Sleep problems in autism: Sex differences in the school-age population.

This study found that autistic girls aged 6-12 have more sleep problems than autistic boys (85% vs 66%). Autistic girls struggled more with going to bed, felt more anxious about sleep, were sleepier during the day, and slept for shorter periods. For autistic boys, having more anxiety was linked to more sleep problems, but this wasn't true for girls. The researchers suggest that sleep problems in autistic girls may need more attention from doctors and therapists.

This cross-sectional study examined sex differences in sleep problems among 6-12 year old autistic children (n=250) compared to typically developing peers (n=114) using parent-reported sleep assessments. Results revealed that 85% of autistic females experienced sleep problems versus 65.8% of autistic males - a statistically significant difference. Autistic females showed greater bedtime resistance, sleep anxiety, sleepiness, and reduced sleep duration compared to autistic males, while other sleep parameters remained similar. Intellectual ability did not correlate with sleep problems.

Notably, higher anxiety scores predicted more sleep problems in autistic males but not females, suggesting different underlying mechanisms may contribute to sleep difficulties across sexes in autism.

Clinical assessment and intervention for sleep problems should prioritize autistic females who show significantly higher rates of sleep difficulties. Different approaches may be needed for males versus females, with anxiety management potentially more relevant for males. Sleep interventions should be considered regardless of intellectual ability level.

Study relies solely on parent-report measures without objective sleep assessment. Cross-sectional design prevents causal inferences. Sample demographics and recruitment methods not detailed in abstract. Mechanisms underlying sex differences in sleep problems remain unclear.

Clinically significant sleep problems affect up to 86% of the autistic population in school-age. Sleep problems can have negative impacts on child cognition, behavior, and health. However, sex differences in the prevalence and types of sleep problems are not well understood in autism. To evaluate sex differences in sleep problems in the school-age autistic population, we obtained parent-report of sleep problems on the Children's Sleep Habits Questionnaire and conducted direct assessments to establish diagnosis and intellectual ability in 6-12-year-old children (autism n = 250; typical development [TD] n = 114).

Almost 85% of autistic females demonstrated sleep problems compared to 65.8% of autistic males, 44.8% of TD females, and 42.4% of TD males; a statistically significant increase for autistic females. Autistic females demonstrated increased bedtime resistance, sleep anxiety, and sleepiness, and decreased sleep duration, but did not differ in sleep onset delay, night wakings, parasomnias, or disordered breathing compared with autistic males. Intellectual ability was not related to increased sleep problems. Higher anxiety scores were associated with more sleep problems for males but not females.

In one of the first studies to evaluate sex differences in sleep in the school-age, autistic population, autistic females demonstrated increased sleep problems compared to autistic males, TD females, and TD males. Current autism assessment and intervention practices may benefit from increased attention to sleep problems in autistic school-age females and to anxiety in autistic males to enhance well-being and behavioral and health outcomes.