An evaluation of a stepped-care telehealth program for improving the sleep of autistic children

Sleep problems are prevalent in Autistic children, adversely affecting their development, well-being and quality of life. Traditional face-to-face behavioral interventions are hindered by accessibility. Using a single-case design, this study evaluated the efficacy of a stepped-care telehealth-delivered behavioral sleep intervention (TDBSI). Seven Autistic children (aged 4–8) and their parents participated in a 12-week program consisting of baseline plus three sequential intervention phases: (1) self-directed online parent psychoeducation, (2) small group parent coaching via video conferencing, and (3) individualized parent coaching via video conferencing. Parent strategy selection and implementation fidelity were closely monitored and rated across intervention phases. Child sleep outcomes were assessed through daily parent-reported sleep diaries and the Children's Sleep Habits Questionnaire. Five of seven parents used online parent education to independently select antecedent strategies (e.g., sleep hygiene, stimulus control) and/or rewards that were appropriate for their child’s sleep and implemented them with high fidelity. This resulted in reductions in sleep onset latency, night wakings, early wakings, and bedsharing for their children. Parent implementation fidelity and child sleep outcomes were further improved for all participants with group or individualized coaching, and results were maintained at 12 weeks and six months post-intervention. TDBSIs show promise in addressing sleep difficulties in Autistic children, warranting further investigation and replication.