To assess the effectiveness of a weighted-blanket intervention in treating severe sleep problems in children with autism spectrum disorder (ASD).
This phase III trial was a randomized, placebo-controlled crossover design. Participants were aged between 5 years and 16 years 10 months, with a confirmed ASD diagnosis and severe sleep problems, refractory to community-based interventions. The interventions were either a commercially available weighted blanket or otherwise identical usual weight blanket (control), introduced at bedtime; each was used for a 2-week period before crossover to the other blanket. Primary outcome was total sleep time (TST) recorded by actigraphy over each 2-week period. Secondary outcomes included actigraphically recorded sleep-onset latency, sleep efficiency, assessments of child behavior, family functioning, and adverse events. Sleep was also measured by using parent-report diaries.
Seventy-three children were randomized and analysis conducted on 67 children who completed the study. Using objective measures, the weighted blanket, compared with the control blanket, did not increase TST as measured by actigraphy and adjusted for baseline TST. There were no group differences in any other objective or subjective measure of sleep, including behavioral outcomes. On subjective preference measures, parents and children favored the weighted blanket.
The use of a weighted blanket did not help children with ASD sleep for a longer period of time, fall asleep significantly faster, or wake less often. However, the weighted blanket was favored by children and parents, and blankets were well tolerated over this period.
"Weighted Blankets" RCT as Demonstrating a New Way to Think about ASD
Thank you for publishing, "Weighted Blankets and Sleep in Autistic Children--A Randomized Controlled Trial." I am privileged to be training in DBP at a multidisciplinary center, and this article provided a fascinating discussion for my multidisciplinary team focusing on the innate difference between Autism Spectrum Disorder/ASD and other, more "medical" diagnoses. While the results did not demonstrate evidence for the prescription of weighted blankets in the treatment of children with Autism Spectrum Disorder (ASD), it highlighted the breadth of differences among these children, which significantly impacts the ability to qualify the effectiveness of any treatment for this disorder, here as it specifically relates to sensory issues.
Compare ASD to Diabetes Mellitus Type 1/DMT1. In DMT1, the amount of insulin is impacted by many factors specific to the particular child, but at the end of the day we know as clinicians that a child with DMT1 will be on insulin. This disorder is well elucidated and the treatments are relatively standardized. Unlike diabetes, relatively little is known about what causes ASD or what influences the severity of the social- communication deficit. Within the spectrum, sensory issues are seen in many, if not most, children with ASD ranging broadly from sensory-seeking to sensory avoidant behaviors.
The subjects of "Weighted Blankets" are described as having sleep problems with criteria most pediatricians could agree upon. This is a complaint heard in every general office in every part of the country. The intervention considers that "the theory underlying the reasons for using weighted blankets and other weighted items for calming purposes is based on sensory integration," a treatment framework that is widely and sometimes even hotly debated. The goal, to consider if children with sleep problems and ASD will respond to the weighted blanket intervention, uses diagnosis of the sleep problem as a basis for a sensory integration intervention. However, children are not considered in terms of types of sensory issues they may have prior to applying the intervention, nor at the breakdown of the results.
A "blanket answer" to address ASD related complaints, particularly regarding sensory issues, with rigid interventions is set up for failure by not considering the high variability of the spectrum in ASD. Could the blanket have worked in a subset of children who are sensory seeking for pressure as demonstrated by needing their shoe laces tied extra tight or their clothes particularly fitted? There is no way of knowing. This article does a wonderful job of using the current medical model to approach this problem and so of course must fail, because children with ASD do not fit into this typical medical model. Until we shift our mentality to look at the individual with ASD in terms of this broad variance, our studies and treatments may continue to struggle. M. Curtin
Conflict of Interest: