CBT for Insomnia in Children with Autism

(RECHArge Trial)

Overseen By Sydney Shoemaker, MS

Age: < 18

Sex: Any

Trial Phase: Academic

Sponsor: University of Missouri-Columbia

Must not be taking: Psychotropics, others

Disqualifiers: Other sleep disorders, Epilepsy, others

No Placebo Group All trial participants will receive the active study treatment (no placebo)

Compensation: Varies

Number of Visits: 7

Duration: 8 weeks

180 Participants Needed

Trial Summary

What is the purpose of this trial?

Children with Autism Spectrum Disorder (ASD) and insomnia, and their parent(s) will undergo 4 sessions of behavioral therapy for sleep problems followed by 4 bimonthly booster sessions. Children and their families will be randomly assigned to one of three conditions: cognitive behavioral therapy (in-person), cognitive behavioral therapy (remote), or behavioral therapy (remote). Arousal will be measured through heart-rate variability. Sleep and secondary outcomes (child daytime behavior, parent sleep) will be collected at baseline (weeks 1-2 before starting the treatment), post-treatment (weeks 6-8 from baseline), 6-month follow-up, and 12-month follow-up.

Will I have to stop taking my current medications?

The trial does not require stopping all medications, but if your child is taking stimulants, sleep medications, or melatonin, they must have been stable on these for at least 3 months before joining the trial.

What data supports the effectiveness of the treatment for insomnia in children with autism?

Research shows that Cognitive Behavioral Therapy for Childhood Insomnia (CBT-CI), whether delivered in-person or via telehealth, can improve sleep and reduce challenging behaviors in children with autism. Studies found that both children and their parents experienced better sleep and reduced fatigue, indicating that CBT-CI is a promising treatment for insomnia in this population. ^{1 2 3 4 5}

Is Cognitive Behavioral Therapy for Insomnia safe for children with autism?

The studies suggest that Cognitive Behavioral Therapy for Insomnia (CBT-CI) is safe for children with autism, as it was well-received by parents and children, and no safety concerns were reported in the research. ^{1 2 3 4 6}

How does the treatment for insomnia in children with autism differ from other treatments?

This treatment is unique because it uses Cognitive Behavioral Therapy (CBT) specifically adapted for children with autism, and it can be delivered remotely via telehealth, making it more accessible for families who may have difficulty attending in-person sessions. It not only improves sleep but also enhances daytime functioning and reduces challenging behaviors in children with autism. ^{1 2 3 4 6}

Research Team

Christina McCrae, PhD

Principal Investigator

University of Missouri-Columbia

Eligibility Criteria

This trial is for children aged 6-12 with Autism Spectrum Disorder and chronic insomnia, who have a verbal IQ of at least 70. Their parent or guardian must be able to read English at a 5th-grade level and live with the child. Kids on stable sleep-related meds can join, but those with untreated medical issues affecting sleep or taking certain other drugs cannot.

Inclusion Criteria

My child has autism and trouble sleeping.

You have been diagnosed with autism spectrum disorder (ASD) in the past.

You need to have a verbal IQ of 70 or higher.

Exclusion Criteria

I am not open to being randomly assigned to a treatment group.

I haven't started any new sleep or stimulant meds in the last month.

Any other health issues that could make it hard to take part in the trial.

Timeline

Screening

Participants are screened for eligibility to participate in the trial

2 weeks

1 visit (in-person)

Treatment

Participants undergo 4 sessions of behavioral therapy for sleep problems followed by 4 bimonthly booster sessions

8 weeks

4 visits (in-person or remote), 4 booster sessions (telephone)

Follow-up

Participants are monitored for sleep and secondary outcomes at 6-month and 12-month intervals

12 months

2 visits (in-person or remote)

Treatment Details

Interventions

• In-Person CBT for insomnia in children with autism
• Remote CBT for insomnia in children with autism
• Remote sleep hygiene and related education (SHARE) for insomnia in children with autism

Trial Overview The study tests three ways to treat insomnia in kids with autism: in-person cognitive behavioral therapy (CBT), remote CBT, and remote sleep hygiene education (SHARE). It involves initial sessions followed by booster sessions, measuring outcomes like heart rate variability and changes in behavior.

Participant Groups

Group I: Remote behavioral SHARE for insomnia in children with autism Experimental Treatment 1 Intervention

Remote/videoconferenced behavioral sleep hygiene and related education (SHARE) for insomnia in children with autism will be conducted from home (families)/Thompson Center (therapist). Remote treatment will consist of four 50-minute, individually administered sessions and four bi-monthly, 20-minute telephone boosters. Using a flexible, case conceptualization approach, the therapist will adapt the treatment to parent and child characteristics (i.e., verbal skills, development) and family situation/dynamics - promoting optimal efficacy and enhancing broad clinical applicability. Module administration order will be tailored to prioritize each child/family's most pressing sleep and related health related concerns/interests.

Group II: Remote CBT for insomnia in children with autism Experimental Treatment 1 Intervention

Remote/videoconferenced cognitive-behavioral treatment (CBT) for insomnia in children with autism will be conducted from home (families)/Thompson Center (therapist). Remote treatment will consist of four 50-minute, individually administered sessions and four bi-monthly, 20-minute telephone boosters. Using a flexible, case conceptualization approach, the therapist will adapt the treatment to parent and child characteristics (i.e., verbal skills, development) and family situation/dynamics - promoting optimal efficacy and enhancing broad clinical applicability. Module administration order will be tailored to prioritize each child/family's most pressing sleep concerns based on the clinical interview.

Group III: In-person CBT for insomnia in children with autism Experimental Treatment 1 Intervention

In-person cognitive-behavioral treatment (CBT) for insomnia in children with autism will be conducted at the Thompson Center. In-person treatment will consist of four 50-minute, individually administered sessions and four bi-monthly, 20-minute telephone boosters. Using a flexible, case conceptualization approach, the therapist will adapt the treatment to parent and child characteristics (i.e., verbal skills, development) and family situation/dynamics - promoting optimal efficacy and enhancing broad clinical applicability. Module administration order will be tailored to prioritize each child/family's most pressing sleep concerns based on the clinical interview.

Who Is Running the Clinical Trial?

University of Missouri-Columbia

Lead Sponsor

Trials

387

Recruited

629,000+

United States Department of Defense

Collaborator

Trials

940

Recruited

339,000+

Findings from Research

Telehealth delivery of cognitive behavioral treatment for insomnia (teleCBT-CI) was successfully implemented for a 7-year-old boy with autism, showing improvements in both objective and subjective sleep measures.

The treatment also led to reductions in behavioral issues such as irritability, lethargy, stereotypy, and hyperactivity, indicating that teleCBT-CI can enhance overall functioning in children with autism and insomnia.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Using Telehealth to Deliver Family-Based Cognitive Behavioral Treatment of Insomnia in a School-Aged Child With Autism Spectrum Disorder. Davenport, MA., Berry, JR., Mazurek, MO., et al.[2022]

A pilot study involving 17 children with autism and insomnia showed that an 8-session cognitive behavioral treatment for childhood insomnia (CBT-CI) significantly improved both child and parent sleep, as well as reduced challenging behaviors like irritability and hyperactivity.

Parents reported that CBT-CI was helpful and suitable for their children, indicating that this treatment is feasible and promising for addressing insomnia in school-aged children with autism, warranting further research through randomized controlled trials.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Cognitive behavioral treatment of insomnia in school-aged children with autism spectrum disorder: A pilot feasibility study. McCrae, CS., Chan, WS., Curtis, AF., et al.[2020]

A pilot study demonstrated that telehealth delivery of cognitive behavioral treatment for childhood insomnia (CBT-CI) effectively improved sleep and behavior in children with autism, as well as reducing parent fatigue.

Parents reported that the telehealth format was helpful, age-appropriate, and suitable for children with autism, suggesting that this method could increase access to treatment for insomnia in this population.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Telehealth cognitive behavioral therapy for insomnia in children with autism spectrum disorder: A pilot examining feasibility, satisfaction, and preliminary findings. McCrae, CS., Chan, WS., Curtis, AF., et al.[2021]

This study will be the first to evaluate cognitive behavioral treatment for childhood insomnia (CBT-CI) specifically adapted for children with autism spectrum disorder (ASD) and insomnia, involving 180 participants aged 6-12 years.

The trial aims to assess the effectiveness of CBT-CI in reducing insomnia and its negative impacts on children with ASD, with outcomes measured at multiple time points, including sleep quality, daytime functioning, and parental stress.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Protocol for targeting insomnia in school-aged children with autism spectrum disorder without intellectual disability: a randomised control trial. McCrae, CS., Mazurek, MO., Curtis, AF., et al.[2021]

A pilot study involving six adolescents with Autism Spectrum Disorder (ASD) showed that internet-delivered cognitive behavioral therapy for insomnia (iCBT-I) was feasible and led to significant reductions in insomnia symptoms.

Participants reported general satisfaction with the treatment, improved sleep, and gained insights into their sleep patterns, highlighting the potential of iCBT-I as a beneficial intervention for insomnia in adolescents with ASD, though further research is needed to confirm its efficacy.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Internet-delivered Cognitive Behavioral Therapy for insomnia in youth with autism spectrum disorder: A pilot study. Georén, L., Jansson-Fröjmark, M., Nordenstam, L., et al.[2022]

A significant percentage (50-80%) of children with autism spectrum disorder (ASD) experience insomnia, which negatively impacts their overall health, highlighting the need for effective screening tools.

An expert panel has recommended routine insomnia screening for all children with ASD and has developed structured tools to help clinicians monitor and manage insomnia, aiming to enhance treatment effectiveness and standardize care across different clinical settings.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Practice Tools for Screening and Monitoring Insomnia in Children and Adolescents with Autism Spectrum Disorder. Banaschewski, T., Bruni, O., Fuentes, J., et al.[2022]

References

1. United States pubmed.ncbi.nlm.nih.gov

Using Telehealth to Deliver Family-Based Cognitive Behavioral Treatment of Insomnia in a School-Aged Child With Autism Spectrum Disorder. [2022]

2. United States pubmed.ncbi.nlm.nih.gov

Cognitive behavioral treatment of insomnia in school-aged children with autism spectrum disorder: A pilot feasibility study. [2020]

3. England pubmed.ncbi.nlm.nih.gov

Telehealth cognitive behavioral therapy for insomnia in children with autism spectrum disorder: A pilot examining feasibility, satisfaction, and preliminary findings. [2021]

4. England pubmed.ncbi.nlm.nih.gov

Protocol for targeting insomnia in school-aged children with autism spectrum disorder without intellectual disability: a randomised control trial. [2021]

5. Netherlands pubmed.ncbi.nlm.nih.gov

Internet-delivered Cognitive Behavioral Therapy for insomnia in youth with autism spectrum disorder: A pilot study. [2022]

6. United States pubmed.ncbi.nlm.nih.gov

Practice Tools for Screening and Monitoring Insomnia in Children and Adolescents with Autism Spectrum Disorder. [2022]