Transdiagnostic Sleep and Circadian Treatment for Autistic Adolescents and Young Adults

/ABSTRACT This proposal will address the critical need for evidence-based transdiagnostic sleep interventions for autistic adolescents and young adults (AYA). Autistic AYA frequently report a multitude of pervasive sleep and circadian problems, including difficulties initiating and maintaining sleep, excessive sleepiness, delayed phase, and irregular sleep–wake schedules. These sleep and circadian problems often occur in unison rather as isolated problems, and contribute to the onset, worsening, and continuation of mental health disorders. This project will adapt and pilot the Transdiagnostic Intervention for Sleep and Circadian Dysfunction (TranS-C), an effective sleep intervention, so that its content and delivery are effective and sustainable for autistic AYA. Aim 1 is to iteratively adapt as needed and pilot TranS-C for autistic AYA (12-25 yrs). Preliminary data, iterative pilot testing with autistic AYA (N=15-24), and input from an advisory panel of autistic AYA (N=4), caregivers (N=4), medical providers (N=2), and behavioral health clinicians (N=2) will guide needed adaptations. Assessments for Aim 1 include multidimensional sleep health (MSH) (actigraphy, self-report measures), as well as implementation science outcomes (feasibility, acceptability, engagement, and fidelity). Aim 2 is to conduct a pilot randomized trial of the adapted TranS-C to examine intervention efficacy, as well as feasibility, acceptability, engagement and fidelity. Autistic AYA (12-25 yrs) (N=90) will be randomly assigned to the adapted TranS-C, traditional TranS-C, or a wait-list control, with assessments of multidimensional sleep health (MSH) (actigraphy, self-report measures), as well as self-report measures of anxiety, depression, emotion regulation, social functioning, and suicidal ideation and behavior, at pretreatment, posttreatment, and 3-month follow-up. Aim 3 is to evaluate hypothesized mediational processes that may explain relationship between sleep and circadian problems and mental health outcomes in autistic AYA. The resources and expertise of the assembled research team of interdisciplinary researchers will provide an outstanding context to successfully execute this project. This project will also provide necessary data for Dr. Lenker’s future R01 submission of a large-scale effectiveness trial of a transdiagnostic sleep intervention trial for autistic AYA. This project aligns with NIMH’s priorities, as it focuses on assessing and treating sleep and circadian problems within a multidimensional and transdiagnostic context to better understand underlying mechanisms related to mental health, as well as optimizing patient-centered treatment options for autistic individuals. Project Number: 1R34MH141224-01 | Fiscal Year: 2026 | NIH Institute/Center: National Institute of Mental Health (NIMH) | Principal Investigator: Kristina Lenker | Institution: PENNSYLVANIA STATE UNIV HERSHEY MED CTR, HERSHEY, PA | Award Amount: $704,700 | Activity Code: R34 | Study Section: Special Emphasis Panel[ZMH1 ERB-C (01)] View on NIH RePORTER: https://reporter.nih.gov/project-details/11220605