Factor Structure of the Sleep Disturbance Scale for Children in a Cohort of Youth With Autism

Despite the substantial evidence base for poor sleep in autism, sleep problems are frequently under-identified and inefficiently managed. This is, in part, due to the fact that available tools do not comprehensively capture the specific sleep phenotypes in autism. The Sleep Disturbance Scale for Children (SDSC) is one of the highest ranked pediatric sleep assessment tools, yet it is scarcely used in autism research. Consequently, the utility of the SDSC for characterizing sleep disturbances in autism remains unknown. This study explored the factor structure of the SDSC in a sample of 513 autistic youth, aged 3-18 years (mean: 10.5 years; SD: 3.7; 18.7% female) drawn from the Healthy Brain Network secondary dataset. Fit of the previously derived SDSC factor structure was appraised using the confirmatory application of the exploratory structural equation modeling. Results indicated a five-factor solution comprising disorders of initiating and maintaining sleep, disorders of arousal, disorders of excessive somnolence (DoES), sleep breathing disorders, and sleep-wake transition disorders (SWTD) provided an excellent fit for the data. The derived factor solution was stable across sex and age. Notably, all sleep subscales were significantly positively associated with internalizing and externalizing behaviors, while age was significantly associated with DoES (r = 0.15) and SWTD (r = -0.18). This study provides the first validation of the SDSC in a large sample of well-characterized autistic youth showing distinct patterns of associations with key clinical correlates. Findings are consistent with independent reviews, suggesting the SDSC may provide a more effective way to screen for sleep disturbances in autistic individuals.