Telehealth-delivered behavioral sleep interventions for Autistic children: An evaluation of an enhanced stepped-care approach

• Published in: Research in autism spectrum disorders Vol. 117; p. 102456
• Main Authors: Clarke, Monique, McLay, Laurie, France, Karyn, Blampied, Neville
• Format: Journal Article
• Language: English
• Published: Elsevier Ltd 01.09.2024
• Subjects: Autism; Child; Intervention; Sleep initiation and maintenance problems; Telehealth; Telemedicine; Intervention; Autism; Sleep initiation and maintenance problems; Telemedicine; Telehealth; Child
• DOI: 10.1016/j.rasd.2024.102456
• ISSN: 1750-9467

Sleep problems are common among Autistic children and can have adverse effects on their development, well-being and quality of life. Telehealth offers a cost-effective and accessible model of delivering evidence-based sleep support. This study used a single-case design to evaluate the efficacy of telehealth-delivered behavioral sleep intervention (TDBSI), with intervention phases designed based according to a stepped-care approach. Fourteen Autistic children (3–17 years) and their parents participated in a 12-week program consisting of three sequential intervention phases: 1) self-directed online parent education supplemented with individualized intervention tip sheets, 2) group parent coaching via video conferencing, and 3) individualized parent coaching via video conferencing. The appropriateness of parent strategy selection and implementation fidelity was rated throughout. Sleep problem severity (SPS) scores are reported for each child as a measure of effect across intervention phases. The Children's Sleep Habits Questionnaire (CSHQ) and CSHQ-Autism are reported as measures of change from baseline to post-intervention. Online parent education and tip sheets facilitated early success in parent strategy selection and implementation fidelity. SPS scores demonstrated large and statistically significant improvements in child sleep following the self-directed phase. Parent implementation fidelity and child sleep outcomes were further improved with group and individualized coaching. Post-intervention, the CSHQ and CSHQ-Autism revealed large and statistically significant improvements across subscales and participants compared to baseline. Online parent education supplemented with individualized tip sheets demonstrates potential for addressing sleep problems in Autistic children. Therapist-led group and individualized parent coaching via videoconferencing show promise as higher intensity support for parents who do not achieve satisfactory results initially. •Guided online education may be an effective first step of the stepped-care model.•Group or individualized parent coaching may be needed for some Autistic children.•Telehealth and stepped-care may be an acceptable method for intervention delivery.