Assessment of Sleep Disorder among Autistic Children

: Objectives: The study objectives are to identify sleep disorders among children with autism and to identify the association between sleep disorders for children with autism and their demographic characteristics including (age, gender, housing, educational level for mother, occupation status of the mother, and monthly income). Methodology: A descriptive analytical study. The study was conducted at the Rami Institute for the care of children with autism, Rahman Institute for the care of children with autism, and Noor Institute for the care of children with autism for the period between 2 nd Dec. 2011 up to the 6 th Feb. 2012.To achieve the objectives of the study, a non-probability (purposive) samples of (80) a child who was registered in the Institutes for the care of children with autism which indicate as above and according to special criteria. Data were collected by mother of the child suffering from autism. Instrument validity was determined through content validity, by a panel of experts. Reliability of the instrument was determined through the use of Pearson correlation coefficient for the test-retest approach, which was (0.85). Analysis of data was performed through the application of descriptive statistics (frequency, percentage, and mean of score) and inferential statistics (Chi-square (x 2 ) test). Results: The study showed that most of the items of sleep disorders own evaluation has got a high level of the arithmetic mean average. Conclusion: The researcher can conclude most of children with autism have sleep disorder. Recommendations: The study recommended the need to initialize the routine night to sleep by a health care provider for your child to give the child a bath or reading a story given to the child at night at the same time encourages the child to go to bed to sleep, and to help the child relax before bedtime by reading a book, back massage, or play soothing music, avoid TV and video games, and other stressful activities before bed .


INTRODUCTION:
Autism is a disorder of neural development characterized by impaired social interaction and communication, and by restricted and repetitive behavior.These signs all begin before a child is three years old (1) .Autism affects information processing in the brain by altering how nerve cells and their synapses connect and organize; how this occurs is not well understood (2) .The severity of symptoms ranges from a mild learning and social disability to a severe impairment, with multiple problems and highly unusual behavior.The disorder may occur alone, or with accompanying problems such as mental retardation or seizures.Autism is not a rare disorder, being the third most common developmental disorder, more common than Down's syndrome (2) .
The prevalence of autism is about (1-2) per 1,000 people worldwide; however, the Centers for Disease Control and Prevention reports approximately (9) per 1,000 children in the United States are diagnosed with autism spectrum disorder (3) .The number of people diagnosed with autism has increased dramatically since the 1980, partly due to changes in diagnostic practice; the question of whether actual prevalence has increased is unresolved (4) .
Sleep disorders may be even more common in children with autism.Researchers estimate that between 40% and 80% of children with autism has difficulty sleeping.The biggest sleep problems among these children include: Difficulty falling asleep; Inconsistent sleep routines; Restlessness or poor sleep quality; and waking early (5) .
The problem for autistic children in Iraq that almost nothing is known about this condition.No clear statistics about number of people were affected by autism as much of the country's health records had been destroyed after war.Only one of its kinds in the Iraq is Rami Institute for autistic and slow learners, although there may be at least 3,000 autistic children in Iraq (3) .

OBJECTIVES:
1. To identify sleep disorders for children with autism.2. To identify the association between sleep disorders for children with autism and their demographic characteristics including (age, gender, housing, educational level for mother, occupation status of the mother, and monthly income).

METHODOLOGY:
Design of the study: A descriptive analytical study was conducted on children suffering from autism disorder.Part III: This part is concerned with the information about child sleep that consist from (25) items.The items were ordinal according to the five level scale which were scored as (never = 1, occasionally = 2, sometimes = 3, often =4, always = 5) for each level respectively so the cut off point was (2).Validity of the Instrument: Content validity was determined through the use of panel of experts.Reliability of the Instrument: Test retest reliability of the item scale was determined as average of(r=0.85).Data collection: The data were collected by self-reporting by mother of the child suffering from autism for the period from 3 rd to 29 th Jan. 2012.Statistical data analysis: Appropriate statistical approach is used that includes descriptive statistics (frequency, percentage, and mean of score) and inferential statistics (Chi-square (x2) test).

NO. =Number, %=Percent
This table shows that the educational level of mother (56.2%) was graduated from institute or college.In relation to age of mother at the birth of the child (45%) of mother were (20-29) years ago.(60%) of mother work outside the home.(63.8%) of the families, the monthly income was adequate.

NO. =Number, %=Percent
This table indicates that the (50%) of families have a house for childcare and receive instructions about taking care of him in their accommodation.While was similar percentage for the families who does not have houses for their children care and receive instructions about taking care of him in their accommodation.This table shows that there is no significant association between sleep disorders for children with autism and gender of the children.This table shows that there is no significant association between sleep disorders for children with autism and housing of the children.This table reveals that there is no significant association between sleep disorders for children with autism and monthly income of the family.

DISCUSSION:
Through the data analysis distribution of demographic variables table (1) reports that most of the autistic children are (3-6) years old and this account for 38 (47.5%) of the sample.This result is similar to the results obtained from studies done by Malow  (2006).These results indicate that the majority of autistic children ages are preschool age children.The researcher emphasizes that the children in this age group are more active and increase motor skills and increase needs to sleep (6) .Regarding gender of autistic children the majority of sample which account 59 (73.8%) are males.This finding is similar to the results obtained from study done by Patzold (1998) (7) .Concerning the housing most of the autistic children are live in urban house 73 (91.2%).These findings are supported by Richdale (1999) (8) .Table (2) indicates that the educational level of mother 45 (56.2%) of autistic children mother was graduate from institute or college.This result is consistent with the studies which indicate that the majority of autistic children mother was graduated from institute or college (9) .In relation to age of mother at the birth of the child 36 (45%) of mother the age at birth of the child were (20-29) years old.This result is in disagreement with some studies that the age of mother at birth of the child was (30-39) years old (10) .(60%) of mother work outside the home.This result is in agreement with a study which indicate that the majority of autistic children mother work outside the home (58%) (11) .In relation to monthly income the majority 51 (63.8%) of the families the monthly income was adequate.This result is not in agreement with study done by Rao; Beidel, and Murray, (2008).These studies indicated that the majority of the families the monthly income was not adequate (12) .With regard to have a house for child care and receive instructions about taking care of him in their accommodation 40 (50%) of autistic children families have a house for child care, table (3) .This finding is similar to the results obtained from study done by Williams (2004) (13) .This finding indicates that the halves of autistic children receive care and instructions form a house for childcare.This result is inconsistent with the study, which indicates that the majority of autistic children are not have a house for childcare (14) .
Table (4) indicates that the majority 28 (35%) of children get (6-7) hours of sleep on most nights.While the most of children 39 (48.8%) need to (15-30) minute after going to bed to fall asleep.This result is supported by Schreck and Mulick  (2005); they indicate that the majority of children with autism get (7-8) hours of sleep on most nights.While the most of children with autism need to (15-30) minute after going to bed to fall asleep (15) .Based on the results the researcher emphasizes the importance assessment of sleep disorder for children with autism because decrease the hours of sleep for those children and long time after going to bed to fall asleep.These disorder effects on daily activity of life.
Table (5) indicated that the mean of scores was low level on four items include items (the child gasps for breath or is unable to breathe during sleep, you have observed the child sleepwalking, you have observed the child talking in his/her sleep, and the child has nightmares which he/she doesn't remember the next day ).This result showed that most of children with autism have sleep disorder.The result of present study agree with study done by Schreck, (2001) Prevalence rates of 41-86% for sleeping problems in children with autism have been reported.Sleeping problems predicted more intense symptoms of autism.Parents of children with autism wake up earlier and sleep fewer hours per night than parents of typically developing children (16)   .While table (5) show on twenty items are moderate level include (the child goes to bed reluctantly, the child has difficulty getting to sleep at night, the child feels anxious or afraid when falling asleep, the child startles or jerks parts of the body while falling asleep, the child shows repetitive actions such as rocking or head banging while falling asleep, the child experiences vivid dream-like scenes while falling asleep, the child sweats excessively while falling asleep, the child wakes up more than twice per night, after waking up in the night ,the child has difficulty to fall asleep again, the child has frequent twitching or jerking of legs while asleep, the child has difficulty in breathing during the night, the child snores, the child sweats excessively during the night, The child grinds teeth during sleep, the child wakes from sleep screaming or confused so that you cannot seem to get through to him/her, but has no memory of these events the next morning, the child is unusually difficult to wake up in the morning, the child awakes in the morning feeling tired, the child feels unable to move when waking up in the morning, the child experiences daytime somnolence, and the child falls asleep suddenly in inappropriate situations).This result disagree with study done by Hoffman, et al., (2005) that indicated the sleep problems are reported in most children with autism.Various aspects of sleeplessness (extreme difficulty getting to sleep, long periods of night waking, short duration sleep at night, early morning waking and consequent daytime sleepiness) are consistently the most commonly reported (17) .
One item in table (5) the mean of scores for it was high level (The child changes position during the night or kicks the covers off the bed) Table (6) indicates that there is no significant association between sleep disorders for children with autism and age of the children.This result agrees with results done by Elia, et al. (2000) which indicated there were no significant difference between age of the children and sleep disorders (18) .The study shows that there is no significant relationship between sleep disorders for children with autism and gender of the children.Table (7).This result agree with results obtained from study done by Hering, et al. (1999) which indicated that, there is no relationship between gender and sleep disorders for children (11) .Analysis of the result of the study shows that there is no significant relationship between sleep disorders for children with autism and housing of the children.Table (8).This result agrees with Richdale (1999), which showed that there is no significant relationship between sleep disorders for children with autism and housing of the children (8) .Table (9) indicated that there is significant association between sleep disorders for children with autism and educational level of the mother.These finding agree with results obtained from a study done by Wiggs, (2001) which indicated that there is significant relationship between educational levels of mother and sleep disorders for children with autism (19) .Regarding the relationship between occupation of the mother and sleep disorders for children with autism the present study indicates that there is no significant relationship between sleep disorders for children with autism and occupation of the mother.Table (10).This result is in agreement with the study done by Acebo, et al. (2005).This study indicates no significant relationship occupation of the mother and sleep disorders for children with autism (20) .
Analysis of the result of the study shows that there is no significant relationship between sleep disorders for children with autism and monthly income of the family.Table (11).This result agrees with Richdale (1999), which showed that there is no significant relationship between sleep disorders for children with autism and monthly income of the family (8) .

CONCLUSION:
The study concluded that most of children with autism have sleep disorder.

RECOMMENDATIONS:
1. Establish a nighttime routine: give child a bath, read a story, and put him or her to bed at the same time every night.2. Help child relax before bed by reading a book, giving a gentle back massage, or turning on soft music.Avoid television, video games, and other stimulating activities just before bedtime.3. To prevent sensory distractions during the night, put heavy curtains on child's windows to block out the light, install thick carpeting, and make sure the door doesn't creak.

Table 7 . The association between sleep disorders for children with autism and gender of the children
df= degree of freedom; f= frequency; NS= Non-significant; P= Level of probability; Sig.= significance; χ² crit.= Chi-square critical; χ² obs.= Chi-square observed

Table 10 . The association between sleep disorders for children with autism and occupation of the mother Scores Occupation of the mother
NS= Non-significant; P= Level of probability; Sig.= significance; χ² crit.= Chi-square critical; χ² obs.= Chi-square observed This table indicates that there is significant association between sleep disorders for children with autism and educational level of the mother.This table reveals that there is no significant association between sleep disorders for children with autism and occupation of the mother.