Sleep problems and the occurrence of dangerous behavior within autistic people: A retrospective community-based sample

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Hatzell, K., Pfingston, B., & Sneed, L. (2026). Sleep problems and the occurrence of dangerous behavior within autistic people: A retrospective community-based sample. Autism, 30(4), 944-957. https://doi.org/10.1177/13623613261417525

Journal or book title
Autism
Publisher
SAGE Publications
Volume
30
Issue
4
Pages
944-957
Publication date: 18 Feb 2026 Added to AutiHub: 25 Sep 2026 Type: Article Article language: English
Publisher source (DOI) OpenAlex source

This publication is integrated into AutiHub through:

Authors

Publication authors
3
Publication authors identified as autistic
1 / 3 (33.3%)
  1. Kalina Hatzell
  2. Ben Pfingston *
  3. Lindsey Sneed

Abstract

Sleep disturbances affect 50%–80% of autistic individuals and are linked to heightened risk for psychiatric comorbidities and dangerous behaviors, including self-injury, suicidal ideation, and aggression. While previous studies have identified correlational relationships, few have examined whether sleep problems predict dangerous behaviors in large, real-world samples. This study used retrospective clinical data from a behavioral health nonprofit to investigate whether sleep problems predict dangerous behaviors among autistic individuals, accounting for age and adaptive functioning. The sample included 8,375 autistic individuals (mean age = 8.35 years). Sleep problems, dangerous behaviors, and adaptive functioning were measured at intake and every 6 months. Binary logistic regressions assessed whether sleep problems predicted current and historical suicidal ideation, self-injury, and aggression. Results showed that sleep problems significantly increased the odds of a history of suicidal ideation and suicidal ideation at intake (odds ratio = 2.29, 2.46, respectively), a history of self-injury and self-injury at intake (odds ratio = 1.95, 2.20, respectively), and aggression at intake (odds ratio = 1.58), even after adjusting for age, sex, and adaptive functioning. Age and adaptive behavior were also independently associated with dangerous behaviors. These findings underscore the importance of routinely assessing and treating sleep problems in autistic individuals as a potential pathway to reducing dangerous behaviors and improving overall wellbeing. Lay Abstract Sleep problems are very common among autistic children and adults, affecting between half and three-quarters of individuals. Poor sleep is linked to higher risks for serious behaviors such as self-injury, suicidal thoughts, and aggression, but it is not well understood whether sleep problems actually predict these behaviors. This study looked at real-world clinical data from over 8,000 autistic individuals, ages 2 to 21, who received services from a large behavioral health organization. We examined whether having sleep problems increased the likelihood of dangerous behaviors, even after taking into account a person’s age, daily living skills, and sex. We found that individuals with sleep problems were more than twice as likely to show self-injury or suicidal thoughts and were also more likely to show aggression. These findings highlight how important it is for providers and families to regularly assess and address sleep difficulties as part of autism care. Improving sleep may be an important step toward reducing the risk of dangerous behaviors and supporting overall wellbeing for autistic individuals and their families.

Bibliography cited by this reference

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Cited bibliography overview

These indicators describe the bibliography cited by this publication. An author name is counted each time it appears in one cited reference, so the same person can be counted more than once. Names not yet linked to an author already present in AutiHub are treated as unknown, not as non-autistic. Last computed: 3 Oct 2026 01:01.

Cited references
93
With a DOI
86
Without a DOI, from raw bibliography text
7
0 / 93 (0.0%) cited references include at least one author identified as autistic.
References with data to complete
5 / 93 (5.4%)
References with detected author names
88 / 93 (94.6%)
Without detected author names
5
Without a structured title
5
Without a stable identifier
7
References with raw author names still to review
5
References with external metadata lookup issues
0
These indicators apply to cited references displayed on this page, after technical duplicates have been merged. A reference without a DOI can still support author statistics when a title and author names are available.
Author names detected in the cited bibliography
575
From DOI or external metadata
575
From validated raw bibliography text
0
Raw names already validated
0
Raw names still to review
8
94 / 575 (16.3%) names are linked to an author already present in AutiHub. 481 / 575 (83.7%) names are not yet linked.
Names linked to a person identified as autistic
0 / 575 (0.0%)
Calculated across all author names detected in the cited bibliography. Among names linked to an author already present in AutiHub: 0 / 94 (0.0%). Distinct people identified as autistic: 0 / 528 (0.0%).
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