Developing and Validating a Parent Guide to Improve Sleep in Children with Autism Spectrum Disorder: Emphasis on the Holistic Approach to Self-Regulation Strategies.

Background: Autism spectrum disorder (ASD) frequently coexists with sleep problems. This study, guided by family-centered and general systems theories and acknowledging the reciprocal relationships between sleep and self-regulation, details the process of designing a parent guide aimed at improving sleep in children aged 6-12 years diagnosed with level 1 or 2 ASD. Methods: A literature search was conducted to identify interventions that emphasize self-regulation strategies aimed at improving children's sleep. The content and face validity of this guide were evaluated based on the opinions of experts and parents. In a pilot study, the guide was presented to parents of children with ASD (n = 3) in the form of a booklet, and its effectiveness was assessed through caregiver feedback and the Children's Sleep Habits Questionnaire (CSHQ). Results: The booklet comprises 23 subtitles organized into four chapters: "Introductory Information," "Child-Related Factors," "Environment-Related Factors," and "Impact of Other Activities on Sleep." In this feasibility pilot (n=3), minor reductions (2-3 points) in CSHQ scores were observed; however, this magnitude of change is below typical minimal clinically important differences, and the study was not designed to assess efficacy. Conclusion: The development of a parent guide for sleep of children with ASD was driven by the need to address self-regulatory strategies across three interrelated dimensions: the child, the environment, and sleep itself. This approach is superior to single-domain interventions that do not adequately consider the complex interplay of self-regulation deficits in ASD. This study provides initial evidence for the viability and promise of this intervention, paving the way for definitive future trials.