorter sleep duration. Further, sleep problems were associated with increased expression of autistic characteristics.
Preliminary findings of worsening sleep and increased autistic characteristics for autistic children throughout the COVID-19 pandemic highlight the need for ongoing, accessible and flexible service provision during exposure to environmental stressors. We propose that behavioural sleep interventions are well suited to telehealth adaptation and play an important role in supporting families when in-person treatment for sleep problems is not possible.
高达80%的自闭症儿童存在行为性睡眠问题，主要表现为就寝抵抗、睡眠焦虑、睡眠失调和睡眠时间缩短，这些问题与自闭症症状表达增加以及情绪和行为困难有关。研究人员预测，由于自闭症儿童对常规和确定性的需求，新冠疫情会使他们的睡眠和行为问题恶化。本系统评价首次聚焦于阐明睡眠障碍在疫情期间加剧自闭症症状以及内化和外化行为方面所起的作用。
在这项已在国际前瞻性系统评价注册平台（PROSPERO）注册的系统评价中，我们汇总并综合了2020年以来的实证研究结果，这些研究涉及自闭症儿童，并对睡眠结果进行了考察，由于所采用的方法和设计各不相同，我们采用了叙述性综合和框架综合法。我们通过归纳主题分析确定了其他相关主题。
71项研究符合检索标准，经过筛选和质量评估后，我们选择了17项进行综述。这些研究报告的结果不一；最有力的证据支持自闭症儿童通常经历的睡眠问题恶化，包括睡眠调节困难和睡眠时间缩短。此外，睡眠问题与自闭症特征的表达增加有关。
在整个新冠疫情期间，自闭症儿童睡眠恶化和自闭症特征增加的初步研究结果凸显了在面临环境压力源时持续提供便捷灵活服务的必要性。我们建议，行为性睡眠干预非常适合远程医疗适配，并且在无法进行面对面睡眠问题治疗时，对支持家庭发挥着重要作用。
