The Relationship Between Sleep Quality, Comorbid Psychopathology, and Behavior Problems in Autism: A Systematic Review

Comorbid psychopathology in autism is prevalent, chronically underdiagnosed, and compounded by sleep problems. Little is known about the relationship between psychopathology and sleep quality across the lifespan. Six databases were systematically searched. N = 3467 items were examined against predetermined eligibility criteria. N = 46 included studies were critically appraised using the Quality Assessment with Diverse Studies tool. Data were thematically analyzed. Anxiety, depression, and attention-deficit/hyperactivity disorder were commonly associated with all categories of sleep problems in autistic children and adolescents. Only N = 7 papers sampled autistic adults. These revealed mixed findings regarding the association between sleep and general comorbidity, depression, and anxiety. Future research needs to involve autistic adults, distinguish between diagnosed psychopathology and their symptoms, and ensure females are adequately represented in samples.