0851 Sleep Moderates Behavioral Difficulties and Quality of Life in Autistic Children

Abstract Introduction Research indicates a relationship between increased behavioral difficulties (e.g., irritability, social withdrawal, stereotypic behaviors, noncompliance, inappropriate speech) and poor quality of life (QoL) in autistic children. However, little is known about how sleep may be associated with this relationship. To assess the mechanistic role of sleep, we examined whether autistic school-age child sleep moderated the relationship between behavioral difficulties and QoL. Methods Children with autism spectrum disorder (N=65; Mage=8.95, SD=2.01, range 6-12; 74% male), verbal IQ >70, and parent reported sleep complaints completed 14 days of sleep diaries (with parental assistance) and their parents completed surveys (Child Sleep Health Questionnaire-CSHQ, Pediatric Quality of Life-PedsQoL, Aberrant Behavior Checklist-ABC). Multiple regressions (SPSS PROCESS Model 1) examined whether sleep (subjective diary total sleep time-TST; CSHQ total score) moderated associations between behavioral difficulties (irritability, inappropriate speech, stereotypic behaviors, hyperactivity) and QoL (health, social, emotional, school) in baseline data. Analyses controlled for age. Results CSHQ moderated associations between irritability and social QoL (β=.34, p=.04). In children with the best overall sleep health, less irritability was associated with better social QoL, β=-6.32, p=.002. CSHQ also moderated associations between hyperactivity and school QoL (β=.25, p=.02). Similarly, in children who had the best overall sleep health, less hyperactivity was associated with better school QoL β=-3.84, p=.001. TST moderated associations between inappropriate speech and social QoL (β=-.12, p=.02). At the longest TST, less inappropriate speech was associated with better social QoL, β=-3.45, p=.001. TST moderated associations between stereotypic behaviors and social QoL (β=-.10, p=.04). At the longest TST, less stereotypic behaviors were associated with better social QoL β=-15.14, p=.004. Conclusion The present findings suggest that, in autistic children, the relationship between behavioral difficulties and school/social QoL depends on overall sleep health, particularly TST. It is possible that improving sleep through behavioral sleep treatments may change the relationship between problematic behaviors QoL in this population. However, more research using longitudinal, experimental, and trial methodology and perhaps even examining other aspects of TST (e.g., variability) are needed. Support (if any)