# Disturbances and Associated Factors Among Children With Autism Spectrum Disorder: A Cross-Sectional Study

## TL;DR

This study found that children with autism in Saudi Arabia have high rates of sleep problems linked to factors like autism severity and parental anxiety.

## Contribution

The study identifies specific clinical and psychosocial predictors of sleep disturbances in children with autism in Al-Ahsa, Saudi Arabia.

## Key findings

- 116 children with ASD had a mean CSHQ score of 76.3, indicating significant sleep disturbances.
- Factors like autism severity and parental sleep-related anxiety were independently linked to sleep problems.
- Early diagnosis and integrated interventions are recommended to improve sleep and quality of life.

## Abstract

Introduction

Children with autism spectrum disorder (ASD) experience a range of comorbidities, including sleep disorders. Sleep disturbances are more prevalent in this population than in typically developing children and may exacerbate behavioral symptoms such as inattention and irritability, increasing the overall psychosocial burden of ASD.

Aim

This study assessed the pattern, frequency, and predictors of sleep disturbances among children with ASD in Al-Ahsa, Saudi Arabia.

Methods

A cross-sectional study was conducted between April 2025 and October 2025 among children diagnosed with ASD at the Child Development Center of Maternity and Children Hospital, Al-Ahsa. Caregivers completed the Children’s Sleep Habits Questionnaire (CSHQ), a validated 33-item instrument covering eight sleep domains, with a total score ≥41 indicating clinically significant sleep disturbance. Additional demographic, behavioral, and clinical data were collected. Descriptive statistics, t-tests, one-way ANOVA, and multiple linear regression were used to identify factors associated with sleep disturbance.

Results

A total of 116 children with ASD were included, with a mean age of 6.2±1.9 years. The mean total CSHQ score was 76.3±9.3, indicating a high burden of sleep disturbances. In bivariate analyses, total CSHQ scores were significantly associated with age at autism diagnosis, autism severity, parental sleep-related anxiety, sleeping arrangement, caffeine intake, and history of sleep medication use. In multivariable linear regression analysis, age at autism diagnosis, autism severity, parental sleep-related anxiety, sleeping arrangement, and prior use of sleep-inducing medications remained independently associated with total sleep disturbance scores, whereas caffeine intake was not retained in the final model.

Conclusion

Sleep disturbances were highly prevalent among children with ASD, affecting multiple sleep domains and influenced by a combination of clinical and psychosocial factors. Routine sleep screening, caregiver education, early ASD diagnosis, and integrated behavioral and medical interventions are essential to improving sleep and overall quality of life in this population.