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Sleep Problem Detection and Documentation in Children With Autism Spectrum Disorder and Attention-Deficit/Hyperactivity Disorder by Developmental-Behavioral Pediatricians

A DBPNet Study

Won, Dana C., MD; Feldman, Heidi M., MD, PhD; Huffman, Lynne C., MD

Journal of Developmental & Behavioral Pediatrics: January 2019 - Volume 40 - Issue 1 - p 20–31
doi: 10.1097/DBP.0000000000000624
Original Articles

Objective: To determine the percentage of children with autism spectrum disorder (ASD), attention-deficit/hyperactivity disorder (ADHD), and combined ASD + ADHD who had sleep problems documented by developmental-behavioral pediatricians at diagnostic and follow-up visits at 12 US academic medical centers comprising the Developmental-Behavioral Pediatrics Research Network (DBPNet) and to identify the predictors of sleep problem documentation.

Methods: Developmental-behavioral pediatricians completed encounter forms that covered sociodemographic, medical, clinician, and visit factors. There was 1 dependent variable, sleep problem documentation, for which 4 definitions were developed (Model 1 = Sleep Disorder coded; Model 2 = Sleep Disorder or polysomnogram coded; Model 3 = Sleep Disorder, polysomnogram, or sleep medication coded; and Model 4 = Sleep Disorder, polysomnogram, sleep medication, or clonidine coded).

Results: Sleep problem documentation was 14.1% for Model 1, 15.2% for Model 2, 17.3% for Model 3, and 19.7% for Model 4. All values were lower (p < 0.001) than the reported prevalence of sleep problems in these conditions. For Model 4, predictors of sleep problem documentation were age group, ethnicity, medical insurance type, and DBPNet site.

Conclusion: Developmental-behavioral pediatricians in DBPNet under-reported sleep problems in children with ASD and ADHD. Variation among sites was substantial. Care plans for children with ASD and ADHD should specify which treating clinician(s) monitors sleep issues.

Division of Developmental-Behavioral Pediatrics, Department of Pediatrics, Stanford University School of Medicine, Stanford, CA.

Address for reprints: Lynne C. Huffman, MD, Division of Developmental-Behavioral Pediatrics, Stanford University School of Medicine, Medical School Office Building, 1265 Welch Rd, X109C, MC 5415, Stanford, CA 94305; e-mail:

The Developmental-Behavioral Pediatrics Research Network (DBPNet) is supported by cooperative agreement UA3MC20218 from the Maternal and Child Health Bureau, Health Resources and Services Administration, US Department of Health and Human Services. This information or content and conclusions are those of the author and should not be construed as the official position or policy of, nor should any endorsements be inferred by the HRSA, HHS, or US government.

Disclosure: The authors declare no conflict of interest.

Received February 27, 2018

Accepted September 05, 2018

Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.