Evaluation of Social Stories in Sleep Treatment for Children with Autism Spectrum Disorder: A Feasibility Study

A majority of children with autism spectrum disorders (ASD) experience sleep disturbances which are apt to negatively impact cognition, behavioral functioning, and the general trajectory of psychosocial development. Additionally, pediatric sleep disorders may contribute to disordered sleep in parents and reduced quality of life for family members. While children with ASD often respond positively to general standard of care in pediatric sleep medicine, there are few sleep treatments that address ASD-specific factors that contribute to sleep disturbances. This limitation may be addressed through the development of a treatment that incorporates sleep behavioral strategies in a format developed for children with ASD, such as a social story. This study evaluated the feasibility and acceptability of using a social story on bedtime routine developed for children as a complementary intervention for standard of care in a pediatric sleep clinic. Results from this study indicated social stories are acceptable as a complementary tool to sleep treatment. All participants approached for the study gave consent. Of those enrolled in the treatment group, all participants randomized to the treatment group read the story for at least one week as part of the bedtime routine (100%) with a mean utilization of 19.4 days during the month. Participants reported the social story was easy to implement and well received by the children, though feedback indicated the need for personalization and flexibility in the implementation of social stories. There were no significant differences in pediatric sleep outcomes between treatment groups. There were significant challenges related to the feasibility of the study in terms of gathering follow-up data, partially due to the impact of the COVID-19 worldwide pandemic that occurred during the study. Secondary analyses found no significant differences in parental sleep outcomes or psychosocial functioning between treatment groups. These findings suggest that social stories may be a promising tool in pediatric sleep treatment for children with ASD, but additional research is warranted to clarify its efficacy.