{"title":"Telehealth-delivered behavioral sleep interventions for Autistic children: An evaluation of an enhanced stepped-care approach","authors":"Monique Clarke , Laurie McLay , Karyn France , Neville Blampied","doi":"10.1016/j.rasd.2024.102456","DOIUrl":null,"url":null,"abstract":"<div><h3>Background</h3><p>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.</p></div><div><h3>Method</h3><p>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.</p></div><div><h3>Results</h3><p>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.</p></div><div><h3>Conclusions</h3><p>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.</p></div>","PeriodicalId":48255,"journal":{"name":"Research in Autism Spectrum Disorders","volume":"117 ","pages":"Article 102456"},"PeriodicalIF":2.2000,"publicationDate":"2024-07-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S1750946724001314/pdfft?md5=9b53d8d7b698492a70a760f7ab30d463&pid=1-s2.0-S1750946724001314-main.pdf","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Research in Autism Spectrum Disorders","FirstCategoryId":"3","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S1750946724001314","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"EDUCATION, SPECIAL","Score":null,"Total":0}
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Abstract
Background
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.
Method
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.
Results
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.
Conclusions
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.
期刊介绍：
Research in Autism Spectrum Disorders (RASD) publishes high quality empirical articles and reviews that contribute to a better understanding of Autism Spectrum Disorders (ASD) at all levels of description; genetic, neurobiological, cognitive, and behavioral. The primary focus of the journal is to bridge the gap between basic research at these levels, and the practical questions and difficulties that are faced by individuals with ASD and their families, as well as carers, educators and clinicians. In addition, the journal encourages submissions on topics that remain under-researched in the field. We know shamefully little about the causes and consequences of the significant language and general intellectual impairments that characterize half of all individuals with ASD. We know even less about the challenges that women with ASD face and less still about the needs of individuals with ASD as they grow older. Medical and psychological co-morbidities and the complications they bring with them for the diagnosis and treatment of ASD represents another area of relatively little research. At RASD we are committed to promoting high-quality and rigorous research on all of these issues, and we look forward to receiving many excellent submissions.
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