| Abstract: | Autism spectrum disorder (ASD) is a developmental neurological disorder that often co-occurs with other conditions. Sleep disorders in children with MAS are very common (prevalence ranges from 40 to 80%), among which behavioral insomnia is the most common, however, evidence on the effectiveness of behavioral interventions to resolve these problems is limited. Sleep is important for cognitive functioning, mood, mental health, and cardiovascular, cerebrovascular, and metabolic health. In this doctoral dissertation, we designed and studied the effectiveness of a psychoeducational intervention for parents of children with autism who had associated behavioral insomnia. We designed the intervention according to the principles of the behavioral-cognitive paradigm. We hypothesized that within the framework of the psychoeducational group there would be a reduction in the general sleep problems of children with autism (fewer night awakenings, longer sleep time, shorter time falling asleep) and that it would have a positive impact on parents' mental health, parental stress and on the reduction problematic behavior of children with MAS. A total of 26 children with MAS and their parents participated in the research, who were divided into an intervention group and a control group. The inclusion criteria were as follows - a confirmed diagnosis of MAS according to the ICD-10, made by a suitably qualified expert (e.g. clinical psychologist, paediatrician, a specialist in child and adolescent psychiatry), the child's age from 2 to 11 years, problems must be related to sleep to falling asleep in the evening or frequent night awakenings or a combination of both (i.e. behavioural insomnia) and last for at least 3 months. The exclusion criteria were the following - the presence of behavioural signs of obstructive sleep apnea (OSA), epilepsy, sensory disorders - deafness, an associated disorder in mental development, receiving melatonin to regulate sleep disorders or other forms of pharmacological treatment, parents of children with autism with poor knowledge of Slovenian language, which could affect the understanding of individual measures, filling out questionnaires. The intervention group consisted of six consecutive weekly sessions lasting 60 minutes. To measure changes in the sleep domain in children with MAS, we used the modified Children's Sleep Habits Questionnaire (CSHQ-A). After completing the program, parents of children in the intervention group reported a statistically significant reduction in sleep anxiety, night awakenings/parasomnias, and overall sleep problems, which were maintained 3 months after the program was completed. Some minor changes could also be observed in the area of children's problematic behavior, namely at the level of age comparison (when we divided the groups into school and preschool children). The designed psycho-educational intervention proved to be an effective and practical way to reduce sleep problems in children with MAS in the Slovenian case of parents of children with MAS and has the potential to be integrated into the Slovenian public health system without major problems. The conducted research also opens up new areas of research, namely what is the general prevalence of sleep disorders in Slovenia among children, adolescents, young adults and adults with MAS, adapting our intervention for other age groups and at the same time generalizing our findings to the aforementioned groups. |
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