Caregiver-reported sleep problems and suicidality in autistic youth: findings from a sleep diary study

Background Sleep problems, including daytime sleepiness, short sleep duration, and poor sleep quality, are strongly associated with suicidality in non-autistic people. Sleep difficulties are also common in Autistic children and adolescents (herein, youth), affecting 40-80%, and may contribute to their elevated suicide risk, which emerges as early as 10 years of age and is 3.5 times higher than the general population. Despite the strong link between sleep difficulties and suicidality in non-autistic people, no study has examined this association in Autistic youth. This cross-sectional online survey addressed this gap by investigating links between sleep and suicidality in Autistic youth using caregiver reports and daily sleep diaries. Methods Fifty-one caregivers (87.7% female, M age = 40.78, SD = 8.04) of Autistic youth aged 7–26 years ( M age = 12.02, SD = 4.14) completed an online survey including the Children’s Sleep Habits Questionnaire and a modified Columbia-Suicide Severity Rating Scale (C-SSRS). Caregivers also completed sleep diaries about their child’s sleep each morning upon awakening for 7 days. Results Most caregivers (88%) reported their Autistic youth had sleep problems, and 64.7% endorsed at least some suicidal behaviour. Daytime sleepiness ( B = 0.19, SE = 0.08, p = .011) and sleep quality ( B = -1.19, SE = 0.585, p = .04) were related to suicidal ideation, such that caregivers of Autistic youth with poorer sleep were more likely to report that their youth experienced suicidal ideation. Daytime sleepiness was related to both lifetime ( B = 0.832, SE = 0.238, p .001) and recent C-SSRS total scores ( B = 0.691, SE = 0.240, p .01), while, unexpectedly, total sleep problems were not associated with total suicidality scores. Conclusion Specific sleep difficulties, particularly daytime sleepiness and sleep quality, may uniquely contribute to caregiver-reported suicidality in Autistic youth. With few effective suicide interventions for Autistic individuals, these findings provide critical insight into the sleep-suicide connection that can help inform targeted prevention strategies.