The Effect of Storytelling Training to Parents on Sleep Disorders of Children Affected by Autism Referred to Tehran Autism Center in 2017

About one-third of human life is in sleep (2). Adequate sleep plays a vital role in mental and cognitive motor development in children and adults (3). Lack of sleep can have adverse effects on endocrine function, cognitive function, metabolism and inflammatory responses (4). With sleep problems, cognitive and emotional issues such as depression, anxiety, cognitive impairment, learning disability and intellectual development disability (2). Sleep complaints are very common in the normal population and about 37% of people suffer from sleep problems, sleep problems are one of the associated problems in autistic patients (7). Autism spectrum disorders ASD (1) is a type of autism spectrum disorder It is a pervasive developmental disorder that starts before 36 months of age and begins before the age of 3 and its prevalence is estimated to be 5 to 10 cases per 10,000 births. Children with autism are also susceptible to sleep disturbances (8). Due to the high prevalence of sleep problems in children with autism, effective treatment is necessary in these children. Many of the behaviors that fertilizer has with autism such as hypersensitivity to environmental disturbances, repetitive behaviors, difficulty in social understanding, etc. are likely to contribute to sleep disturbances in children. Behavioral approaches improve sleep onset. These approaches include behaviors that make it easier to fall asleep and stay asleep (10). In the process of story therapy, children are trying to become more aware of their feelings and thoughts, face their painful emotions and feelings, and express them throughout the story (11). Recent studies have shown that behavioral interventions that are present in early life. Autistic children are considered as a valuable and effective treatment for behavioral symptoms of autism. Blossom fard and Mazaheri in 2015, a study aimed at investigating the effectiveness of attachment-based storytelling on reducing sleep time problems and improving the child-mother relationship, the results of this study showed that attachment-based storytelling, in addition to being a solution for female routines, showed that attachment-based storytelling, in addition to being a solution for female-born routines, showed that the results of this study were based on attachment-based storytelling. Beth was able to reduce the disturbances of the child's sleep time, leading to a significant improvement in the parent-child relationship as one of the correlatives of sleep problems, so the clinical work of attachment-based storytelling is not only about improving sleep problems, but also for improving the emotional and mental health of the child and their families (18). It is controlling diseases and considering the educational and therapeutic aspects of storytelling that can be used as a valuable and efficient tool for improving life and social skills as well as treatment of sleep disorders, therefore, the researcher has decided to study the effect of storytelling education on sleep disorders of children with autism in order to prove the hypothesis that "teaching storytelling" It is effective for parents to "perform sleep disorders in children with autism" that ultimately provide a successful way of treating with minimal cost and time so that children with autism benefit from reduced sleep problems.

This study is a clinical trial study, in which the research population consists of children with autism and their parents who have a medical record with a definite diagnosis of autism. The sample in this study is parents of children with autism who have records in Tehran autism center in 2018 and meet the inclusion criteria. Researcher after reviewing the records of children with autism, a certain number of them are used. The available method and the sample size were randomly assigned to the intervention group using a pre-test-post-test experimental design with 45 parents in the Autism Society and 45 as the control group. In this stage, sleep disorders were measured using the CSHQ children's sleep habits questionnaire. The questionnaire consists of 45 questions, some of which have only diagnostic and therapeutic value and not research, so in scoring it only 33 questions are identified, most of which are scored on likert scale from 1 to 3 and its options are usually (7-5 nights per week), sometimes (2-4 nights per week) and rarely (0-1 nights per week). The score is between 33-99 and the total score is more than 41 indicating sleep disturbances in the child. In Iran, the validity of the instrument in the research of Shoghi, Khanjari, Farmani, and Hosseini (2005) was evaluated by content validity method and its validity was determined by two-week interval testing for 10 children between 11-6 years old, 97.97. The Cronbach's alpha coefficient was obtained from two studies, 0.77 and 0.79 (23). The researcher used the treatment method only for the intervention group in five sessions each for 60 minutes and finally obtained the scores of the questionnaire from both intervention and control groups.

In describing the characteristics of the research units, the demographic and contextual characteristics of the sample were compared and tested in two groups and the homogeneity of each of these variables was evaluated in the intervention and control groups. Nominal variables were compared and tested using Chi-Square test, precision chi-square (for tables larger than two and expected low frequency) and Fisher's accurate test (for tables two in two and expected low frequency) in both groups.In the inferential statistics section, the main variable, i.e. sleep disorder score in the sample, was compared in the intervention and control groups and in the previous stage with after the intervention, it was compared and tested. Classical tests were used due to the high sample size and according to the central limit theorem in the statistics, which with the increase of the sample size, the average distribution of the sample is close to the normal distribution.For comparing the two groups before the intervention, independent T-test was used for intra-group tests and comparison of two stages before and after the intervention for each group, and finally, using covariance analysis (ANCOVA) by eliminating the effect of pre-test, the effect of storytelling education to parents on sleep disorders of children with autism was investigated. Comparison of sleep disorders in children with autism was done in the intervention and control groups after teaching storytelling to parents and in the control group after the second test using independent T-test. There was a significant difference between the mean score of sleep disorder in the control group and the intervention after teaching storytelling to parents and in the control group after the second test.

Table information regarding the research hypothesis about determining the effect of storytelling education to parents on sleep disorders in children with autism indicates that the score of sleep disorder in the intervention group decreased by 5.7 ± 7.3 and in the control group  increased by 0.1 ± 2.1 the independent T-test showed this significant difference (P<0.001). Therefore, based on the data and findings, it can be claimed that the research hypothesis has been confirmed. Comparative diagram of sleep disorder score in children with autism before and after the intervention in the intervention and control groups shows that the difference before and after the intervention in the intervention group is higher than the control group. Comparative diagram of sleep disorder score in children with autism studied Before and after the intervention in the intervention and control groups.