根據美國精神醫學會(American Psychiatric Association)，自閉症類群障礙症(Autism Spectrum Disorder, ASD) 是一種持續終生的神經系統疾病，其診斷標準為：社交溝通能力缺損以及侷限且重複的興趣與行為。世界衛生組織的統計顯示全球自閉症人口有逐年快速增加的趨勢，而近年來針對ASD兒童的睡眠問題已被證實，造成其日常功能、認知、適應性行為下降甚至影響照顧者心理健康與家庭生活之運作。因此，檢視睡眠對於ASD兒童之影響，已成為新興的關注議題。過去國內外針對ASD兒童之睡眠障礙只將睡眠作為其中一種變項來檢視而非中介因子；再者，過去研究所納入ASD兒童的年齡範圍大，橫跨學齡前、學齡與青少年，而針對臺灣本土學齡前階段的研究較缺乏。而有關ASD兒童的睡眠研究已證實與感覺敏感和焦慮具有高度相關性，因此有其必要性使用實證研究來支持學齡前ASD兒童之睡眠障礙、感覺處理與焦慮三者之間的潛在關係。本研究之目的為檢視有感覺處理問題的學齡前ASD兒童是否會透過睡眠障礙作為中介因子來影響其焦慮表現。研究對象為50位ASD個案，經過初步篩選後照顧者需要填寫三份問卷，睡眠習慣問卷、感覺剖析量表以及兒童行為量表，並教導照顧者與兒童如何佩戴加速規，連續記錄7天之資料予以分析。透過皮爾森相關係數檢視三個變項之間的關聯性強度，並使用多元線性回歸模型中的中介因子方法(The Barron and Kenny method)來檢視睡眠障礙是否可以作為感覺處理與行為表現的中介因子。研究結果顯示，98% 的ASD兒童經歷過睡眠障礙，所有ASD兒童的總睡眠時間都低於美國睡眠醫學會的健康睡眠時間標準。感覺敏感較嚴重的 ASD 兒童在 CSHQ 的五個分量表、 CSHQ 的總分以及 CBCL 的焦慮分量表上的得分高於感覺敏感較不嚴重的兒童。睡眠障礙與學齡前ASD兒童的感覺敏感和焦慮有顯著相關。睡眠障礙部分調節了感覺敏感和焦慮之間的關係。感覺敏感較高的學齡前ASD兒童的睡眠障礙程度較高，同時其焦慮程度也較高。本研究結果將有助於專業臨床工作者有新的方向去考慮ASD兒童的焦慮表現，是否與其睡眠障礙與感覺處理問題有關，重新檢視並促進ASD兒童的健康與發展。

The American Psychiatric Association outlines two main criteria for diagnosing Autism Spectrum Disorder (ASD): (1) Persistent deficits in social communication and social interaction across multiple contexts and (2) Restricted, repetitive patterns of behavior, interests, or activities. In recent years, according to the estimation of World Health Organization, the prevalence of ASD has been increasing globally. For children with ASD, there is evidence to support that sleep problems have been confirmed leading to negative association with their daily function, cognition, and adaptive behavior. These issues not only affect the children themselves but also have repercussions for their families. Therefore, understanding the link between sleep and ASD has become more and more important. There is limited research specifically focus on the age range of preschool children with ASD. Previous studies only examine sleep disturbances as one of the variables rather than as a mediating factor. Additionally, past studies have already verified that there are strongly positive correlations between sleep disturbances, sensory sensitivity, and anxiety. However, there are no studies that view sleep disturbances as a mediator to investigate the potential association between sensory processing and anxiety in the context of Taiwan. As a result, it is crucial to investigate whether there is a potential association among sleep disturbances, sensory processing disorder, and anxiety in preschool children with ASD.
Current research aimed to investigate whether sensory sensitivities in children with ASD would be associated with anxiety via the mediating effect of sleep disturbances. A total of 50 participants aged 36 to 71 months would be recruited. To understand children’s sleep habits, sensory processing, and anxiety, their caregivers filled three questionnaires which are (1) Children sleep habits questionnaire-Chinese version; (2) Sensory profile; and (3) Child Behavior Checklist-Chinese version of Caregiver-Teacher Report Form for Ages 1½-5 (CBCL- TRF). Additionally, the caregivers also learned how to use ActiGraph accelerometers properly to record their children’s changes in sleep patterns for consecutive seven days. Then, the recorded data was analyzed. For data analysis, using Pearson’s coefficients of correlation to explore the potential associations among these three variables. The Baron and Kenny methods of linear multivariate regressions were used to examine whether sleep disturbances act as a mediator between sensory sensitivities and anxiety in preschool children with ASD.
Results indicated that 98% of the children with ASD experienced sleep disturbance and all children with ASD had a total sleep time falling below the American Academy of Sleep Medicine guidelines. Children with ASD who exhibited more severe sensory sensitivities scored higher on the five subscales of the CSHQ, as well as the total score of the CSHQ and the anxiety subscale of the CBCL than those with less severe sensitivities. In bivariate correlations, sleep disturbances were significantly correlated to both sensory sensitivities and anxiety in preschool children with ASD. Sleep disturbances partially mediated the relationship between sensory sensitivities and anxiety. Their higher level of disturbed sleep accounted for the higher level of anxiety in preschool children with greater sensory sensitivities.
Through the current study, a better understanding of anxiety in preschool children with ASD may be associated with underlying sleep disturbances or sensory processing difficulties. The result of this study could provide guidance on interventions for clinical practitioners and increase the well-being of these kids and their families.

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