View in EDS HTML Full Text PDF Full Text

A Longitudinal Study of the Relationships between Sleep Problems in Autistic Children and Maternal Mental Health

Saved in:
Bibliographic Details
Title: A Longitudinal Study of the Relationships between Sleep Problems in Autistic Children and Maternal Mental Health
Language: English
Authors: Baker, Emma K. (ORCID 0000-0003-1165-0490), Giallo, Rebecca, Seymour, Monique, Hearps, Stephen J. C., Wood, Catherine E.
Source: Autism: The International Journal of Research and Practice. Oct 2023 27(7):1891-1905.
Availability: SAGE Publications. 2455 Teller Road, Thousand Oaks, CA 91320. Tel: 800-818-7243; Tel: 805-499-9774; Fax: 800-583-2665; e-mail: journals@sagepub.com; Web site: https://sagepub.com
Peer Reviewed: Y
Page Count: 15
Publication Date: 2023
Document Type: Journal Articles
Reports - Research
Descriptors: Young Children, Mothers, Autism Spectrum Disorders, Mental Health, Sleep, Problems, Relationship, Mental Disorders, Foreign Countries, Change, Educational Attainment, Time Perspective
Geographic Terms: Australia
DOI: 10.1177/13623613221147397
ISSN: 1362-3613
1461-7005
Abstract: Autistic children experience a high rate of sleep problems, which have been associated with maternal mental health difficulties. However, the directionality of these relationships has received little attention. The extent to which children's sleep problems influence maternal mental health difficulties and vice versa remains unclear. The aim of this study was to examine the bidirectional relationships between the sleep problems of autistic children and maternal mental health difficulties over 12 years. Six biennial waves of longitudinal data from when children were 4 to 5 years old were drawn from the Longitudinal Study of Australian Children. The sample comprised 397 child-mother dyads. Maternal mental health was assessed with the Kessler-6, while sleep problems were assessed through a series of questions relating to common sleep problems in children. The results demonstrated significant bidirectional effects between maternal mental health and child sleep problems at key developmental transition time points. Specifically, when children transitioned from preschool to primary school and again when the children transitioned from primary school to high school. These findings highlight the need for increased support for both the child and mother at these critical time points to reduce the negative impact of maternal psychological distress on child sleep problems and vice versa.
Abstractor: As Provided
Entry Date: 2023
Accession Number: EJ1393060
Database: ERIC
Full text is not displayed to guests.
FullText Links:
  – Type: pdflink
    Url: https://content.ebscohost.com/cds/retrieve?content=AQICAHj0k_4E0hTGH8RJwT4gCJyBsGNe_WN95AvKlDbXJGqwxwG1Z2sfOSxG_a_RMxBgHr8AAAAA4jCB3wYJKoZIhvcNAQcGoIHRMIHOAgEAMIHIBgkqhkiG9w0BBwEwHgYJYIZIAWUDBAEuMBEEDEc1ogIPz-OYCrcCNAIBEICBmvJeKr4IWJW7Etqd9kax--vOnSjPsnzUt7dTmAx7Xy_5ggWcGu4wMTdXtzCfrAMjEWAPGx2_q3llHPxHlmVFtqOKENdR1izddvIO6aZKZ7693rSYr0wMvgR1XF2b06VTtRvnox_s6a908bCtsE7-lR7kPI9jyAgRUM0-lDvOs9S_b2mwAiDRZ5j_57rgpdyeOxS2bObnWSEsiIc=
Text:
  Availability: 1
  Value: <anid>AN0171988762;f9d01oct.23;2023Sep20.03:57;v2.2.500</anid> <title id="AN0171988762-1">A longitudinal study of the relationships between sleep problems in autistic children and maternal mental health </title> <p>Autistic children experience a high rate of sleep problems, which have been associated with maternal mental health difficulties. However, the directionality of these relationships has received little attention. The extent to which children's sleep problems influence maternal mental health difficulties and vice versa remains unclear. The aim of this study was to examine the bidirectional relationships between the sleep problems of autistic children and maternal mental health difficulties over 12 years. Six biennial waves of longitudinal data from when children were 4 to 5 years old were drawn from the Longitudinal Study of Australian Children. The sample comprised 397 child–mother dyads. Maternal mental health was assessed with the Kessler-6, while sleep problems were assessed through a series of questions relating to common sleep problems in children. The results demonstrated significant bidirectional effects between maternal mental health and child sleep problems at key developmental transition time points. Specifically, when children transitioned from preschool to primary school and again when the children transitioned from primary school to high school. These findings highlight the need for increased support for both the child and mother at these critical time points to reduce the negative impact of maternal psychological distress on child sleep problems and vice versa. Autistic children experience increased the rates of sleep problems. These sleep problems have been associated with mother's mental health symptoms. However, the direction of these relationships is not well understood. This study investigated the relationships between autistic children's sleep problems and mothers' mental health over a 12-year period using data collected as part of the Longitudinal Study of Australian Children. Data from 397 autistic children and their mothers were included in this study. Mothers completed a questionnaire about their own mental health and common childhood sleep problems at four time points from 4–5 years to 14–15 years. The results showed important relationships between mothers' mental health symptoms and child sleep problems at two time points. Specifically, (<reflink idref="bib1" id="ref1">1</reflink>) mothers' mental health symptoms when the child was aged 4 to 5 years predicted child sleep problems at age 6 to 7 years; and (<reflink idref="bib2" id="ref2">2</reflink>) child sleep problems at age 12–13 years predicted mothers' mental health symptoms when the child was aged 14 to 15 years. Interestingly, these significant relationships also coincide with key developmental transition time points, when the child is transitioning in and out of primary school. These findings highlight the need for increased support for both the child and mother at these times to optimise outcomes for both.</p> <p>Keywords: autism; longitudinal; maternal mental health; sleep</p> <p>Sleep problems are one of the most common comorbid conditions experienced by autistic children, with prevalence estimates as high as 50 to 80% ([<reflink idref="bib7" id="ref3">7</reflink>]; [<reflink idref="bib34" id="ref4">34</reflink>]; [<reflink idref="bib40" id="ref5">40</reflink>]). Insomnia symptoms such as difficulties initiating and maintaining sleep as well as early morning waking are the most commonly reported problems ([<reflink idref="bib5" id="ref6">5</reflink>]). Sleep problems in autistic children have significant negative impacts on the child's daytime functioning ([<reflink idref="bib48" id="ref7">48</reflink>]), as well as on the sleep and mental health of their parents, particularly mothers ([<reflink idref="bib18" id="ref8">18</reflink>]; [<reflink idref="bib31" id="ref9">31</reflink>]).</p> <p>Despite these known associations, treatments for sleep problems in autistic children are limited ([<reflink idref="bib39" id="ref10">39</reflink>]). Consequently, outcomes for both the child and family are poor ([<reflink idref="bib6" id="ref11">6</reflink>]; [<reflink idref="bib9" id="ref12">9</reflink>]). Often treatments focus specifically on the child's sleep problem, and do not consider other factors, which might be contributing to the problem such as maternal mental health. Child sleep problems can affect maternal mental health ([<reflink idref="bib32" id="ref13">32</reflink>]). However, poor maternal mental health may also make it harder for mothers to consistently respond to their child and implement behavioural strategies which may improve their child's sleep ([<reflink idref="bib31" id="ref14">31</reflink>]). Better understanding of the relationship between the sleep problems experienced by children on the autism spectrum and their mothers' mental health might assist in determining more appropriate intervention and treatment planning. If familial factors, such as maternal mental health, play a role in the child's sleep problems, then family systems approaches may be more appropriate, rather than treating the child's sleep problem in isolation.</p> <hd id="AN0171988762-2">Sleep in autism spectrum disorder</hd> <p>Sleep problems in autism begin early with evidence showing their persistence across the lifespan ([<reflink idref="bib26" id="ref15">26</reflink>]; [<reflink idref="bib48" id="ref16">48</reflink>]). While insomnias are the most common problems, autistic children also experience elevated rates of bedtime resistance, parasomnias, obstructive sleep apnoea, and sleep enuresis ([<reflink idref="bib48" id="ref17">48</reflink>]), with most children experiencing multiple sleep problems ([<reflink idref="bib30" id="ref18">30</reflink>]; [<reflink idref="bib44" id="ref19">44</reflink>]). Elevated rates of circadian sleep wake-rhythm disorders (CSWRDs) are also reported, particularly during adolescence ([<reflink idref="bib57" id="ref20">57</reflink>]) and adulthood ([<reflink idref="bib3" id="ref21">3</reflink>]). This rise in CSWRDs may be due to an exacerbation of existing sleep difficulties in childhood in combination with the biological alterations associated with puberty and the natural shift in sleep-wake patterns that occur during adolescence ([<reflink idref="bib53" id="ref22">53</reflink>]).</p> <p>The underlying cause of sleep problems in autism remains unclear. [<reflink idref="bib41" id="ref23">41</reflink>] proposed a biopsychosocial model of sleep problems suggesting that sleep problems in autism can arise because of one or more of the following factors: (<reflink idref="bib1" id="ref24">1</reflink>) intrinsic biological or genetic abnormalities (e.g. melatonin dysregulation and CLOCK gene abnormalities; [<reflink idref="bib19" id="ref25">19</reflink>]); (<reflink idref="bib2" id="ref26">2</reflink>) psychological or behavioural characteristics connected with core or associated features of autism (e.g. anxiety, attention deficit hyperactive disorder (ADHD), autism symptoms); and/or (<reflink idref="bib3" id="ref27">3</reflink>) familial factors in the home or environment, including parenting practices that are not conducive to good sleep (e.g. high parental stress, marital discord). Other models of sleep in Autism Spectrum Disorder (ASD) have also been proposed and tested by [<reflink idref="bib23" id="ref28">23</reflink>] and [<reflink idref="bib24" id="ref29">24</reflink>], respectively</p> <p>In [<reflink idref="bib23" id="ref30">23</reflink>] model, the core symptoms of autism (i.e. social communication deficits and repetitive and restricted behaviours) were included as vulnerability factors, predisposing children to insomnia when challenged with environmental stressors such as social interactions and unpredictable environments. In addition, core autistic symptoms, social communication challenges, and repetitive behaviours and were proposed to create an additive effect that exacerbated maladaptive coping mechanisms (e.g. internalising and externalising behaviours) and insomnia symptoms. The effects of comorbid intellectual impairment, medical conditions (e.g. epilepsy) and associated medications were also included as predictors of sleep disturbance. As poor sleep quality and quantity may increase maladaptive responding, a bidirectional component was included. The model was subsequently tested ([<reflink idref="bib24" id="ref31">24</reflink>]), with results indicating some predictor variables were consistent with the original framework, while others were contradictory or inconclusive. Anxiety problems explained the most variance in sleep scores. Other significant contributors included developmental regression, gastrointestinal problems and younger age. However, the total model only accounted for 19.3% of the variance in sleep scores, suggesting other factors not included in the model contribute towards sleep problems. In particular, family functioning factors, including poor parental mental health and marital discord, have been proposed but were not originally tested ([<reflink idref="bib23" id="ref32">23</reflink>]).</p> <hd id="AN0171988762-3">Mental health of mothers of autistic children</hd> <p>As seen in the general population ([<reflink idref="bib14" id="ref33">14</reflink>]), maternal mental health might be a key aspect of family functioning impacting the sleep of autistic children. Research has consistently shown that mothers of autistic children experience greater mental health difficulties including anxiety and depression, poorer quality of life, fatigue, and higher levels of stress compared to both parents of typically developing children and parents of children with other neurodevelopmental conditions ([<reflink idref="bib20" id="ref34">20</reflink>]; [<reflink idref="bib49" id="ref35">49</reflink>]; [<reflink idref="bib54" id="ref36">54</reflink>]).</p> <p>A systematic review and meta-analysis examining the prevalence of clinical psychological disorders in parents of autistic children found 31% of parents to have a depressive disorder and 33% to have an anxiety disorder ([<reflink idref="bib47" id="ref37">47</reflink>]). Both estimates were significantly higher than the estimated global prevalence of these disorders in the general population. Focusing more specifically on mothers, research consistently demonstrates increased parenting-related stress ([<reflink idref="bib16" id="ref38">16</reflink>]), psychological distress ([<reflink idref="bib15" id="ref39">15</reflink>]), and anxiety and depression symptoms ([<reflink idref="bib43" id="ref40">43</reflink>]) when compared to mothers of children with other developmental disabilities and neurotypical children. The mother's own mental health can also have flow on effects to the mental health of the child ([<reflink idref="bib59" id="ref41">59</reflink>]). In a recent qualitative study examining maternal perspectives of raising a child on the autism spectrum ([<reflink idref="bib37" id="ref42">37</reflink>]), three themes were identified: emotional burden, family burden and social burden. Mothers reported feelings of guilt and frustration around their child's diagnosis (emotional burden), as well as changes in the family system and economic impacts (family burden). Finally, mothers reported tending to avoid social activities due to increased childcare responsibilities and concerns that their child may have outbursts in public and social settings. Such challenges likely contribute towards the elevated mental health difficulties seen in these mothers.</p> <p>Several factors have been associated with the mental health of mothers of children with autism, including parental characteristics, child characteristics, and contextual factors ([<reflink idref="bib56" id="ref43">56</reflink>]). In particular, the mother's coping skills were a consistent parental characteristic, while child characteristics included hyperactivity, conduct problems and lower prosocial behaviours ([<reflink idref="bib1" id="ref44">1</reflink>]). Common contextual factors include unemployment and socio-economic disadvantage ([<reflink idref="bib56" id="ref45">56</reflink>]). Families of children experiencing disadvantage likely experience more life stress, more mental health difficulties, and have fewer practical and emotional resources to manage and cope. This may in turn exacerbate the mother's mental health problems and diminish their capacity to manage the child's behaviours including sleep difficulties ([<reflink idref="bib32" id="ref46">32</reflink>]).</p> <hd id="AN0171988762-4">Relationship between child sleep problems and maternal mental health in ASD</hd> <p>In a systematic review of 11 studies of autistic children and ADHD ([<reflink idref="bib31" id="ref47">31</reflink>]), increased child sleep problems were consistently associated with increased parental stress and poorer mental health. In a study of 90 autistic children (aged 4–12 years), total sleep problems on the Children's Sleep Habits Questionnaire (CSHQ) were associated with overall maternal mental health after controlling for autism severity ([<reflink idref="bib21" id="ref48">21</reflink>]). Similarly, in a larger study of 234 autistic children (aged 5–13 years) by [<reflink idref="bib32" id="ref49">32</reflink>] a significant association between sleep initiation and duration of the problem and maternal psychological distress was found.</p> <p>To date, most studies are cross-sectional, limiting the ability to determine the nature of the relationship between children's sleep problems and maternal mental health over time. It is plausible that child sleep problems contribute to parental stress and well-being by limiting the parents' opportunities for time to self, self-care, and interrupting their own sleep. Parents who are fatigued might use less effective parenting strategies, leading to a vicious cycle of the problem. Parenting stress, fatigue and mental health difficulties can also impede their ability to effectively implement consistent bedtime routines, as well as distorting how they perceive and manage the child's sleep problems ([<reflink idref="bib31" id="ref50">31</reflink>]). However, the impact on mothers may dissipate over time. As children age, they are less likely to alert their parents to sleep difficulties, minimising the impact on parental down time and sleep ([<reflink idref="bib22" id="ref51">22</reflink>]). In addition, common childhood sleep problems (e.g. sleep enuresis, night terrors and not wanting to sleep alone) that may also interfere with parental downtime and sleep, become less common during the school-aged years ([<reflink idref="bib36" id="ref52">36</reflink>]). The additive effects of multiple types of sleep problems during early childhood may also have greater impacts on maternal mental health and well-being compared to a single sleep problem. Thus, the relationships are likely complex and require further exploration via longitudinal studies.</p> <p>While bidirectional studies are lacking in the autism literature, a recent study investigated the bidirectional relationships between maternal mental health and sleep problems in children with ADHD ([<reflink idref="bib32" id="ref53">32</reflink>]). This study included mothers and other female caregivers of 379 children with ADHD aged 5 to 13 years. Child sleep and maternal mental health were assessed at three time points (baseline, 6 months, 12 months) across a 12-month period. Findings showed that both child sleep problems and maternal mental health difficulties were stable over time. In addition, child sleep problems at 6 months predicted maternal mental health difficulties and anxiety at 12 months. However, little support was indicated for maternal mental health predicting child sleep problems over the 12-month period. These findings highlighted the significant impact of child sleep problems on maternal mental health, in another common childhood neurodevelopmental disorder, which is often comorbid with autism. Therefore, it might be expected that similar bidirectional relationships are seen between autistic children and their mothers.</p> <hd id="AN0171988762-5">The current study</hd> <p>In summary, although sleep problems are highly prevalent in autistic individuals, treatment options are limited with persistence of the sleep problems occurring across the lifespan. While research has identified correlates and contributors to poor sleep, including maternal mental health, these studies have primarily been cross-sectional, and longitudinal studies have typically covered short time frames. Longitudinal studies spanning critical developmental periods are needed to identify important time points between these relationships, as well as to provide a better understanding of the bidirectional nature of these relationships. This knowledge will be vital for the development of appropriate interventions for both the child and the family.</p> <p>Thus, the aim of this study was to examine the bidirectional relationships between the sleep problems of autistic children and maternal mental health difficulties using six waves of longitudinal data. Given sleep problems are more likely to interfere with the mother's own sleep in earlier childhood ([<reflink idref="bib46" id="ref54">46</reflink>]), it was hypothesised that early child sleep problems would significantly predict poorer maternal mental health, with stronger associations in the earlier childhood period (4–7 years) compared to later time points (8–16 years).</p> <hd id="AN0171988762-6">Method</hd> <p></p> <hd id="AN0171988762-7">Study design and participants</hd> <p>Participants were drawn from the Longitudinal Study of Australian Children (LSAC), a nationally representative study of children's health, well-being and development that was initiated by the Australian Government Department of Social Services ([<reflink idref="bib52" id="ref55">52</reflink>]). To recruit the sample, 10% of all Australian postcodes, stratified by state of residence and urban versus rural status were initially selected. Second, children were randomly selected from each of these postcodes. Specifically, children proportional to population size were selected using the Medicare database, a national health insurance scheme that includes >90% of all Australian infants. For a full description of the LSAC study design and sampling information see [<reflink idref="bib52" id="ref56">52</reflink>].</p> <p>The LSAC includes two cohorts of children: a birth cohort (children aged 0–1 years in 2003–2004) and a kindergarten cohort (children aged 4–5 years in 2003–2004) comprising a total of 10,090 children. In multi-child families, only one child is identified as the study child. Data are collected every 2 years via face-to-face interview, parent-, self-, and teacher-report questionnaires, and direct assessments. The two cohorts begin to 'overlap in age' at wave 3 (w3), that is when children in both cohorts are aged 4 to 5 years. At the time of data retrieval from the LSAC database eight waves of data were available. Consequently, this study utilised data from the overlapping cohorts from wave 3 (w3) through to wave 8 (w8), ensuring that data were available for both cohorts at each time point and allowing for consistency between datasets.</p> <p>As part of the LSAC study, the primary caregiver completes an interview and is asked to respond to, 'Does your child have any of these ongoing conditions?' Response selections include 'Autism, Aspergers, or other autism spectrum'. Children were included if they had a parent-reported diagnosis of ASD, at any wave. Based on these criteria, 397 mother–child dyads were identified and included in the study. Of the 397 children included in this cohort, 324 (81.6%) were endorsed as having a diagnosis of ASD in their final reported wave, and a further 22 (5.5%) endorsed a diagnosis of ASD in the majority of reported waves.</p> <p>Ethics approval for LSAC was obtained from the Australian Institute of Family Studies (AIFS) Ethics Committee. Ethics approval for the current study was obtained from the Swinburne University Human Research Ethics Committee (HREC approval number: 20215750-9016). The LSAC data were accessed through the National Centre for Longitudinal Data (NCLD) Dataverse ([<reflink idref="bib12" id="ref57">12</reflink>]).</p> <hd id="AN0171988762-8">Materials</hd> <p></p> <hd id="AN0171988762-9">Demographic data</hd> <p>The LSAC database includes a range of demographic information collected for each study child and their family. Child information extracted for this study included biological sex, age of ASD diagnosis and country of birth. For mothers, age when the study child was born, country of birth, highest level of education, and employment status were extracted. Familial factors included main language spoken at home, family structure (single or couple parents and number of siblings), and socio-economic index for area (SEIFA). SEIFA is a product developed by the Australian Bureau of Statistics (ABS) that ranks areas in Australia according to relative socio-economic advantage and disadvantage. This variable is based on information gathered from the 5-yearly Census ([<reflink idref="bib2" id="ref58">2</reflink>]). SEIFA scores from the 2016 Census have a mean of 1000 and standard deviation of 100 (range: 400–1239), with higher scores indicating a greater advantage.</p> <hd id="AN0171988762-10">Sleep</hd> <p>Parents responded to questions relating to their child's sleep patterns and behaviour at each wave. In the first five waves, 10 questions relating to sleep were included, while at the final wave only eight questions were included. In addition, the final wave had a slightly different set of questions (see Supplementary Note S1 for list of questions). Each question was asked in the following format: 'does your child have any of these problems on 4 or more nights a week, that is, more than half of the time?' Each question was answered either yes or no for each problem. Given the difference in the number of questions, the percent endorsed at each wave was used in the analysis. Thus, a higher percent endorsed represents greater sleep problems. Internal consistency was good for waves 3, 4, and 5 (Cronbach's α = 0.7), moderate for waves 6 and 7 (α = 0.6), and poor for wave 8 (α = 0.5). The internal consistency of the sleep questions is likely reduced given the questions examine multiple aspects of sleep rather than specific sleep disorders. For example, snoring is related to sleep-disordered breathing, while difficulties falling asleep are a symptom of insomnia and while children may experience both symptoms, they do not fall within the same sleep construct.</p> <hd id="AN0171988762-11">Maternal mental health</hd> <p>Parents were asked to complete the six-item version of the Kessler Psychological Distress Scale (K-6; [<reflink idref="bib28" id="ref59">28</reflink>]). The K-6 comprises items assessing depressive and anxiety symptoms in the preceding 4 weeks, rated on a 5-point Likert-type scale from 1 'none of the time' to 5 'all of the time'. High scores are indicative of higher psychological distress. Internal consistency was very good for wave 3 (α = 0.8) and excellent for all other waves (α = 0.9).</p> <hd id="AN0171988762-12">Community involvement</hd> <p>This study did not include community members in the development of this project.</p> <hd id="AN0171988762-13">Data analysis</hd> <p>Descriptive statistics were generated for demographic characteristics, child sleep problems and maternal mental health. Frequencies and proportions were presented for categorical variables, and means and standard deviations for continuous measures. Pearson correlations were calculated between child sleep problems and maternal mental health summary measures, as well as within measures (between data waves).</p> <p>Cross-lagged panel models were used to estimate the model pathways between child sleep problems and maternal mental health across the six waves, spanning 12 years. Cross-lagged models are discrete-time structural equation models used to analyse data in which two or more variables are repeatedly measured at two or more different time points. This technique assesses causal models in data derived from longitudinal research designs ([<reflink idref="bib17" id="ref60">17</reflink>]).</p> <p>The first model examined the stability effect, including only temporal stabilities of sleep problems and maternal mental health (i.e. paths between the same variables measured at different time points) and synchronous correlations (i.e. correlations between different variables measured at the same time). The second model, the causal model, added the lagged associations from earlier maternal mental health to later child sleep problems. The third model, the reversed causation model, tested the lagged association from earlier child sleep problems to later maternal mental health, without the lagged associations included in Model 2. The fourth model tested the lagged bidirectional relationships between sleep problems and maternal mental health across all six time points, to estimate the directional effects of child sleep problems and maternal mental health. All models included child biological sex, as well as socio-economic status, highest maternal education (high school or less, certificate/advanced diploma, or tertiary) and family structure (married/de facto vs single) at the first analysis wave (age 4/5) as covariates.</p> <p>Finally, the model fit of Models 2 to 4 was compared with the fit of Model 1, to assess whether the lagged and cross-lagged paths account for unique variability beyond that attributed to the stability of child sleep problems and maternal mental health over time. This allows the best-fitting model of the directional and bidirectional relationships between child sleep problems and maternal mental health over time to be identified. Standardised coefficients were presented for all paths.</p> <p>Model fit for the four models was determined using several fit indices: normed chi-square test (χ<sups>2</sups>/<emph>df</emph>), Tucker–Lewis Index (TLI), comparative fit index (CFI) and root mean square error of approximation (RMSEA). Acceptable fit values were assessed as a χ<sups>2</sups>/<emph>df</emph> < 3, >0.9 for TLI and CFI, and <0.05 for the RMSEA ([<reflink idref="bib25" id="ref61">25</reflink>]). Next, the model fit of Models 2 to 4 was compared with the model fit for Model 1 (stability model) using chi-square difference tests to assess whether the lagged and cross-lagged paths increased model fit over the stability model.</p> <p>Data missingness varied across the six data collection waves, from 4.5% at the second analysis wave (age 6/7) to 23.8% at the final wave (age 14/15). Total missingness for variables included in the full cross-lagged model was 11.8%, with less missingness on average in the sleep problems variables (9.9%) than in the K–6 (18.3%). Missing data were managed by using full-information maximum likelihood (FMIL). The FMIL method uses all the information from the observed data, including the mean and variance for the missing portions of a variable, given the observed portions of other variables (Wothke, 1998). Analyses were carried out with Stata version 17, and statistical significance set at p < 0.05.</p> <hd id="AN0171988762-14">Results</hd> <p>Of the 10,090 children and their families enrolled in LSAC, 8665 had a valid response to the primary caregiver interview question pertaining to an autism diagnosis. From these valid responses, 397 (4.58%) were reported to have a diagnosis of autism and were included in the analyses. The sample comprised predominantly male children born in Australia. The majority of mothers were born in Australia and had completed further education after high school. English was the most common primary language spoken at home and most mothers were married or in a de-facto relationship. SEIFA scores were similar to the Australian population average. Further information regarding the sample characteristics are provided in Table 1.</p> <p>Graph</p> <p>Table 1. Sample characteristics.</p> <p> <ephtml> <table><colgroup><col align="left" /><col align="char" char="." /></colgroup><thead><tr><th align="left">Sample characteristic</th><th align="left"><italic>N</italic> = 397</th></tr></thead><tbody><tr><td colspan="2">Child</td></tr><tr><td> Male (n (%))</td><td>306 (77.1)</td></tr><tr><td> Age of autism diagnosis (years)<xref ref-type="table-fn" rid="tfn2">a</xref> (M (SD))</td><td>6.45 (3.70)</td></tr><tr><td> Country of birth (n (%))</td><td /></tr><tr><td> Australia</td><td>396 (99.8)</td></tr><tr><td> Other</td><td>1 (0.2)</td></tr><tr><td>Anxiety/depression (n (%))</td><td>263 (66.3)</td></tr><tr><td>Epilepsy (n (%))</td><td>22 (5.5)</td></tr><tr><td colspan="2">Mother</td></tr><tr><td> Age at child's birth (years) (M (SD))</td><td>29.70 (5.74)</td></tr><tr><td> Country of birth<xref ref-type="table-fn" rid="tfn3">b</xref> (n (%))</td><td /></tr><tr><td> Australia</td><td>338 (86.45)</td></tr><tr><td> Oceania</td><td>11 (2.81)</td></tr><tr><td> Europe</td><td>18 (4.60)</td></tr><tr><td> Asia</td><td>17 (4.35)</td></tr><tr><td> Americas</td><td>3 (0.77)</td></tr><tr><td> Africa</td><td>4 (1.02)</td></tr><tr><td> Highest level of education<xref ref-type="table-fn" rid="tfn4">c</xref> (n (%))</td><td /></tr><tr><td> High school or less</td><td>89 (23.36)</td></tr><tr><td> Certificate/advanced diploma</td><td>154 (40.42)</td></tr><tr><td> Tertiary</td><td>138 (36.22)</td></tr><tr><td> Employment status<xref ref-type="table-fn" rid="tfn4">c</xref> (n (%))</td><td /></tr><tr><td> Employed</td><td>204 (53.54)</td></tr><tr><td> Unemployed</td><td>11 (2.89)</td></tr><tr><td> Not in labour force</td><td>166 (43.57)</td></tr><tr><td>Family</td><td /></tr><tr><td> English main language spoken at home<xref ref-type="table-fn" rid="tfn4">c</xref> (n (%))</td><td>349 (91.60)</td></tr><tr><td> SEIFA (M (<italic>SD</italic>))</td><td>1000.26 (74.58)</td></tr><tr><td> Family structure<xref ref-type="table-fn" rid="tfn5">d</xref> (n (%))</td><td /></tr><tr><td> Married/de-facto</td><td>323 (84.11)</td></tr><tr><td> Single parent</td><td>61 (15.89)</td></tr><tr><td> Two or more siblings in the home<xref ref-type="table-fn" rid="tfn5">d</xref> (<italic>n</italic> (%))</td><td>138 (35.94)</td></tr></tbody></table> </ephtml> </p> <p>1 SEIFA: socio-economic index for area.</p> <ulist> <item>2 Age at diagnosis was missing for 17 mothers.</item> <item>3 Country of birth was missing for 6 mothers.</item> <item>4 Highest education, employment status and language were missing for 16 mothers.</item> <item>5 SEIFA, family structure and number of siblings household were missing for 13 families.</item> </ulist> <hd id="AN0171988762-15">Child sleep problems and maternal mental health</hd> <p>On average, approximately 14.9% of the sleep problems were endorsed for each child at each wave (Table 2). The most endorsed sleep problem overall was 'difficulties getting off to sleep' (34.2%), followed by 'seeming tired' (28.5%). The least common sleep problem among autistic children reported by their parents was 'wheezing/asthma' (2.4%). Table 3 shows the proportion of children who experienced each sleep problem by wave. The scores on the K-6, representing maternal mental health, were similar at each wave. On average scores were in the non-clinical range at each wave (Table 2). Descriptive statistics for K-6 scores and child sleep problems are shown in Table 2. Correlations between variables are provided in Supplementary Table S1.</p> <p>Graph</p> <p>Table 2. Mean and standard deviation for K-6 scores and child sleep problems at each wave.</p> <p> <ephtml> <table><colgroup><col align="left" /><col align="char" char="." /><col align="char" char="." /><col align="char" char="." /><col align="char" char="." /><col align="char" char="." /><col align="char" char="." /><col align="char" char="." /><col align="char" char="." /></colgroup><thead><tr><th /><th align="left" colspan="4">K-6</th><th align="left" colspan="4">Sleep problems (% endorsed)</th></tr><tr><th /><th align="left"><italic>n</italic></th><th align="left">Mean</th><th align="left">SD</th><th align="left">Range</th><th align="left"><italic>n</italic></th><th align="left">Mean</th><th align="left">SD</th><th align="left">Range</th></tr></thead><tbody><tr><td>Wave 3 4/5 years</td><td>270</td><td>10.65</td><td>3.94</td><td>6–25.0</td><td>384</td><td>16.21</td><td>18.35</td><td>0–70.0</td></tr><tr><td>Wave 4 6/7 years</td><td>370</td><td>10.67</td><td>4.45</td><td>6–30.0</td><td>388</td><td>14.77</td><td>17.06</td><td>0–80.0</td></tr><tr><td>Wave 5 8/9 years</td><td>350</td><td>10.39</td><td>4.13</td><td>6–30.0</td><td>378</td><td>13.33</td><td>16.78</td><td>0–90.0</td></tr><tr><td>Wave 6 10/11 years</td><td>341</td><td>10.76</td><td>4.42</td><td>6–27.0</td><td>354</td><td>14.01</td><td>16.03</td><td>0–70.0</td></tr><tr><td>Wave 7 12/13 years</td><td>320</td><td>10.55</td><td>4.03</td><td>6–30.0</td><td>332</td><td>14.67</td><td>15.86</td><td>0–60.0</td></tr><tr><td>Wave 8 14/15 years</td><td>296</td><td>10.78</td><td>4.61</td><td>6–28.0</td><td>309</td><td>16.41</td><td>15.24</td><td>0–71.4</td></tr></tbody></table> </ephtml> </p> <p>Graph</p> <p>Table 3. Proportions of endorsement of child sleep problem items by wave.</p> <p> <ephtml> <table><colgroup><col align="left" /><col align="char" char="." /><col align="char" char="." /><col align="char" char="." /><col align="char" char="." /><col align="char" char="." /><col align="char" char="." /></colgroup><thead><tr><th /><th align="left">W3 4/5 years (<italic>n</italic> = 384)</th><th align="left">W4 6/7 years (<italic>n</italic> = 388)</th><th align="left">W5 8/9 years (<italic>n</italic> = 378)</th><th align="left">W6 10/11 years (<italic>n</italic> = 354)</th><th align="left">W7 12/13 years (<italic>n</italic> = 332)</th><th align="left">W8 14/15 years (<italic>n</italic> = 309)</th></tr><tr><th /><th align="left">%</th><th align="left">%</th><th align="left">%</th><th align="left">%</th><th align="left">%</th><th align="left">%</th></tr></thead><tbody><tr><td>Wheezing or asthma</td><td>1.56</td><td>3.09</td><td>1.85</td><td>1.41</td><td>3.61</td><td>2.91</td></tr><tr><td>Snoring/breathing</td><td>13.02</td><td>9.79</td><td>6.88</td><td>7.91</td><td>7.23</td><td>10.03</td></tr><tr><td>Getting to sleep</td><td>21.61</td><td>26.80</td><td>33.33</td><td>37.85</td><td>42.17</td><td>47.57</td></tr><tr><td>Sleeping alone</td><td>26.04</td><td>25.52</td><td>18.78</td><td>19.77</td><td>11.75</td><td>–</td></tr><tr><td>Waking during night</td><td>29.69</td><td>20.36</td><td>15.34</td><td>15.25</td><td>15.66</td><td>–</td></tr><tr><td>Other</td><td>2.08</td><td>2.32</td><td>2.91</td><td>2.26</td><td>3.31</td><td>4.21</td></tr><tr><td>Bed wetting</td><td>24.48</td><td>15.46</td><td>10.05</td><td>7.06</td><td>4.52</td><td>2.91</td></tr><tr><td>Nightmares/terrors</td><td>8.07</td><td>8.25</td><td>5.82</td><td>6.50</td><td>7.83</td><td>3.56</td></tr><tr><td>Seeming tired</td><td>20.05</td><td>21.91</td><td>24.07</td><td>28.53</td><td>34.64</td><td>45.95</td></tr><tr><td>Restless sleep<xref ref-type="table-fn" rid="tfn6">a</xref></td><td>13.98</td><td>14.18</td><td>14.29</td><td>13.56</td><td>15.96</td><td>–</td></tr><tr><td>Poor sleep<xref ref-type="table-fn" rid="tfn7">b</xref></td><td>–</td><td>–</td><td>–</td><td>–</td><td>–</td><td>8.66</td></tr></tbody></table> </ephtml> </p> <ulist> <item>6 <emph>N</emph> = 236 for 4/5.</item> <item>7 <emph>N</emph> = 127 for 14/15.</item> </ulist> <hd id="AN0171988762-16">Bidirectional influences between child sleep problems and maternal mental health across time</hd> <p>Model 1 estimating the stability of the time adjacent measures, that is the temporal stability of child sleep problems and maternal mental health showed good model fit (Table 4; Figure 1(a)). Upon examination of the standardised residuals and modification indices, it was evident that the strength of the relationship between the nonadjacent time points for child sleep problems and maternal mental health scores was not adequately accounted for by the model. Thus, second-order autoregressive paths (i.e. within-outcome lags spanning 2 years) were added, which resulted in improved fit. Table 4 shows the summary fit indices for the modified Model 1 with covariates, in addition to the further models described below.</p> <p>Graph</p> <p>Table 4. Summary fit indices for nested models of the relationships between maternal mental health scores and child sleep problems.</p> <p> <ephtml> <table><colgroup><col align="left" /><col align="char" char="." /><col align="char" char="." /><col align="char" char="." /><col align="char" char="." /><col align="char" char="." /><col align="char" char="." /><col align="char" char="." /><col align="char" char="." /><col align="char" char="." /><col align="char" char="." /></colgroup><thead><tr><th /><th align="left">χ<sup>2</sup></th><th align="left">(<italic>df</italic>)</th><th align="left">χ<sup>2</sup>/<italic>df</italic></th><th align="left">χ<sup>2</sup><sub>diff</sub></th><th align="left">(<italic>df</italic>)<xref ref-type="table-fn" rid="tfn9">a</xref></th><th align="left"><italic>p</italic></th><th align="left">CFI</th><th align="left">TLI</th><th align="left">RMSEA</th><th align="left">(90%CI)</th></tr></thead><tbody><tr><td>Model 1: Stability</td><td>207.36</td><td>(92)</td><td>2.25</td><td>–</td><td /><td /><td>0.923</td><td>0.895</td><td>0.056</td><td>(0.046, 0.066)</td></tr><tr><td>Model 2: Lagged Kessler-6 to Sleep Problems<xref ref-type="table-fn" rid="tfn9">a</xref></td><td>195.62</td><td>(87)</td><td>2.25</td><td>11.75</td><td>(5)</td><td><bold>0.038</bold></td><td>0.928</td><td>0.895</td><td>0.056</td><td>(0.046, 0.067)</td></tr><tr><td>Model 3: Lagged Sleep Problems to Kessler-6<xref ref-type="table-fn" rid="tfn9">a</xref></td><td>198.30</td><td>(87)</td><td>2.28</td><td>9.07</td><td>(5)</td><td>0.107</td><td>0.926</td><td>0.893</td><td>0.057</td><td>(0.046, 0.067)</td></tr><tr><td>Model 4: Lagged bidirectional<xref ref-type="table-fn" rid="tfn9">a</xref></td><td>187.40</td><td>(82)</td><td>2.29</td><td>19.97</td><td>(10)</td><td><bold>0.030</bold></td><td>0.930</td><td>0.892</td><td>0.057</td><td>(0.046, 0.068)</td></tr></tbody></table> </ephtml> </p> <ulist> <item>8 CFI: comparative fit index; TLI: Tucker–Lewis Index; RMSEA: root mean square error of approximation; CI: confidence interval.</item> <item>9 Compared with Model 1 using likelihood ratio test.</item> <item>10 Bold text indicates statistical significance <emph>p</emph> <.05.</item> </ulist> <p>Graph: Figure 1. Lagged models depicting relationships between child sleep problems and maternal mental health adjusted for covariates. (a) Stability model (Model 1); (b) lagged maternal mental health to child sleep problems (Model 2); (c) lagged child sleep problems to maternal mental health (Model 3) (d) fully cross-lagged bidirectional model (Model 4).SP: sleep problems; K-6: Kessler-6. *p <.05; **p <.01; *** p <.001.</p> <p>After the stability model was estimated, the causal models were estimated. Model 2 added the lagged pathways from maternal mental health to later child sleep problems (Figure 1(b)) to the stability model. The reverse causation model (Model 3) added the lagged pathways from child sleep problems to later maternal mental health (Figure 1(c)). Model 2 showed statistically significant improvement on Model 1 (Table 4). A single statistically significant lagged path was found in each model; earlier maternal mental health scores (child age 4/5) were associated with later child sleep problems (child age 6/7) and child sleep problems at 13/14 years were associated with maternal mental health scores at the final time point (child age 15/16 years). However, Model 3 did not significantly improve model fit beyond the stability model (Model 1; Table 4).</p> <p>Finally, the lagged bidirectional model (Model 4) estimated the directional effects of child sleep problems and maternal mental health. This model showed statistically significant improvement from the stability model, suggesting that specific bidirectional pathways were associated with changes in child sleep problems and maternal mental health beyond that of the stability model alone (Figure 1(d)). Apart from one statistically significant path between 'partnered parents' and wave 3 maternal mental health, there were no other statistically significant covariate paths (family structure, biological sex, economic status, highest maternal education).</p> <hd id="AN0171988762-17">Discussion</hd> <p>The aim of this study was to examine the bidirectional relationships between sleep problems in autistic children and maternal mental health using six waves of longitudinal data drawn from the LSAC. The results highlighted several key findings with implications for the treatment and management of sleep among autistic children. Contrary to the proposed hypothesis, maternal mental health when the child was aged 4 to 5 years significantly predicted child sleep problems at age 6 to 7 years. However, later child sleep problems at age 12 to 13 years predicted mothers' psychological distress in the following wave (14 to 15 years). Possible explanations for these unexpected findings are discussed below. It is interesting to note that these significant relationships emerge at critical transitioning time points for both the child and mother, suggesting that extra supports are needed at this time.</p> <p>Maternal mental health when the child was aged 4 to 5 years significantly predicted child sleep problems at 6 to 7 years. One of the most critical transitions a child will undertake during this time is the move from preschool to primary school, usually occurring between the ages of 4 and 6 years in Australia. This time has been described as particularly challenging for children on the autism spectrum and their families ([<reflink idref="bib13" id="ref62">13</reflink>]). Specifically, parents have reported elevated rates of stress and pressure at this time to find the right school for their child ([<reflink idref="bib8" id="ref63">8</reflink>]). In addition, this transition often coincides with families receiving their child's autism diagnosis, further increasing stress in the family system ([<reflink idref="bib8" id="ref64">8</reflink>]). Consistent with this, the average age of diagnosis for children included in the current study was approximately 6 years. However, it is well established that parental concerns begin well before this age and that the diagnostic process in Australia takes approximately 12 months ([<reflink idref="bib4" id="ref65">4</reflink>]) with significant stress experienced by mothers during this process ([<reflink idref="bib27" id="ref66">27</reflink>]). In addition, it is around the age of 6 years when changes in sleep patterns occur ([<reflink idref="bib36" id="ref67">36</reflink>]). This is the age when sleep is experienced as it would be through adulthood, consolidated in a single block at night ([<reflink idref="bib36" id="ref68">36</reflink>]). The sleep of children on the autism spectrum might be particularly vulnerable to external stressors, such as maternal psychological stress during this time.</p> <p>A significant association between child sleep at age 12 to 13 years and maternal mental health at age 14 to 15 years was also observed. This is a second transition point in the child's life, when most Australian children aged 12 to 13 years commence secondary education. This time likely results in increased stress for both the young person and their caregivers. Specifically, the increased social demands and independence required of adolescents in high school can be particularly challenging for those on the autism spectrum ([<reflink idref="bib42" id="ref69">42</reflink>]). Difficulties with social communication, a core component of autism, might negatively impact this transition. Furthermore, research has demonstrated that to autistic students are more likely to experience social exclusion, be victims of bullying and have lower academic achievement than their neurotypical classmates at the mainstream secondary level ([<reflink idref="bib42" id="ref70">42</reflink>]). Such factors may predispose autistic adolescents to sleep difficulties. In the current study, 42% of children at age 12 to 13 years had difficulties getting to sleep on four or more nights per week. In contrast, only 20% of neurotypical adolescents are reported to experience similar sleep problems ([<reflink idref="bib36" id="ref71">36</reflink>]). Autistic adolescents have reported difficulties with switching off thoughts at night with frequent ruminations on ideas or concerns, which delay sleep onset ([<reflink idref="bib55" id="ref72">55</reflink>]). The chronicity of these sleep problems into adolescence appears to have a significant impact on mother's mental health. It is suggested that as children age they are less likely to alert their parents to sleep problems, minimising the impacts on parental down time ([<reflink idref="bib22" id="ref73">22</reflink>]). However, this may not be the case when there are significant difficulties with getting to sleep. Autistic adolescents may still alert their parents to these difficulties, impacting parental down time and ultimately having a negative impact on the mother's mental health.</p> <p>Sleep-wake patterns also undergo a significant reorganisation with the transition to adolescence ([<reflink idref="bib45" id="ref74">45</reflink>]). Specifically, sleep-wake timing gradually becomes delayed during adolescence, with a significant rise in the prevalence of delayed sleep-wake phase disorder (DSWPD; [<reflink idref="bib50" id="ref75">50</reflink>]). Like early childhood development, this may be a more vulnerable time for disruption to the circadian system in autistic adolescents. While adults on the autism spectrum have been shown to have elevated rates of DSWPD compared to neurotypical controls ([<reflink idref="bib3" id="ref76">3</reflink>]), little research has systematically examined these circadian rhythm disorders in autistic adolescents. It is likely that dysregulated sleep-wake patterns emerge during adolescence and persist into adulthood. Consistent with proposed models ([<reflink idref="bib24" id="ref77">24</reflink>]; [<reflink idref="bib41" id="ref78">41</reflink>]), the presence of autism combined with a dysregulated circadian system may be specific vulnerability factors for poor sleep, that are exacerbated by environmental stressors, specifically maternal mental health, school transitions, negative school transition outcomes (e.g. social exclusion), and maladaptive coping mechanisms that are commonly seen in autistic children such as hyperarousal and internalising and externalising behaviours ([<reflink idref="bib23" id="ref79">23</reflink>]). Using Hollway and Aman's model as a base, a model for sleep at the current study's time periods is proposed (Figure 2). Nonetheless, as noted by [<reflink idref="bib24" id="ref80">24</reflink>], there are likely other factors that contribute towards poor sleep in autism that require consideration. Further comprehensive and systematic research examining these factors is required to fully elucidate sleep in autism. Nonetheless, in the current study, the full cross-lagged model (Model 4) was a statistically significantly better fit than the base model, suggesting that the identified cross-lag effects are important.</p> <p>Graph: Figure 2. Proposed model of poor sleep in autism at critical school transition time points.aAge of diagnosis is likely most relevant at the transition from preschool to primary school.</p> <p>Consistent with previous literature in the field ([<reflink idref="bib51" id="ref81">51</reflink>]), early child sleep problems predicted future sleep problems across all time points. Similarly, earlier maternal mental health predicted later maternal mental health, highlighting the chronicity of both problems in the child and mother and the need to provide appropriate interventions and supports. As noted by [<reflink idref="bib32" id="ref82">32</reflink>], autistic children's sleep problems are likely modifiable. Although current treatment options are lacking, support for tailored sleep interventions for children with ASD is emerging ([<reflink idref="bib38" id="ref83">38</reflink>]).</p> <p>In a recent randomised controlled trial of the Sleeping Sound intervention with 245 children (aged 5–13 years) with an autism diagnosis ([<reflink idref="bib38" id="ref84">38</reflink>]), significant improvements with large effect sizes on most subscales of the CSHQ at 3 and 6 months post-randomisation were shown. The Sleeping Sound programme includes psychoeducation regarding child sleep in addition to individualised behavioural sleep management plans. Such interventions have the potential to have positive effects for both the child and the mother's mental health and well-being. Moreover, mothers of autistic children who experience increased psychological distress should be monitored routinely and provided appropriate intervention and management to prevent ongoing difficulties. A high level of social and professional support has been associated with better quality of life in parents of autistic children ([<reflink idref="bib29" id="ref85">29</reflink>]; [<reflink idref="bib35" id="ref86">35</reflink>]), further emphasising the need for such external supports at transition times.</p> <hd id="AN0171988762-18">Implications</hd> <p>The findings of the current study highlight the need to provide extra support not only for the child but also for parents and caregivers around the time of diagnosis, school transitions, and times when sleep patterns shift. While specific school transition programmes are available these are often broad-reaching programmes for children with disability more generally, and not specific for autistic children ([<reflink idref="bib13" id="ref87">13</reflink>]). [<reflink idref="bib11" id="ref88">11</reflink>] have proposed a targeted framework of a 3-year school transition programme, which begins 2 years prior to the transition and continues for 1 year after, to facilitate a successful transition and optimise outcomes for the young autistic person. The results of the current study suggest that routine checks and close monitoring of the child's sleep patterns and the mother's mental health at these times should also be considered as important components of transition programmes. Psychological support including psychoeducation around typical sleep patterns for both the child (during adolescence) and mother at these times may be warranted. Further, there is evidence linking child sleep problems in autism with poorer attention, learning and social skills ([<reflink idref="bib7" id="ref89">7</reflink>]; [<reflink idref="bib24" id="ref90">24</reflink>]; [<reflink idref="bib44" id="ref91">44</reflink>]). Thus, detecting and appropriately treating sleep problems will also be crucial for school success, and may also have positive effects on mothers' mental health.</p> <hd id="AN0171988762-19">Strengths and limitations</hd> <p>This is the first known study to use data drawn from families of autistic children participating in a population-based longitudinal study of children to examine the bidirectional relationships between child sleep problems and maternal mental health. Nonetheless, one limitation of the current study is the use of parent reports for the diagnosis of autism. Confirmation of diagnosis was not available and could not be included in the current study. Consequently, the estimated prevalence of autism in this cohort was 4.8%, representing an overestimation of autism diagnoses. Nonetheless, 81.6% of the 397 parents endorsed autism in their child's final data collection wave, and a further 5.5% endorsed autism in the majority of waves. In addition, parent reports are appropriate for and enable large population-based studies and can provide significant insights into epidemiological trends. Moreover, research using other databases has demonstrated that parent reports of autism diagnosis to be valid ([<reflink idref="bib10" id="ref92">10</reflink>]). More specifically, a recent study examined the stability of ASD diagnosis in the LSAC database, demonstrating that the majority of children (between 86% and 74% depending on the cohort) retained their diagnosis over time ([<reflink idref="bib33" id="ref93">33</reflink>]).</p> <p>This study did not use a standardised assessment of sleep, such as the CSHQ, which is commonly used in paediatric sleep research. This limited the ability to examine the severity of sleep problems and their relationship with maternal mental health symptoms. The sheer frequency of endorsed child sleep problems may not accurately represent how severe these sleep problems are. It is possible that severe sleep problems have a greater impact on the mother's own sleep and consequently mental health. In line with this notion, in a study of 234 parent–child dyads ([<reflink idref="bib32" id="ref94">32</reflink>]) where the child had received a diagnosis of autism, sleep initiation difficulties and duration of the problem were the only sleep problems that were significantly associated with maternal mental health difficulties, after adjusting for confounders. Thus, further longitudinal research that examines the specific types and severity of sleep problems may shed further light on the relationships examined here. Finally, the impact of sleep medications on the relationships between maternal mental health and child sleep problems could not be examined in the current study, as these data were not available in the LSAC.</p> <hd id="AN0171988762-20">Conclusions</hd> <p>This study highlighted important associations between child sleep problems and maternal mental health as measured by the K-6. These relationships were particularly evident at key time periods, including time of diagnosis, school transitions and sleep–wake reorganisation. These findings highlight the need for extra support to both the child/young person and their mothers at these times, to prevent exacerbation of sleep problems and maternal psychological distress. Specifically, targeted transition programmes for autistic children should be considered. Such programmes are likely to alleviate parental stress and result in positive outcomes for the child in the classroom setting and at home. Future research should also aim to examine other factors that may contribute to (e.g. child behaviour) or mitigate risks (e.g. social support) between child sleep problems and maternal mental health in this population.</p> <hd id="AN0171988762-21">Supplemental Material</hd> <p>Graph: Supplemental material, sj-docx-1-aut-10.1177_13623613221147397 for A longitudinal study of the relationships between sleep problems in autistic children and maternal mental health by Emma K Baker, Rebecca Giallo, Monique Seymour, Stephen JC Hearps and Catherine E Wood in Autism</p> <ref id="AN0171988762-22"> <title> Footnotes </title> <blist> <bibl id="bib1" idref="ref1" type="bt">1</bibl> <bibtext> Ethics approval for LSAC was obtained from the Australian Institute of Family Studies (AIFS) Ethics Committee. Ethics approval for the current study was obtained from the Swinburne University Human Research Ethics Committee (HREC approval number: 20215750-9016). The LSAC data were accessed through the National Centre for Longitudinal Data (NCLD) Dataverse ([12]).</bibtext> </blist> <blist> <bibl id="bib2" idref="ref2" type="bt">2</bibl> <bibtext> Data included in this study can be accessed through the National Centre for Longitudinal Data (NCLD) Dataverse.</bibtext> </blist> <blist> <bibl id="bib3" idref="ref21" type="bt">3</bibl> <bibtext> The author(s) declared no potential conflicts of interest with respect to the research, authorship and/or publication of this article.</bibtext> </blist> <blist> <bibl id="bib4" idref="ref65" type="bt">4</bibl> <bibtext> The author(s) received no financial support for the research, authorship and/or publication of this article.</bibtext> </blist> <blist> <bibl id="bib5" idref="ref6" type="bt">5</bibl> <bibtext> Emma K Baker</bibtext> </blist> <blist> <bibtext>Graph https://orcid.org/0000-0003-1165-0490</bibtext> </blist> <blist> <bibl id="bib6" idref="ref11" type="bt">6</bibl> <bibtext> Supplemental material for this article is available online.</bibtext> </blist> <blist> <bibl id="bib7" idref="ref3" type="bt">7</bibl> <bibtext> * Rebecca Giallo is also affiliated to Deakin University, Geelong, Australia and Stephen JC Hearps is also affiliated to University of Melbourne, Australia</bibtext> </blist> </ref> <ref id="AN0171988762-23"> <title> References </title> <blist> <bibtext> Allik H., Larsson J., Smedje H. (2006). Health-related quality of life in parents of school-age children with Asperger syndrome or high-functioning autism. Health and Quality of Life Outcomes, 4, Article 1. https://doi.org/10.1186/1477-7525-4-1</bibtext> </blist> <blist> <bibtext> Australian Bureau of Statistics. (2011). Socio-Economic Indexes for Areas (SEIFA).</bibtext> </blist> <blist> <bibtext> Baker E. K., Richdale A. L. (2017). Examining the behavioural sleep-wake rhythm in adults with autism spectrum disorder and no comorbid intellectual disability. Journal of Autism and Developmental Disorders, 47(4), 1207–1222. https://doi.org/10.1007/s10803-017-3042-3</bibtext> </blist> <blist> <bibtext> Bent C. A., Barbaro J., Dissanayake C. (2020). Parents' experiences of the service pathway to an autism diagnosis for their child: What predicts an early diagnosis in Australia? Research in Developmental Disabilities, 103, Article 103689. https://doi.org/10.1016/j.ridd.2020.103689</bibtext> </blist> <blist> <bibtext> Carnett A., McLay L., Hansen S., France K., Blampied N. (2021). Sleep problems in children and adolescents with autism: Type, severity and impact. Journal of Developmental and Physical Disabilities, 33(6), 977–991. https://doi.org/10.1007/s10882-020-09783-5</bibtext> </blist> <blist> <bibtext> Catalano D., Holloway L., Mpofu E. (2018). Mental health interventions for parent carers of children with autistic spectrum disorder: Practice guidelines from a critical interpretive synthesis (CIS) systematic review. International Journal of Environmental Research and Public Health, 15(2), 341. https://doi.org/10.3390/ijerph15020341</bibtext> </blist> <blist> <bibtext> Chen H., Yang T., Chen J., Chen L., Dai Y., Zhang J., Li L., Jia F., Wu L., Hao Y., Ke X., Yi M., Hong Q., Chen J., Fang S., Wang Y., Wang Q., Jin C., Li T. (2021). Sleep problems in children with autism spectrum disorder: A multicenter survey. BMC Psychiatry, 21(1), 406–406. https://doi.org/10.1186/s12888-021-03405-w</bibtext> </blist> <blist> <bibl id="bib8" idref="ref63" type="bt">8</bibl> <bibtext> Connolly M., Gersch I. (2016). Experiences of parents whose children with autism spectrum disorder (ASD) are starting primary school. Educational Psychology in Practice, 32(3), 245–261. https://doi.org/10.1080/02667363.2016.1169512</bibtext> </blist> <blist> <bibl id="bib9" idref="ref12" type="bt">9</bibl> <bibtext> Cuomo B. M., Vaz S., Lee E. A. L., Thompson C., Rogerson J. M., Falkmer T. (2017). Effectiveness of sleep-based interventions for children with autism spectrum disorder: A meta-synthesis. Pharmacotherapy: The Journal of Human Pharmacology and Drug Therapy, 37(5), 555–578. https://doi.org/10.1002/phar.1920</bibtext> </blist> <blist> <bibtext> Daniels A. M., Rosenberg R. E., Anderson C., Law J. K., Marvin A. R., Law P. A. (2012). Verification of parent-report of child autism spectrum disorder diagnosis to a web-based autism registry. Journal of Autism and Developmental Disorders, 42(2), 257–265. https://doi.org/10.1007/s10803-011-1236-7</bibtext> </blist> <blist> <bibtext> Deacy E., Jennings F., O'Halloran A. (2015). Transition of students with autistic spectrum disorders from primary to post-primary school: A framework for success. Support for Learning, 30(4), 292–304. https://doi.org/10.1111/1467-9604.12102</bibtext> </blist> <blist> <bibtext> Department of Social Services. (2022). DSS longitudinal studies data access and use guidelines V5.0. Australian Government.</bibtext> </blist> <blist> <bibtext> Eapen V., Grove R., Aylward E., Joosten A. V., Miller S. I., Van Der Watt G., Fordyce K., Dissanayake C., Maya J., Tucker M., DeBlasio A. (2017). Transition from early intervention program to primary school in children with autism spectrum disorder. World Journal of Clinical Pediatrics, 6(4), 169–175. https://doi.org/10.5409/wjcp.v6.i4.169</bibtext> </blist> <blist> <bibtext> El-Sheikh M., Kelly R. J., Bagley E. J., Wetter E. K. (2012). Parental depressive symptoms and children's sleep: The role of family conflict. Journal of Child Psychology and Psychiatry, 53(7), 806–814. https://doi.org/10.1111/j.1469-7610.2012.02530.x</bibtext> </blist> <blist> <bibtext> Estes A., Munson J., Dawson G., Koehler E., Zhou X.-H., Abbott R. (2009). Parenting stress and psychological functioning among mothers of preschool children with autism and developmental delay. Autism, 13(4), 375–387. https://doi.org/10.1177/1362361309105658</bibtext> </blist> <blist> <bibtext> Estes A., Olson E., Sullivan K., Greenson J., Winter J., Dawson G., Munson J. (2013). Parenting-related stress and psychological distress in mothers of toddlers with autism spectrum disorders. Brain and Development, 35(2), 133–138. https://doi.org/10.1016/j.braindev.2012.10.004</bibtext> </blist> <blist> <bibtext> Finkel S. E. (1995). Causal analysis with panel data. SAGE. https://doi.org/10.4135/9781412983594</bibtext> </blist> <blist> <bibtext> Giallo R., Wood C. E., Jellett R., Porter R. (2013). Fatigue, wellbeing and parental self-efficacy in mothers of children with an autism spectrum disorder. Autism, 17(4), 465–480. https://doi.org/10.1177/1362361311416830</bibtext> </blist> <blist> <bibtext> Glickman G. (2010). Circadian rhythms and sleep in children with autism. Neuroscience and Biobehavioral Reviews, 34(5), 755–768. https://doi.org/10.1016/j.neubiorev.2009.11.017</bibtext> </blist> <blist> <bibtext> Hayes S. A., Watson S. L. (2013). The impact of parenting stress: A meta-analysis of studies comparing the experience of parenting stress in parents of children with and without autism spectrum disorder. Journal of Autism and Developmental Disorders, 43(3), 629–642. https://doi.org/10.1007/s10803-012-1604-y</bibtext> </blist> <blist> <bibtext> Hodge D., Hoffman C. D., Sweeney D. P., Riggs M. L. (2013). Relationship between children's sleep and mental health in mothers of children with and without autism. Journal of Autism and Developmental Disorders, 43(4), 956–963. https://doi.org/10.1007/s10803-012-1639-0</bibtext> </blist> <blist> <bibtext> Holley S., Hill C. M., Stevenson J. (2010). A comparison of actigraphy and parental report of sleep habits in typically developing children aged 6 to 11 years. Behavioral Sleep Medicine, 8(1), 16–27. https://doi.org/10.1080/15402000903425462</bibtext> </blist> <blist> <bibtext> Hollway J. A., Aman M. G. (2011). Sleep correlates of pervasive developmental disorders: A review of the literature. Research in Developmental Disabilities, 32(5), 1399–1421. https://doi.org/10.1016/j.ridd.2011.04.001</bibtext> </blist> <blist> <bibtext> Hollway J. A., Aman M. G., Butter E. (2013). Correlates and risk markers for sleep disturbance in participants of the autism treatment network. Journal of Autism and Developmental Disorders, 43(12), 2830–2843. https://doi.org/10.1007/s10803-013-1830-y</bibtext> </blist> <blist> <bibtext> Hu L. t., Bentler P. M. (1999). Cutoff criteria for fit indexes in covariance structure analysis: Conventional criteria versus new alternatives. Structural Equation Modeling: A Multidisciplinary Journal, 6(1), 1–55. https://doi.org/10.1080/10705519909540118</bibtext> </blist> <blist> <bibtext> Humphreys J. S., Gringras P., Blair P. S., Scott N., Henderson J., Fleming P. J., Emond A. M. (2014). Sleep patterns in children with autistic spectrum disorders: A prospective cohort study. Archives of Disease in Childhood, 99(2), 114–118. https://doi.org/10.1136/archdischild-2013-304083</bibtext> </blist> <blist> <bibtext> Karp E. A., Kuo A. A. (2015). Maternal mental health after a child's diagnosis of autism spectrum disorder. JAMA, 313(1), 81–82. https://doi.org/10.1001/jama.2014.11187</bibtext> </blist> <blist> <bibtext> Kessler R. C., Andrews G., Colpe L. J., Hiripi E., Mroczek D. K., Normand S. L., Walters E. E., Zaslavsky A. M. (2002). Short screening scales to monitor population prevalences and trends in non-specific psychological distress. Psychological Medicine, 32(6), 959–976. https://doi.org/10.1017/s0033291702006074</bibtext> </blist> <blist> <bibtext> Khanna R., Madhavan S. S., Smith M. J., Patrick J. H., Tworek C., Becker-Cottrill B. (2011). Assessment of health-related quality of life among primary caregivers of children with autism spectrum disorders. Journal of Autism and Developmental Disorders, 41(9), 1214–1227. https://doi.org/10.1007/s10803-010-1140-6</bibtext> </blist> <blist> <bibtext> 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</bibtext> </blist> <blist> <bibtext> Martin C. A., Papadopoulos N., Chellew T., Rinehart N. J., Sciberras E. (2019). Associations between parenting stress, parent mental health and child sleep problems for children with ADHD and ASD: Systematic review. Research in Developmental Disabilities, 93, Article 103463. https://doi.org/10.1016/j.ridd.2019.103463</bibtext> </blist> <blist> <bibtext> Martin C. A., Sciberras E., Papadopoulos N., Engel L., Hiscock H., Williams K., Howlin P., McGillivray J., Rinehart N. J. (2021). Associations between child sleep problem severity and maternal well-being in children with autism spectrum disorder. Journal of Autism and Developmental Disorders, 51(7), 2500–2510. https://doi.org/10.1007/s10803-020-04726-7</bibtext> </blist> <blist> <bibtext> May T., Brignell A., Williams K. (2021). Parent-reported autism diagnostic stability and trajectories in the longitudinal study of Australian children. Autism Research, 14(4), 773–786. https://doi.org/10.1002/aur.2470</bibtext> </blist> <blist> <bibtext> Mazurek M. O., Dovgan K., Neumeyer A. M., Malow B. A. (2019). Course and predictors of sleep and co-occurring problems in children with autism spectrum disorder. Journal of Autism and Developmental Disorders, 49(5), 2101–2115. https://doi.org/10.1007/s10803-019-03894-5</bibtext> </blist> <blist> <bibtext> McStay R. L., Trembath D., Dissanayake C. (2014). Stress and family quality of life in parents of children with autism spectrum disorder: Parent gender and the double ABCX model. Journal of Autism and Developmental Disorders, 44(12), 3101–3118. https://doi.org/10.1007/s10803-014-2178-7</bibtext> </blist> <blist> <bibtext> Mindell J. A., Owens J. A. (2015). A clinical guide to pediatric sleep: Diagnosis and management of sleep problems. Lippincott Williams & Wilkins.</bibtext> </blist> <blist> <bibtext> Papadopoulos D. (2021). Mothers' experiences and challenges raising a child with autism spectrum disorder: A qualitative study. Brain Sciences, 11(3), Article 309. https://doi.org/10.3390/brainsci11030309</bibtext> </blist> <blist> <bibtext> 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. (2022). Sleeping sound autism spectrum disorder (ASD): A randomised controlled trial of a brief behavioural sleep intervention in primary school-aged autistic children. Journal of Child Psychology and Psychiatry, 63, 1423–1433. https://doi.org/10.1111/jcpp.13590</bibtext> </blist> <blist> <bibtext> Pattison E., Papadopoulos N., Marks D., McGillivray J., Rinehart N. (2020). Behavioural treatments for sleep problems in children with autism spectrum disorder: A review of the recent literature. Current Psychiatry Reports, 22, 46. https://doi.org/10.1007/s11920-020-01172-1</bibtext> </blist> <blist> <bibtext> Reynolds A. M., Soke G. N., Sabourin K. R., Hepburn S., Katz T., Wiggins L. D., Schieve L. A., Levy S. E. (2019). Sleep problems in 2- to 5-year-olds with autism spectrum disorder and other developmental delays. Pediatrics, 143(3), e20180492. https://doi.org/10.1542/peds.2018-0492</bibtext> </blist> <blist> <bibtext> 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.smrv.2009.02.003</bibtext> </blist> <blist> <bibtext> Richter M., Popa-Roch M., Clément C. (2019). Successful transition from primary to secondary school for students with autism spectrum disorder: A systematic literature review. Journal of Research in Childhood Education, 33(3), 382–398. https://doi.org/10.1080/02568543.2019.1630870</bibtext> </blist> <blist> <bibtext> Roubinov D., Don B., Blades R., Epel E. (2022). Is it me or my child? The association between maternal depression and children's behavior problems in mothers and their children with or without autism. Family Process, 2022, Article e12810. https://doi.org/10.1111/famp.12810</bibtext> </blist> <blist> <bibtext> Roussis S., Richdale A. L., Katz T., Malow B. A., Barbaro J., Sadka N. (2021). Behaviour, cognition, and autism symptoms and their relationship with sleep problem severity in young children with autism spectrum disorder. Research in Autism Spectrum Disorders, 83, Article 101743. https://doi.org/10.1016/j.rasd.2021.101743</bibtext> </blist> <blist> <bibtext> Sadeh A., Dahl R. E., Shahar G., Rosenblat-Stein S. (2009). Sleep and the transition to adolescence: A longitudinal study. Sleep, 32(12), 1602–1609. https://doi.org/10.1093/sleep/32.12.1602</bibtext> </blist> <blist> <bibtext> Sadeh A., Raviv A., Gruber R. (2000). Sleep patterns and sleep disruptions in school-age children. Developmental Psychology, 36(3), 291–301. https://doi.org/10.1037/0012-1649.36.3.291</bibtext> </blist> <blist> <bibtext> Schnabel A., Youssef G. J., Hallford D. J., Hartley E. J., McGillivray J. A., Stewart M., Forbes D., Austin D. W. (2019). Psychopathology in parents of children with autism spectrum disorder: A systematic review and meta-analysis of prevalence. Autism, 24(1), 26–40. https://doi.org/10.1177/1362361319844636</bibtext> </blist> <blist> <bibtext> Schreck K. A., Richdale A. L. (2020). Sleep problems, behavior, and psychopathology in autism: Inter-relationships across the lifespan. Current Opinion in Psychology, 34, 105–111. https://doi.org/10.1016/j.copsyc.2019.12.003</bibtext> </blist> <blist> <bibtext> Seymour M., Wood C., Giallo R., Jellett R. (2013). Fatigue, stress and coping in mothers of children with an autism spectrum disorder. Journal of Autism and Developmental Disorders, 43(7), 1547–1554. https://doi.org/10.1007/s10803-012-1701-y</bibtext> </blist> <blist> <bibtext> Sivertsen B., Pallesen S., Stormark K. M., Bøe T., Lundervold A. J., Hysing M. (2013). Delayed sleep phase syndrome in adolescents: Prevalence and correlates in a large population based study. BMC Public Health, 13(1), Article 1163. https://doi.org/10.1186/1471-2458-13-1163</bibtext> </blist> <blist> <bibtext> Sivertsen B., Posserud M.-B., Gillberg C., Lundervold A. J., Hysing M. (2012). Sleep problems in children with autism spectrum problems: A longitudinal population-based study. Autism, 16(2), 139–150. https://doi.org/10.1177/1362361311404255</bibtext> </blist> <blist> <bibtext> Soloff C., Lawrence D., Johnstone R. (2005). The longitudinal study of Australian children: Sample design. LSAC Technical Paper Number 1.</bibtext> </blist> <blist> <bibtext> Tarokh L., Saletin J. M., Carskadon M. A. (2016). Sleep in adolescence: Physiology, cognition and mental health. Neuroscience and Biobehavioral Reviews, 70, 182–188. https://doi.org/10.1016/j.neubiorev.2016.08.008</bibtext> </blist> <blist> <bibtext> Totsika V., Hastings R. P., Emerson E., Lancaster G. A., Berridge D. M. (2011). A population-based investigation of behavioural and emotional problems and maternal mental health: Associations with autism spectrum disorder and intellectual disability. Journal of Child Psychology and Psychiatry, 52(1), 91–99. https://doi.org/10.1111/j.1469-7610.2010.02295.x</bibtext> </blist> <blist> <bibtext> Van Deurs J. R., France K. G., McLay L. K., Blampied N. M. (2021). Cognitive-behavioral treatment of sleep disturbance in children and adolescents with autism: Eight case studies using functional behavior assessment. Research in Autism Spectrum Disorders, 86, Article 101823. https://doi.org/10.1016/j.rasd.2021.101823</bibtext> </blist> <blist> <bibtext> Vasilopoulou E., Nisbet J. (2016). The quality of life of parents of children with autism spectrum disorder: A systematic review. Research in Autism Spectrum Disorders, 23, 36–49. https://doi.org/10.1016/j.rasd.2015.11.008</bibtext> </blist> <blist> <bibtext> Wiggs L., Stores G. (2004). Sleep patterns and sleep disorders in children with autistic spectrum disorders: Insights using parent report and actigraphy. Developmental Medicine & Child Neurology, 46(6), 372–380. https://doi.org/10.1017/s0012162204000611</bibtext> </blist> <blist> <bibtext> Wothke W. (2000). Longitudinal and multi-group modeling with missing data. In Little T. D., Schnabel K. U., Baumert J. (Eds.), Modeling longitudinal and multiple group data: Practical issues, applied approaches and specific examples (pp. 197–216). Lawrence Erlbaum.</bibtext> </blist> <blist> <bibtext> Zablotsky B., Bradshaw C.P., Stuart E.A. (2013). The association between mental health, stress, and coping supports in mothers of children with autism spectrum disorders. Journal of Autism and Developmental Disorders, 43, 1380–1393. https://doi.org/10.1007/s10803-012-1693-7</bibtext> </blist> </ref> <aug> <p>By Emma K Baker; Rebecca Giallo; Monique Seymour; Stephen JC Hearps and Catherine E Wood</p> <p>Reported by Author; Author; Author; Author; Author</p> </aug> <nolink nlid="nl1" bibid="bib34" firstref="ref4"></nolink> <nolink nlid="nl2" bibid="bib40" firstref="ref5"></nolink> <nolink nlid="nl3" bibid="bib48" firstref="ref7"></nolink> <nolink nlid="nl4" bibid="bib18" firstref="ref8"></nolink> <nolink nlid="nl5" bibid="bib31" firstref="ref9"></nolink> <nolink nlid="nl6" bibid="bib39" firstref="ref10"></nolink> <nolink nlid="nl7" bibid="bib32" firstref="ref13"></nolink> <nolink nlid="nl8" bibid="bib26" firstref="ref15"></nolink> <nolink nlid="nl9" bibid="bib30" firstref="ref18"></nolink> <nolink nlid="nl10" bibid="bib44" firstref="ref19"></nolink> <nolink nlid="nl11" bibid="bib57" firstref="ref20"></nolink> <nolink nlid="nl12" bibid="bib53" firstref="ref22"></nolink> <nolink nlid="nl13" bibid="bib41" firstref="ref23"></nolink> <nolink nlid="nl14" bibid="bib19" firstref="ref25"></nolink> <nolink nlid="nl15" bibid="bib23" firstref="ref28"></nolink> <nolink nlid="nl16" bibid="bib24" firstref="ref29"></nolink> <nolink nlid="nl17" bibid="bib14" firstref="ref33"></nolink> <nolink nlid="nl18" bibid="bib20" firstref="ref34"></nolink> <nolink nlid="nl19" bibid="bib49" firstref="ref35"></nolink> <nolink nlid="nl20" bibid="bib54" firstref="ref36"></nolink> <nolink nlid="nl21" bibid="bib47" firstref="ref37"></nolink> <nolink nlid="nl22" bibid="bib16" firstref="ref38"></nolink> <nolink nlid="nl23" bibid="bib15" firstref="ref39"></nolink> <nolink nlid="nl24" bibid="bib43" firstref="ref40"></nolink> <nolink nlid="nl25" bibid="bib59" firstref="ref41"></nolink> <nolink nlid="nl26" bibid="bib37" firstref="ref42"></nolink> <nolink nlid="nl27" bibid="bib56" firstref="ref43"></nolink> <nolink nlid="nl28" bibid="bib21" firstref="ref48"></nolink> <nolink nlid="nl29" bibid="bib22" firstref="ref51"></nolink> <nolink nlid="nl30" bibid="bib36" firstref="ref52"></nolink> <nolink nlid="nl31" bibid="bib46" firstref="ref54"></nolink> <nolink nlid="nl32" bibid="bib52" firstref="ref55"></nolink> <nolink nlid="nl33" bibid="bib12" firstref="ref57"></nolink> <nolink nlid="nl34" bibid="bib28" firstref="ref59"></nolink> <nolink nlid="nl35" bibid="bib17" firstref="ref60"></nolink> <nolink nlid="nl36" bibid="bib25" firstref="ref61"></nolink> <nolink nlid="nl37" bibid="bib13" firstref="ref62"></nolink> <nolink nlid="nl38" bibid="bib27" firstref="ref66"></nolink> <nolink nlid="nl39" bibid="bib42" firstref="ref69"></nolink> <nolink nlid="nl40" bibid="bib55" firstref="ref72"></nolink> <nolink nlid="nl41" bibid="bib45" firstref="ref74"></nolink> <nolink nlid="nl42" bibid="bib50" firstref="ref75"></nolink> <nolink nlid="nl43" bibid="bib51" firstref="ref81"></nolink> <nolink nlid="nl44" bibid="bib38" firstref="ref83"></nolink> <nolink nlid="nl45" bibid="bib29" firstref="ref85"></nolink> <nolink nlid="nl46" bibid="bib35" firstref="ref86"></nolink> <nolink nlid="nl47" bibid="bib11" firstref="ref88"></nolink> <nolink nlid="nl48" bibid="bib10" firstref="ref92"></nolink> <nolink nlid="nl49" bibid="bib33" firstref="ref93"></nolink>
Header DbId: eric
DbLabel: ERIC
An: EJ1393060
AccessLevel: 3
PubType: Academic Journal
PubTypeId: academicJournal
PreciseRelevancyScore: 0
IllustrationInfo
Items – Name: Title
  Label: Title
  Group: Ti
  Data: A Longitudinal Study of the Relationships between Sleep Problems in Autistic Children and Maternal Mental Health
– Name: Language
  Label: Language
  Group: Lang
  Data: English
– Name: Author
  Label: Authors
  Group: Au
  Data: <searchLink fieldCode="AR" term="%22Baker%2C+Emma+K%2E%22">Baker, Emma K.</searchLink> (ORCID <externalLink term="https://orcid.org/0000-0003-1165-0490">0000-0003-1165-0490</externalLink>)<br /><searchLink fieldCode="AR" term="%22Giallo%2C+Rebecca%22">Giallo, Rebecca</searchLink><br /><searchLink fieldCode="AR" term="%22Seymour%2C+Monique%22">Seymour, Monique</searchLink><br /><searchLink fieldCode="AR" term="%22Hearps%2C+Stephen+J%2E+C%2E%22">Hearps, Stephen J. C.</searchLink><br /><searchLink fieldCode="AR" term="%22Wood%2C+Catherine+E%2E%22">Wood, Catherine E.</searchLink>
– Name: TitleSource
  Label: Source
  Group: Src
  Data: <searchLink fieldCode="SO" term="%22Autism%3A+The+International+Journal+of+Research+and+Practice%22"><i>Autism: The International Journal of Research and Practice</i></searchLink>. Oct 2023 27(7):1891-1905.
– Name: Avail
  Label: Availability
  Group: Avail
  Data: SAGE Publications. 2455 Teller Road, Thousand Oaks, CA 91320. Tel: 800-818-7243; Tel: 805-499-9774; Fax: 800-583-2665; e-mail: journals@sagepub.com; Web site: https://sagepub.com
– Name: PeerReviewed
  Label: Peer Reviewed
  Group: SrcInfo
  Data: Y
– Name: Pages
  Label: Page Count
  Group: Src
  Data: 15
– Name: DatePubCY
  Label: Publication Date
  Group: Date
  Data: 2023
– Name: TypeDocument
  Label: Document Type
  Group: TypDoc
  Data: Journal Articles<br />Reports - Research
– Name: Subject
  Label: Descriptors
  Group: Su
  Data: <searchLink fieldCode="DE" term="%22Young+Children%22">Young Children</searchLink><br /><searchLink fieldCode="DE" term="%22Mothers%22">Mothers</searchLink><br /><searchLink fieldCode="DE" term="%22Autism+Spectrum+Disorders%22">Autism Spectrum Disorders</searchLink><br /><searchLink fieldCode="DE" term="%22Mental+Health%22">Mental Health</searchLink><br /><searchLink fieldCode="DE" term="%22Sleep%22">Sleep</searchLink><br /><searchLink fieldCode="DE" term="%22Problems%22">Problems</searchLink><br /><searchLink fieldCode="DE" term="%22Relationship%22">Relationship</searchLink><br /><searchLink fieldCode="DE" term="%22Mental+Disorders%22">Mental Disorders</searchLink><br /><searchLink fieldCode="DE" term="%22Foreign+Countries%22">Foreign Countries</searchLink><br /><searchLink fieldCode="DE" term="%22Change%22">Change</searchLink><br /><searchLink fieldCode="DE" term="%22Educational+Attainment%22">Educational Attainment</searchLink><br /><searchLink fieldCode="DE" term="%22Time+Perspective%22">Time Perspective</searchLink>
– Name: Subject
  Label: Geographic Terms
  Group: Su
  Data: <searchLink fieldCode="DE" term="%22Australia%22">Australia</searchLink>
– Name: DOI
  Label: DOI
  Group: ID
  Data: 10.1177/13623613221147397
– Name: ISSN
  Label: ISSN
  Group: ISSN
  Data: 1362-3613<br />1461-7005
– Name: Abstract
  Label: Abstract
  Group: Ab
  Data: Autistic children experience a high rate of sleep problems, which have been associated with maternal mental health difficulties. However, the directionality of these relationships has received little attention. The extent to which children's sleep problems influence maternal mental health difficulties and vice versa remains unclear. The aim of this study was to examine the bidirectional relationships between the sleep problems of autistic children and maternal mental health difficulties over 12 years. Six biennial waves of longitudinal data from when children were 4 to 5 years old were drawn from the Longitudinal Study of Australian Children. The sample comprised 397 child-mother dyads. Maternal mental health was assessed with the Kessler-6, while sleep problems were assessed through a series of questions relating to common sleep problems in children. The results demonstrated significant bidirectional effects between maternal mental health and child sleep problems at key developmental transition time points. Specifically, when children transitioned from preschool to primary school and again when the children transitioned from primary school to high school. These findings highlight the need for increased support for both the child and mother at these critical time points to reduce the negative impact of maternal psychological distress on child sleep problems and vice versa.
– Name: AbstractInfo
  Label: Abstractor
  Group: Ab
  Data: As Provided
– Name: DateEntry
  Label: Entry Date
  Group: Date
  Data: 2023
– Name: AN
  Label: Accession Number
  Group: ID
  Data: EJ1393060
PLink https://search.ebscohost.com/login.aspx?direct=true&site=eds-live&db=eric&AN=EJ1393060
RecordInfo BibRecord:
  BibEntity:
    Identifiers:
      – Type: doi
        Value: 10.1177/13623613221147397
    Languages:
      – Text: English
    PhysicalDescription:
      Pagination:
        PageCount: 15
        StartPage: 1891
    Subjects:
      – SubjectFull: Young Children
        Type: general
      – SubjectFull: Mothers
        Type: general
      – SubjectFull: Autism Spectrum Disorders
        Type: general
      – SubjectFull: Mental Health
        Type: general
      – SubjectFull: Sleep
        Type: general
      – SubjectFull: Problems
        Type: general
      – SubjectFull: Relationship
        Type: general
      – SubjectFull: Mental Disorders
        Type: general
      – SubjectFull: Foreign Countries
        Type: general
      – SubjectFull: Change
        Type: general
      – SubjectFull: Educational Attainment
        Type: general
      – SubjectFull: Time Perspective
        Type: general
      – SubjectFull: Australia
        Type: general
    Titles:
      – TitleFull: A Longitudinal Study of the Relationships between Sleep Problems in Autistic Children and Maternal Mental Health
        Type: main
  BibRelationships:
    HasContributorRelationships:
      – PersonEntity:
          Name:
            NameFull: Baker, Emma K.
      – PersonEntity:
          Name:
            NameFull: Giallo, Rebecca
      – PersonEntity:
          Name:
            NameFull: Seymour, Monique
      – PersonEntity:
          Name:
            NameFull: Hearps, Stephen J. C.
      – PersonEntity:
          Name:
            NameFull: Wood, Catherine E.
    IsPartOfRelationships:
      – BibEntity:
          Dates:
            – D: 01
              M: 10
              Type: published
              Y: 2023
          Identifiers:
            – Type: issn-print
              Value: 1362-3613
            – Type: issn-electronic
              Value: 1461-7005
          Numbering:
            – Type: volume
              Value: 27
            – Type: issue
              Value: 7
          Titles:
            – TitleFull: Autism: The International Journal of Research and Practice
              Type: main
ResultId 1