Otizm Spektrum Bozukluğu ve Uyku Sorunları: Aileler için Davranışsal Stratejiler

Abstract

Uyku, insan bedeni için yaşamsal öneme sahip temel bir biyolojik süreçtir. Araştırmalar, otizm spektrum bozukluğu olan çocuklarda uyku sorunlarının tipik gelişen akranlarına göre yaklaşık iki kat daha sık görüldüğünü göstermektedir. Alan yazında, çocuklarda görülen uyku sorunlarının önemli bir bölümünün davranışsal nedenlere bağlı olduğu ve etkili davranışsal müdahalelerle ortadan kaldırılabileceği ifade edilmektedir. Uyku sorunlarının belirlenmesi ve değerlendirilmesinde uyku günlüğü, ebeveyn anketleri, ev video kaydı ve işlevsel davranış analizi gibi yöntemler kullanılmaktadır. Bu değerlendirmeler sonucunda düzenli gündüz-akşam rutini oluşturma, görsel destek kullanımı, sosyal öyküler, olumlu pekiştirme, aşamalı uzaklaşma ve uyku saatini geri çekme gibi çeşitli davranışsal müdahaleler önerilmektedir. Bu çalışmada, OSB’li çocuklarda uyku kalitesini artırmak ve uyku sorunlarıyla başa çıkabilmeleri için ailelere bilimsel temelli, pratik ve sürdürülebilir davranışsal öneriler sunulmuştur.

Keywords

• otizm spektrum bozukluğu
• uyku
• uyku sorunları
• problem davranış
• davranışsal müdahaleler
• insomnia

Autism Spectrum Disorder and Sleep Problems: Behavioral Strategies for Families

Abstract

Sleep is a vital biological process with essential importance for the human body. Research shows that sleep problems are observed approximately twice as frequently in children with autism spectrum disorder compared to their typically developing peers. The literature indicates that a significant portion of sleep problems in children is based on behavioral factors and can be resolved through effective behavioral interventions. Various methods, such as sleep diaries, parent questionnaires, home video recordings, and functional behavior assessments, are used in the identification and evaluation of sleep problems. As a result of these assessments, several behavioral interventions are recommended, including establishing consistent daytime-evening routines, the use of visual supports, social stories, positive reinforcement, graduated withdrawal, and bedtime fading. In this study, science-based, practical, and sustainable behavioral recommendations were presented to families to improve sleep quality and to help them cope with sleep problems in children with ASD.

Keywords

• autism spectrum disorder
• sleep
• sleep problems
• problem behavior
• behavioral interventions
• insomnia

References

1. An American Academy of Sleep Medicine Review. (2006). Behavioral treatment of bedtime problems and night wakings in infants and young children. Sleep, 29(10), 1263-1276. https://doi.org/10.1093/sleep/29.10.1263
2. American Academy of Sleep Medicine. (2005). International Classification of Sleep Disorders: Diagnostic and Coding Manual, ICSD-2 (2nd ed.). Westchester, IL: American Academy of Sleep Medicine.
3. Buckley, A. W., Hirtz, D., Oskoui, M., Armstrong, M. J., Batra, A., Bridgemohan, C., Coury, D., Dawson, G., Donley, D., Findling, R. L., Gaughan, T., Gloss, T. D., Gronseth, G., Kessler, R., Merillat, S., Michelson, D., Owens, J., Pringsheim, T., Sikich, L., Stahmer, A. & Ashwal, S. (2020). Practice guideline: Treatment for insomnia and disrupted sleep behavior in children and adolescents with autism spectrum disorder: Report of the Guideline Development, Dissemination, and Implementation Subcommittee of the American Academy of Neurology. Neurology, 94(9), 392-404. https://doi.org/10.1212/WNL.0000000000009033
4. Christodulu, K. V., & Durand, V. M. (2004). Reducing bedtime disturbance and night waking using positive bedtime routines and sleep restriction. Focus on Autism and Other Developmental Disabilities, 19(3), 130-139. https://doi.org/10.1177/10883576040190030101
5. Clarke, M. A., Mclay, L. K., France, K. G., & Blampied, N. M. (2024). An evaluation of a stepped-care telehealth program for improving the sleep of autistic children. Research in Autism Spectrum Disorders, 112, 102356. https://doi.org/10.1016/j.rasd.2024.102356
6. Cohen, S., Conduit, R., Lockley, S. W., Rajaratnam, S. M., & Cornish, K. M. (2014). The relationship between sleep and behavior in autism spectrum disorder (ASD): a review. Journal of neurodevelopmental disorders, 6(1), 44. https://doi.org/10.1186/1866-1955-6-44
7. Cooper, J. O., Heron, T. E., & Heward, W. L. (2020). Applied behavior analysis. Pearson.
8. Corkum, P., & Coulombe, J. A. (2013). Sleep in the context of ADHD: A review of reviews to determine implications for research and clinical practice. In Amy Wolfson, and Hawley Montgomery-Downs (eds), The Oxford Handbook of Infant, Child, and Adolescent Sleep and Behavior, pp. 495-514, Oxford Library of Psychology. https://doi.org/10.1093/oxfordhb/9780199873630.013.0033

9. Cortesi, F., Giannotti, F., Ivanenko, A., & Johnson, K. (2010). Sleep in children with autistic spectrum disorder. Sleep Medicine, 11(7), 659-664. https://doi.org/10.1016/j.sleep.2010.01.010
10. Couturier, J., Speechley, K. N., Steele, M., Norman, R., Ballantyne, M., Smith, A., & Narayan, A. (2005). Parental perception of sleep problems in children of normal intelligence with pervasive developmental disorders: Prevalence, severity, and pattern. Journal of the American Academy of Child & Adolescent Psychiatry, 44(8), 815-822. https://doi.org/10.1097/01.chi.0000166377.22651.87
11. Delahaye, J., Kovacs, E., Sikora, D., Hall, T. A., Orlich, F., Clemons, T. E., van der Weerd, E., Glick, L., & Kuhlthau, K. (2014). The relationship between health-related quality of life and sleep problems in children with autism spectrum disorders. Research in Autism Spectrum Disorders, 8(3), 292-303. https://doi.org/10.1016/j.rasd.2013.12.015
12. Durand, V. M. (2014). Sleep problems. In J. K. Luiselli (Ed.) Children and youth with autism spectrum disorder (ASD): Recent advances and innovations in assessment, education and intervention (pp.174-192). New York: Oxford University Press.
13. Genç-Tosun, D., & Kurt, O. (2014). Otizm spektrum bozukluğu ve video modelle öğretim. Ankara Üniversitesi Eğitim Bilimleri Fakültesi Özel Eğitim Dergisi, 15(03), 37-50. https://doi.org/10.1501/Ozlegt_0000000213
14. Goldman, S. E., Surdyka, K., Cuevas, R., Adkins, K., Wang, L., & Malow, B. A. (2009). Defining the sleep phenotype in children with autism. Developmental Neuropsychology, 34(5), 560-573. https://doi.org/10.1080/87565640903133509
15. Goldman, S. E., McGrew, S., Johnson, K. P., Richdale, A. L., Clemons, T., & Malow, B. A. (2011). Sleep is associated with problem behaviors in children and adolescents with autism spectrum disorders. Research in Autism Spectrum Disorders, 5(3), 1223-1229. https://doi.org/10.1016/j.rasd.2011.01.010
16. Herrmann, S. (2016). Counting sheep: sleep disorders in children with autism spectrum disorders. Journal of Pediatric Health Care, 30(2), 143-154. https://doi.org/10.1016/j.pedhc.2015.07.003
17. Hunter, J. E., McLay, L. K., France, K. G., Swit, C. S., & Blampied, N. M. (2022). Parent perceptions of sleep-related stereotypy within sleep problems in children on the autism spectrum: Implications for behavioral treatment. Advances in Neurodevelopmental Disorders, 6(4), 456-472. https://doi.org/10.1007/s41252-022-00246-w
18. Ip, B. Y. T., Lee, S. L., & Li, S. X. (2024). Telehealth-delivered parent-based sleep-focused intervention for insomnia in preschool children with autism spectrum disorder: A randomized controlled study. Autism, 28(11), 2881-2896. https://doi.org/10.1177/13623613241246502
19. Johnson, C. R., Barto, L., Worley, S., Rothstein, R., & Wenzell, M. L. (2024). Follow-up of telehealth parent training for sleep disturbances in young children with autism spectrum disorder. Sleep Medicine, 119, 114-117. https://doi.org/10.1016/j.sleep.2024.04.022
20. Katz, T., & Malow, B. (2014). Solving sleep problems in children with autism spectrum disorders: A guide for frazzled families. Woodbine House.
21. Koudys, J., McConnell, C., Savard, A., Spottiswood, K., Treszl, A., O’Neill, P., Harrison, K., Ratko, M. G., & Randhawa, A. P. (2025). The Use of Technology and Telehealth to Improve Behavioral Sleep Assessment and Intervention. Behavior Analysis in Practice, 18(1), 74-95. https://doi.org/10.1007/s40617-024-00942-0
22. Krakowiak, P., Goodlin- Jones, B., Picciotto, I. Z., Croen, L. A., & Hansen, R. L. (2008). Sleep problems in children with autism spectrum disorders, developmental delays, and typical development: A population-based study. Journal of Sleep Research, 17(2), 197-206. https://doi.org/10.1111/j.1365-2869.2008.00650.x
23. Liu, R., Dong, H., Wang, Y., Lu, X., Li, Y., Xun, G., Ou, J., Shen, Y., Xia, K., & Zhao, J. (2021). Sleep problems of children with autism may independently affect parental quality of life. Child Psychiatry & Human Development, 52(3), 488-499. https://doi.org/10.1007/s10578-020-01035-z
24. Liu, X., Hubbard, J. A., Fabes, R. A., & Adam, J. B. (2006). Sleep disturbances and correlates of children with autism spectrum disorders. Child psychiatry and human development, 37(2), 179-191. https://doi.org/10.1007/s10578-006-0028-3
25. Malow, B. A., Marzec, M. L., McGrew, S. G., Wang, L., Henderson, L. M., & Stone, W. L. (2006). Characterizing sleep in children with autism spectrum disorders: a multidimensional approach. Sleep, 29(12), 1563-1571. https://doi.org/10.1093/sleep/29.12.1563
26. Malow, B. A., Byars, K., Johnson, K., Weiss, S., Bernal, P., Goldman, S. E., Panzer, R., Coury, D. L., & Glaze, D. G. (2012). A practice pathway for the identification, evaluation, and management of insomnia in children and adolescents with autism spectrum disorders. Pediatrics, 130(Supplement_2), S106-S124. https://doi.org/10.1542/peds.2012-0900I
27. Meltzer, L. J., & Mindell, J. A. (2008). Behavioral sleep disorders in children and adolescents. Sleep Medicine Clinics, 3(2), 269-279. https://doi.org/10.1016/j.jsmc.2008.01.004
28. Mindell, J. A., Meltzer, L. J., Carskadon, M. A., & Chervin, R. D. (2009). Developmental aspects of sleep hygiene: Findings from the 2004 National Sleep Foundation Sleep in America Poll. Sleep Medicine, 10(7), 771-779.https://doi.org/10.1016/j.sleep.2008.07.016
29. Mindell, J. A., Lee, C., & Sadeh, A. (2017). Young child and maternal sleep in the Middle East. Sleep Medicine, 32, 75-82. https://doi.org/10.1016/j.sleep.2016.11.011
30. Owens, J. A., Spirito, A., & McGuinn, M. (2000). Children’s Sleep Habits Questionnaire (CSHQ).
31. Owens, J. A., & Burnham, M. M. (2009). Sleep disorders. Handbook of infant mental health, 362-376.
32. Papadopoulos, N., Sciberras, E., Hiscock, H., Williams, K., McGillivray, J., Mihalopoulos, C., Engel, L., Fuller-Tyszkiewicz, M., Bellows, S. T., Marks, D., Howlin, P., & Rinehart, N. (2019). Sleeping sound with autism spectrum disorder (ASD): study protocol for an efficacy randomised controlled trial of a tailored brief behavioural sleep intervention for ASD. BMJ open, 9(11), e029767. https://doi.org/10.1136/bmjopen-2019-029767
33. Reynolds, A. M., & Malow, B. A. (2011). Sleep and autism spectrum disorders. Pediatric Clinics, 58(3), 685-698. https://doi.org/10.1016/j.pcl.2011.03.009
34. Richdale, A. L., & Schreck, K. A. (2009). Sleep problems in autism spectrum disorders: prevalence, nature, & possible biopsychosocial aetiologies. Sleep Medicine Reviews, 13(6), 403-411. https://doi.org/10.1016/j.pcl.2011.03.009
35. Roane, B. M., & Taylor, D. J. (2013). Pediatric Insomnia. In Amy Wolfson, and Hawley Montgomery-Downs (eds), The Oxford Handbook of Infant, Child, and Adolescent Sleep and Behavior, pp. 305-326, Oxford Library of Psychology. https://doi.org/10.1093/oxfordhb/9780199873630.013.0020
36. Sadeh, A., Tikotzky, L., & Scher, A. (2010). Parenting and infant sleep. Sleep Medicine Reviews, 14(2), 89-96. https://doi.org/10.1016/j.smrv.2009.05.003
37. Sadikova, E., Dovgan, K., & Mazurek, M. O. (2023). Longitudinal examination of sleep problems and symptom severity in children with autism spectrum disorder. Journal of Autism and Developmental Disorders, 53(4), 1673-1681. https://doi.org/10.1007/s10803-021-05401-1
38. Shaw, K. A., Williams, , S., Patrick, M. E., Valencia-Prado, M., Durkin, M. S., Howerton, M. E., Ladd-Acosta, C. M., Pas, E. T., Bakian, A. V., Bartholomew, P., Nieves-Muñoz, N., Sidwell, K., Alford, A., Bilder, D. A., DiRienzo, M., Fitzgerald, R. T., Furnier, S. M., Hudson, A. E., Pokoski, O. M., Shea, L.,… Maenner, M. J. (2025). Prevalence and early identification of autism spectrum disorder among children aged 4 and 8 years-Autism and Developmental Disabilities Monitoring Network, 16 Sites, United States, 2022. MMWR. Surveillance Summaries, 74. http://dx.doi.org/10.15585/mmwr.ss7402a1
39. Souders, M. C., Mason, T. B., Valladares, O., Bucan, M., Levy, S. E., Mandell, D. S., Weaver, T. E., & Pinto-Martin, J. (2009). Sleep behaviors and sleep quality in children with autism spectrum disorders. Sleep, 32(12), 1566-1578. https://doi.org/10.1093/sleep/32.12.1566
40. Souders, M. C., Zavodny, S., Eriksen, W., Sinko, R., Connell, J., Kerns, C., Schaaf, R., & Pinto-Martin, J. (2017). Sleep in children with autism spectrum disorder. Current Psychiatry Reports, 19(6), 34. https://doi.org/10.1007/s11920-017-0782-x
41. Türk Nöroloji Derneği. (2023). https://noroloji.org.tr/menu/98/uyku-tibbi
42. van der Heijden, K. B., Stoffelsen, R. J., Popma, A., & Swaab, H. (2018). Sleep, chronotype, and sleep hygiene in children with attention-deficit/hyperactivity disorder, autism spectrum disorder, and controls. European Child & Adolescent Psychiatry, 27(1), 99-111. https://doi.org/10.1007/s00787-017-1025-8
43. van Deurs, J. R., McLay, L. K., France, K. G., Blampied, N. M., Lang, R. B., & Hunter, J. E. (2019). Behavioral sleep intervention for adolescents with autism spectrum disorder: A pilot study. Advances in Neurodevelopmental Disorders, 3(4), 397-410. https://doi.org/10.1007/s41252-019-00123-z
44. Veatch, O. J., Goldman, S. E., Adkins, K. W., & Malow, B. A. (2015). Melatonin in children with autism spectrum disorders: how does the evidence fit together?. Journal of Nature and Science, 1(7), e125.
45. Watson, E. J., Banks, S., Coates, A. M., & Kohler, M. J. (2017). The relationship between caffeine, sleep, and behavior in children. Journal of Clinical Sleep Medicine, 13(4), 533-543. https://doi.org/10.5664/jcsm.6536
46. Autism Speaks. (2025, Ekim 11). ATN/AIR-P Strategies to Improve Sleep in Children with Autism. https://www.autismspeaks.org/sites/default/files/SC_ATN%20Sleep%20Topic%20Flyer_083120_v5.pdf