Term of Award

Fall 2020

Degree Name

Doctor of Public Health in Epidemiology (Dr.P.H.)

Document Type and Release Option

Dissertation (restricted to Georgia Southern)

Copyright Statement / License for Reuse

Creative Commons License
This work is licensed under a Creative Commons Attribution 4.0 License.


Department of Biostatistics, Epidemiology, and Environmental Health Sciences

Committee Chair

Kelly Sullivan

Committee Member 1

Logan Cowan

Committee Member 2

Joanne Copak-Foss

Committee Member 3

Gavin Colquitt

Committee Member 3 Email



Sleep problems have been estimated as 40% and 80% in children with ASD, thereby leading to inadequate sleep duration in this population. The National Sleep Foundation (NSF), in collaboration with Best Practice Project Management, Inc., identified children with ASD as one of the highest priority populations for sleep research (Souders et al., 2009). Unfortunately, few studies have evaluated the effect of sleep disorders exclusively in autism. Hence, this present study examined the association of sleep characteristics in children with ASD and mental health and functional outcomes. Data were taken from the combined 2016 and 2017 version of the National Survey of Children’s Health (NSCH), with 71,811 eligible children aged 2-17. The final analysis consisted of 51,156 eligible children aged 6-7 years, after excluding children aged 2-5 years. Logistic regression models were used to estimate odds ratios (OR), 95% confidence intervals (CI), and trends. The odds of meeting sleep recommendations differed among children with ASD and those without ASD, especially in children with low socioeconomic status (SES). In children with ASD, increased age was associated with improved sleep problems. However, black children and those with lower SES were less likely to have an adequate sleep, and similar associations were found in children without ASD. This study found that physical activity engagement and consistent bedtime on weeknights significantly improved the odds of adequate sleep in children with ASD. In children with ASD who met their recommended sleep duration, behavioral conduct problems were significantly lower than those who did not. However, watching TV or playing video games and receiving behavioral treatment did not improve the odds of meeting the recommended sleep duration in this population. While inadequate sleep duration was associated with absenteeism up to 6 days, it was not associated with repeated grades. This study gives credence to the famous phrase that “exercise is medicine,” particularly in children with ASD. Physical activity should be promoted in children with ASD; parents, physical education teachers, pediatricians can be of significant influence. Parents should enforce consistent bedtime and ensure that children spend less time with screens (watching TV or playing video games).

Research Data and Supplementary Material


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