The role of insomnia, pre-sleep arousal and psychopathology symptoms in daytime impairment in adolescents with high-functioning autism spectrum disorder
Abstract
Objectives Sleep disturbance and psychopathology are common during adolescence and are highly prevalent in individuals diagnosed with autism spectrum disorder (ASD). The aim of this study was to investigate relationships between sleep disturbance, psychopathology symptoms, and daytime functioning in adolescents with high-functioning autism spectrum disorder (HFASD) compared to typically developing (TD) adolescents. Methods Twenty-seven adolescents with HFASD and 27 age- and sex-matched TD adolescents completed questionnaires related to sleep, psychopathology and daytime functioning. Participants also completed a 7-day sleep/wake diary. A subsample of HFASD adolescents (55%) and all the TD adolescents wore an actigraphy monitor concurrently with the sleep diary. Results Adolescents with HFASD had significantly higher scores for depressed mood, anxiety and pre-sleep arousal compared with TD adolescents and poorer daytime functioning. There were more significant correlations between sleep variables and psychopathology variables, and sleep variables and daytime functioning, in the HFASD group than in the TD group. Standard regression found that sleep variables significantly accounted for 57% of the variance in daytime functioning symptoms of insufficient sleep in the HFASD group, while psychopathology variables accounted for 63% of the variance in daytime functioning. Conclusions Both sleep disturbance and psychopathology are more prevalent in adolescents with HFASD and are major…
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The SAAQ has excellent internal consistency in autistic adolescents (α = .92) and nonautistic adolescents (α = .87).
“Higher scores indicate greater arousal, and it has excellent internal consistency in autistic adolescents ( α = .92) and nonautistic adolescents ( α = .87) (Richdale et al ., 2014).”
From ACT-i, an insomnia intervention for autistic adults: A pilot study (2023) · cites this paper as Richdale et al., 2014
The significant reduction in anxiety symptoms and pre-sleep arousal in response to ACT-i supports the identified relationship between insomnia, anxiety or poor mental health, and presleep arousal in autistic populations.
“The significant reduction in anxiety symptoms and pre-sleep arousal in response to ACT-i supports the identified relationship between insomnia, anxiety or poor mental health, and presleep arousal in autistic populations (Baker et al ., 2019b; Gilbert Gustemp et al ., 2021; Richdale et al ., 2014; Tani et al ., 2003)”
From ACT-i, an insomnia intervention for autistic adults: A pilot study (2023) · cites this paper as Richdale et al., 2014
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Cleary, M., Keeley, J., Richardson, C., Heussler, H., Wilson, A., Walsh, J., & Downs, J. (2025) · Sleep Medicine · doi:10.1016/j.sleep.2025.106507 · Cited by 1 · see citing works
Autism and sleep across development: Advancing research and treatment through co-production
Spanò, G., Combs, D., Dwyer, P. S. R., Luongo, A., Parent-Johnson, W., & Edgin, J. O. (2024) · Neurodiversity · doi:10.1177/27546330241238668 · Cited by 2 · see citing works
“…around 80% of adolescents and young autistic adults may experience sleep problems (Godbout et al., 2000; Mannion et al., 2013; Øyane & Bjørvatn, 2005; Richdale et al., 2014), making them one of the most frequent comorbidities consistently highlighted by both families and healthcare practitioners…”
Akter, R., & Rahman, M. H. (2021) · Springer eBooks · doi:10.1007/978-981-16-4558-7_14 · Cited by 3 · see citing works
Hamad, O. F., Klára, S., Elmadani, M., Mbaabu, G., Tóth, L., Horváth, É., Mesmar, A., & Máté, O. (2026) · Frontiers in Health Services · doi:10.3389/frhs.2026.1835710
“Physiological conditions, sleep disturbance, gastrointestinal problems, and epilepsy are more prevalent in autistic children than in non-autistic peers, contributing to more complex clinical needs (35).”
Sleep in Children With Developmental Disabilities: How Can Videosomnography Inform Intervention?
Lee, J., Schwichtenberg, A., & Spratling, R. (2026) · Journal of Pediatric Health Care · doi:10.1016/j.pedhc.2025.11.023
Clarke, M., McLay, L., France, K. G., & Blampied, N. M. (2025) · Research in Autism Spectrum Disorders · doi:10.1016/j.rasd.2024.102514
Off-body Sleep Analysis for Predicting Adverse Behavior in Individuals with Autism Spectrum Disorder
Kiarashi, Y., Suresha, P., Rad, A. B., Reyna, M. A., Anderson, C., Foster, J., Lantz, J., Villavicencio, T., Hamlin, T., & Clifford, G. (2024) · medRxiv · doi:10.1101/2024.01.23.24301681
“…improvements in daytime behavior following sleep interventions [37], indicated that sleep variables account for variances in daytime functioning [43], highlighted that individuals with severe sleep issues display higher levels of challenging behaviors [2], and even proposed that the severity of…”
InfluentialMcCrae, C. S., Mazurek, M. O., Nevill, R. E. A., Davenport, M., Rouch, E. F., & Curtis, A. F. (2021) · Springer eBooks · doi:10.1007/978-3-030-65574-7_50 · Cited by 5 · see citing works
van Deurs, J. R. (2020) · doi:10.26021/7901
“Further, as both cognitive and behavioural components can be implicated in the establishment and maintenance of sleep disturbance, interventions which address both areas are likely to be effective in lessening sleep disturbance (Richdale et al., 2014).”
BackgroundCircadian Rhythm Disorders in Childhood
Miano, S. (2016) · Springer eBooks · doi:10.1007/978-3-319-28640-2_12 · Cited by 2 · see citing works
Psychiatric Disorders and the RAS
D’Onofrio, S. M., Messias, E., & Garcia-Rill, E. (2015) · Elsevier eBooks · doi:10.1016/b978-0-12-801385-4.00011-2
- Authors
- Richdale, A. L., Baker, E., Short, M., & Gradisar, M.
- Affiliations
- La Trobe University (AU)
- University of South Australia (AU)
- Flinders University (AU)
- Corresponding author
- Richdale, Amanda L.
- Venue
- Sleep Medicine
- Publisher
- Elsevier BV
- Published
- 2014-09
- Volume
- 15
- Issue
- 9
- Pages
- 1082-1088
- ISSN
- 1389-9457 (ISSN-L)
- OpenAlex
- W1973571342
- Cited by
- 87
- References
- 0
- Citations by year
- 2026: 6 · 2025: 5 · 2024: 8 · 2023: 10 · 2022: 4 · 2021: 10 · 2020: 10 · 2019: 9 · 2018: 6 · 2017: 5 · 2016: 9 · 2015: 3 · 2014: 2
- FWCI
- 8.81
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Sleep Medicine (publishedVersion)
- PubMed (publishedVersion)
- Adelaide Research & Scholarship (AR&S) (University of Adelaide) (submittedVersion)
- Topics
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Sleep and related disorders
- Life Sciences › Neuroscience › Cognitive Neuroscience › Autism Spectrum Disorder Research
- Life Sciences › Neuroscience › Cognitive Neuroscience › Sleep and Wakefulness Research
- Keywords
- high-functioning autism, insomnia, pre-sleep arousal, sleep disorders, psychopathology, daytime functioning, adolescents, depression, anxiety, insufficient sleep, actigraphy
- MeSH terms
- Activities of Daily Living, Adolescent, Anxiety Disorders, Arousal, Child Development Disorders, Pervasive, Depressive Disorder, Humans, Sleep Initiation and Maintenance Disorders, Psychopathology, South Australia, Statistics as Topic, Asperger Syndrome
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