Abstract
This study investigated sleep difficulties in Sensory Modulation Disorder (SMD). Parents of 105 typical children and 84 children with SMD completed both a sensory and a sleep questionnaire. Significant correlations were found. Too, tactile sensitivity, auditory filtering, seeks sensation, and low energy were significant predictors for 29% of the variance, p<.001. Knowledge of which sensory parameters are affected by poor sleep will enable practitioners to focus their interventions with efficacy.
Primary Author and Speaker: Geela Spira
Contributing Authors: Eyal Ben Mair, Dalia Schecter, Miriam Botzer
The aim of this study was to investigate the presence of behavioral sleep problems in children with sensory difficulties, without the presence of other co-morbid diagnoses, and to establish a relationship between the two domains. Initial literature has begun to look at typically- developing populations, or populations with additional co-morbid diagnoses such as ADHD or ASD, but to date, no study has studied the relationship of sleep in children with Sensory Modulation Disorder (SMD) (Foitzik & Brown, 2018; Shani-Adir et al, 2009; Vasik et al, 2015), making it difficult to obtain a clear picture of the relationship of sleep problems to sensory issues in children with SMD.
The study was a cross-sectional questionnaire-based design. Report of child behaviors was collected via parent report in the Short Sensory Profile (SSP) and Child Sleep Behavior Questionnaire (CSHQ). Although reported on by their parents, for simplicity’s sake, the children will heretofore be called ‘subjects’. Sensory subjects in this convenience sample were recruited in Israel at the Modi'in Elite Developmental Health Center & the Sieff Hospital in Safed. Control group subjects were recruited via posted advertisements. This study was approved by the Sieff Medical Center Review Board in Safed, Israel.
The typically developing children were excluded from having any other diagnosis, and have a z-score < 1.0 standard deviations below the mean. Subjects in the SMD diagnosed group were required to have a z-score > 2.0 standard deviations below the mean and not be diagnosed with Autism. After exclusions, the remaining 191 children included 88 subjects in the sensory group and 103 children in the typically developing group. 114 were Boys and 77 were girls. The mean age was 7.59 years. 7 subjects in the Sensory group were diagnosed with ADHD. SSP & CSHQ questionnaires were filled out on a single time basis on all subjects. The Short Sensory Profile (SSP) contains 38 questions divided into seven subcategories. The Children's Sleep Habits Questionnaire encompasses eight subscales- bedtime resistance, sleep onset delay, sleep duration, sleep anxiety, night wakings, parasomnias, sleep disordered breathing, and daytime sleepiness.
Correlation coefficients between CSHQ total and SSP total score was negatively correlated, r =-605, p< .001. CSHQ total score was negatively correlated with SSP subgroups of Tactile Sensitivity (r= -0.478, p <.05), Taste/smell sensitivity (r= -0.362, p <.05), Movement sensitivity (r= -0.307, p <.05), Seeks Sensation (r= -0.506, p <.05), Auditory filtering (r= -0.545, p <.05), Low Energy (r= -0.409, p <.05), and Visual/Auditory Sensitivity (r= -0.443, p <.05). And, 29% of the variance in the sleep score, p< .001, was accounted for by the sensory factors of tactile sensitivity, auditory filtering, seeks sensation and low energy.
The study conclusions include a moderately significant correlation between sleep disturbances and children aged 5-11 with SMD, both in the total sleep to sensory scores, and in the total sleep scores to some of the sensory sub-scores. The sensory factors of tactile sensitivity, auditory filtering, seeks sensation and low energy were particularly found to account for the 29% of the variance in the sleep difficulties in these children. The impact of this study is to establish an initial relationship between the constructs of sensory issues and behavioral sleep problems in children diagnosed with SMD. This step was essential before proceeding to plan interventions in clinical practice. Occupational Therapists will have increased awareness of specific sleep issues in the SMD population, and will now be able to use evidence-based practice when formulating intervention plans for these children.
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Owens, J. A., Spirito, A., & McGuinn, M. (2000). The Children’s Sleep Habits Questionnaire (CSHQ): Psychometric properties of a survey instrument for school-aged children. Sleep, 23(8), 1-9.
Shani-Adir, A., Rozenman, D., Kessel, A., & Engel-Yeger, B. (2009). The relationship between sensory hypersensitivity and sleep quality of children with atopic dermatitis. Pediatric Dermatology, 26(2), 143-149.
Vasak, M., Williamson, J., Garden, J., & Zwicker, J. G. (2015). Sensory Processing and Sleep in Typically Developing Infants and Toddlers. American Journal of Occupational Therapy, 69(4), 1-8.