Scoping Review of Socio-Ecological Factors Contributing to Sleep Health Disparities in Children with Autism Spectrum Disorder.

Abstract

Given the high prevalence of sleep problems in children with autism spectrum disorder (ASD), there is a critical need to examine how sleep problems may be exacerbated for children exposed to social and environmental adversity. Guided by the socio-ecological model, this review aimed to evaluate factors linked to sleep health disparities (SHDs) in children with ASD, determine possible gaps/limitations in existing literature, and identify possible solutions. A scoping review was selected to ascertain what is known about SHDs in ASD. Four databases identified articles from 2004 to 2023. Included articles were those conducted in children with ASD that focused on sleep and examined socio-ecological factors (i.e., individual, family, neighborhood and socio-cultural) possibly contributing to SHDs. 41 studies were extracted; 31 (75.6%) focused on individual factors, 27 (65.9%) focused on family factors, 11 (26.8%) focused on neighborhood and/or socio-cultural factors; 3 (7.3%) focused on factors across all three socio-ecological levels. Six studies included interventions that found improvements in child sleep, behavior, and quality of life. Representation of racial and ethnic minoritized groups was limited across studies. Most studies focused on individual child factors associated with sleep problems, with less research focused on family factors, and very few studies examining broader neighborhood and socio-cultural factors. Only about half of studies reported race and ethnicity data, with sparse representation of racial and ethnic minoritized children and families overall. These findings highlight the need for future research on modifiable socio-ecological factors to guide equitable sleep interventions for children with ASD.