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Sadikova E, Mazurek MO. The Association Between Adverse Childhood Experiences and Sleep in Children with Autism Spectrum Disorder. J Autism Dev Disord 2024:10.1007/s10803-024-06321-6. [PMID: 38970717 DOI: 10.1007/s10803-024-06321-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/08/2024]
Abstract
Children with autism spectrum disorder are at higher risk for adverse childhood experiences (ACEs). They are also more vulnerable to sleep problems and are less likely to obtain the recommended number of hours of sleep than neurotypical children. In the general population, ACEs have been linked to future sleep difficulties. Despite increased vulnerabilities to both ACEs and sleep problems, no study has examined this association in ASD. Using the National Survey of Children's Health across four cohorts, we examined whether ACEs were a risk factor to obtaining the recommended number of hours of sleep, while accounting for demographic and health factors typically associated with sleep duration. Findings indicate that children with ASD with more ACEs were less likely to get the recommended number of hours of sleep than children with fewer ACEs. Other factors associated with sleep included race, anxiety, autism severity, and overall health. These findings indicate that sleep problems in children with ASD are complex and multifaceted. Among other considerations, it is important for clinicians to screen children with ASD for ACEs and consider the possible impact of ACEs on sleep.
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Affiliation(s)
- Eleonora Sadikova
- University of Virginia, 417 Emmet Street South, Charlottesville, VA, 22904, USA.
| | - Micah O Mazurek
- University of Virginia, 417 Emmet Street South, Charlottesville, VA, 22904, USA
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2
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Kiarashi Y, Suresha PB, Rad AB, Reyna MA, Anderson C, Foster J, Lantz J, Villavicencio T, Hamlin T, Clifford GD. Off-body Sleep Analysis for Predicting Adverse Behavior in Individuals with Autism Spectrum Disorder. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2024:2024.01.23.24301681. [PMID: 38343835 PMCID: PMC10854324 DOI: 10.1101/2024.01.23.24301681] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/18/2024]
Abstract
Poor sleep quality in Autism Spectrum Disorder (ASD) individuals is linked to severe daytime behaviors. This study explores the relationship between a prior night's sleep structure and its predictive power for next-day behavior in ASD individuals. The motion was extracted using a low-cost near-infrared camera in a privacy-preserving way. Over two years, we recorded overnight data from 14 individuals, spanning over 2,000 nights, and tracked challenging daytime behaviors, including aggression, self-injury, and disruption. We developed an ensemble machine learning algorithm to predict next-day behavior in the morning and the afternoon. Our findings indicate that sleep quality is a more reliable predictor of morning behavior than afternoon behavior the next day. The proposed model attained an accuracy of 74% and a F1 score of 0.74 in target-sensitive tasks and 67% accuracy and 0.69 F1 score in target-insensitive tasks. For 7 of the 14, better-than-chance balanced accuracy was obtained (p-value<0.05), with 3 showing significant trends (p-value<0.1). These results suggest off-body, privacy-preserving sleep monitoring as a viable method for predicting next-day adverse behavior in ASD individuals, with the potential for behavioral intervention and enhanced care in social and learning settings.
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Affiliation(s)
- Yashar Kiarashi
- Department of Biomedical Informatics, Emory University, Atlanta, GA
| | | | - Ali Bahrami Rad
- Department of Biomedical Informatics, Emory University, Atlanta, GA
| | - Matthew A Reyna
- Department of Biomedical Informatics, Emory University, Atlanta, GA
| | | | | | | | | | | | - Gari D Clifford
- Department of Biomedical Informatics, Emory University, Atlanta, GA
- Department of Biomedical Engineering, Georgia Institute of Technology, Atlanta, GA
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Kiarashi Y, Lantz J, Reyna MA, Anderson C, Rad AB, Foster J, Villavicencio T, Hamlin T, Clifford GD. Forecasting High-Risk Behavioral and Medical Events in Children with Autism through Analysis of Digital Behavioral Records. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2024:2024.05.06.24306938. [PMID: 38766049 PMCID: PMC11100855 DOI: 10.1101/2024.05.06.24306938] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2024]
Abstract
Individuals with Autism Spectrum Disorder may display interfering behaviors that limit their inclusion in educational and community settings, negatively impacting their quality of life. These behaviors may also signal potential medical conditions or indicate upcoming high-risk behaviors. This study explores behavior patterns that precede high-risk, challenging behaviors or seizures the following day. We analyzed an existing dataset of behavior and seizure data from 331 children with profound ASD over nine years. We developed a deep learning-based algorithm designed to predict the likelihood of aggression, elopement, and self-injurious behavior (SIB) as three high-risk behavioral events, as well as seizure episodes as a high-risk medical event occurring the next day. The proposed model attained accuracies of 78.4%, 80.68%, 85.43%, and 69.95% for predicting the next-day occurrence of aggression, SIB, elopement, and seizure episodes, respectively. The results were proven significant for more than 95% of the population for all high-risk event predictions using permutation-based statistical tests. Our findings emphasize the potential of leveraging historical behavior data for the early detection of high-risk behavioral and medical events, paving the way for behavioral interventions and improved support in both social and educational environments.
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Affiliation(s)
- Yashar Kiarashi
- Department of Biomedical Informatics, Emory University, Atlanta, GA
| | | | - Matthew A Reyna
- Department of Biomedical Informatics, Emory University, Atlanta, GA
| | | | - Ali Bahrami Rad
- Department of Biomedical Informatics, Emory University, Atlanta, GA
| | | | | | | | - Gari D Clifford
- Department of Biomedical Informatics, Emory University, Atlanta, GA
- Department of Biomedical Engineering, Georgia Institute of Technology, Atlanta, GA
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Inkelis SM, Soja J, Mattson SN, Chambers CD, Bhattacharjee R, Thomas JD. Characteristics of sleep in children with heavy prenatal alcohol exposure. ALCOHOL, CLINICAL & EXPERIMENTAL RESEARCH 2024; 48:928-943. [PMID: 38523054 PMCID: PMC11073897 DOI: 10.1111/acer.15303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/05/2023] [Revised: 02/16/2024] [Accepted: 03/03/2024] [Indexed: 03/26/2024]
Abstract
BACKGROUND Sleep plays an important role in neurodevelopment. However, the effects of prenatal alcohol exposure on sleep quality have been understudied, despite reports of sleep disturbance in infants prenatally exposed to alcohol and elevated levels of sleep problems reported by caregivers of children with fetal alcohol spectrum disorders. The current study characterizes sleep in children with prenatal alcohol exposure using both objective (actigraphy) and subjective (questionnaires, sleep diaries) methods. METHODS Participants aged 6-10 years, with and without prenatal alcohol exposure, were included in the study (alcohol-exposed [AE]: n = 35; control [CON]: n = 39). Objective sleep was measured via 24-h actigraphy for 2 weeks. Parents completed sleep diaries and sleep questionnaires (Children's Sleep Habits Questionnaire, Pediatric Sleep Questionnaire). Multivariate analysis of variance was used to characterize the sleep profile (objective, subjective) and examine group differences. RESULTS There were no group differences on actigraphy metrics averaged across 2 weeks. However, the AE group showed significantly greater intraindividual variability on most actigraphy measures, particularly total sleep time, percent sleep, wake after sleep onset, and number of wake bouts. Parents reported significantly more sleep problems in the AE group than in the CON group, primarily driven by night wakings, parasomnias (e.g., sleepwalking), snoring, and daytime sleepiness. These effects were more severe in children >8.5 years of age. CONCLUSIONS Despite similar 2-week average sleep outcomes, children with prenatal alcohol exposure showed greater intraindividual sleep variability and parents reported more sleep problems related to sleep behavior and snoring. These difficulties with sleep may be related to other cognitive and behavioral outcomes. Importantly, sleep is a modifiable behavior, and interventions that focus on variability in sleep, particularly in sleep duration, can impact the quality of life in children with prenatal alcohol exposure and their families.
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Affiliation(s)
- Sarah M Inkelis
- Department of Neurology, University of California San Francisco, San Francisco, California, USA
| | - Jacqueline Soja
- Department of Psychology, Center for Behavioral Teratology, San Diego State University, San Diego, California, USA
| | - Sarah N Mattson
- Department of Psychology, Center for Behavioral Teratology, San Diego State University, San Diego, California, USA
| | - Christina D Chambers
- Department of Pediatrics, University of California San Diego, San Diego, California, USA
| | - Rakesh Bhattacharjee
- Department of Pediatrics, University of California San Diego, San Diego, California, USA
| | - Jennifer D Thomas
- Department of Psychology, Center for Behavioral Teratology, San Diego State University, San Diego, California, USA
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Avci D. Mental Health Problems Among Adolescents With Mild Intellectual Disability and Relation to Sleep Quality and Perceived Social Support: A Comparative Study. J Psychosoc Nurs Ment Health Serv 2024; 62:39-50. [PMID: 37646605 DOI: 10.3928/02793695-20230821-04] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/01/2023]
Abstract
The current cross-sectional study sought to determine the mental health problems of adolescents with mild intellectual disability (ID) and influencing factors. This study, which used a comparison group, was performed with 188 adolescents (91 with mild ID and 97 without ID) between January 2019 and June 2019 in Turkey. Data were collected using a Personal Information Form, the Strengths and Difficulties Questionnaire, Pittsburgh Sleep Quality Index, and Perceived Social Support Scale. Adolescents with mild ID were at higher risk for mental health problems compared to those without ID. According to linear regression analysis, sex, age, birth order, maternal age, parents' educational level, sleep quality, and perceived social support were statistically significant predictive factors of mental health problems in adolescents with mild ID. Results of this study indicate that adolescents with mild ID are at greater risk for mental health problems and that effective prevention/intervention strategies are needed. [Journal of Psychosocial Nursing and Mental Health Services, 62(3), 39-50.].
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Lo A, Lowery LA, Kuhlthau K, Parker RA, Chan J, Haddad F, Radom-Aizik S, Gehricke JG. Effects of physical exercise, LEGO, and Minecraft activities on anxiety in underserved children with autism: Study design and methodological strategies. MethodsX 2023; 11:102332. [PMID: 37649622 PMCID: PMC10463252 DOI: 10.1016/j.mex.2023.102332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Accepted: 08/16/2023] [Indexed: 09/01/2023] Open
Abstract
Anxiety is a common comorbidity for individuals with ASD, and there is some preliminary data about the efficacy of physical exercise to alleviate anxiety. However, we are not aware of any studies that have compared the effects of a physical exercise program on anxiety in underserved children with ASD using a randomized controlled research design. This paper describes a method to evaluate and compare the efficacy of an 8-week physical exercise intervention with a sedentary play intervention to alleviate anxiety in young children with autism spectrum disorders (ASD) from underserved backgrounds. We assessed anxiety and its physical symptoms using the parent-rated Child Behavior Checklist DSM-5 anxiety (CBCL DSM-5) subscale, the child-rated Screen for Childhood Anxiety Related Emotional Disorder (SCARED), the parent-rated Child's Sleep Habits Questionnaire (CSHQ), and salivary cortisol. We also utilized the Physical Activity Questionnaire for Older Children (PAQ-C) to assess physical activity level and identify compounds. Unique components of this study include: •Implementation of novel physical exercise and sedentary play interventions that have been designed for children with ASD.•Recruitment of predominantly underserved and non-English speaking families.
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Affiliation(s)
- Angelina Lo
- University of California, Irvine, School of Medicine. 1001 Health Sciences Rd, Irvine, CA 92617, USA
| | - Lea Ann Lowery
- Thompson Center for Autism & Neurodevelopmental Disorders, University of Missouri. 205 Portland Street, Columbia, MO 65211, USA
| | - Karen Kuhlthau
- Massachusetts General Hospital (MGH), Harvard University. 125 Nashua Street 8th Floor Boston, MA 02114, USA
| | - Robert A. Parker
- Massachusetts General Hospital (MGH), Harvard University. 125 Nashua Street 8th Floor Boston, MA 02114, USA
| | - James Chan
- Massachusetts General Hospital (MGH), Harvard University. 125 Nashua Street 8th Floor Boston, MA 02114, USA
| | - Fadia Haddad
- Pediatric Exercise & Genomics Research Center, Department of Pediatrics, University of California, Irvine. 101 Academy, Suite 150, Irvine, CA 92617, USA
| | - Shlomit Radom-Aizik
- Pediatric Exercise & Genomics Research Center, Department of Pediatrics, University of California, Irvine. 101 Academy, Suite 150, Irvine, CA 92617, USA
| | - Jean-G. Gehricke
- The Center for Autism & Neurodevelopmental Disorders, Department of Pediatrics, University of California, Irvine, 2500 Red Hill Ave #100, Santa Ana, CA 92705, USA
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McArthur GE, Lee E, Laycock R. Autism Traits and Cognitive Performance: Mediating Roles of Sleep Disturbance, Anxiety and Depression. J Autism Dev Disord 2023; 53:4560-4576. [PMID: 36138298 PMCID: PMC10627948 DOI: 10.1007/s10803-022-05742-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/31/2022] [Indexed: 10/14/2022]
Abstract
Theories about autism spectrum disorder (ASD) have addressed cognitive deficits however few have examined how comorbid diagnoses, including sleep disturbance, anxiety and depression contribute to the underlying deficits. We investigated potential mediations of common ASD comorbidities in the relationship between sub-clinical autism traits and cognitive performance using an international community sample. Cognitive tasks assessed working memory [executive functioning (EF) theory], mental state attribution [theory of mind (ToM)], and global/local visual processing [weak central coherence (WCC) theory]. Structural equation modelling (SEM) demonstrated sleep disturbance and anxiety mediated the relationship of autism traits on measures of EF, but not WCC and ToM. This suggests that treating the symptoms of sleep disturbance and anxiety may lead to improvements in working memory.
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Affiliation(s)
- Gaynor E McArthur
- School of Health and Biomedical Sciences, RMIT University, Plenty Rd, Bundoora, VIC, Australia
| | - Eunro Lee
- School of Health and Biomedical Sciences, RMIT University, Plenty Rd, Bundoora, VIC, Australia
| | - Robin Laycock
- School of Health and Biomedical Sciences, RMIT University, Plenty Rd, Bundoora, VIC, Australia.
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Chua SY, Abd Rahman FN, Ratnasingam S. Problem behaviours and caregiver burden among children with Autism Spectrum Disorder in Kuching, Sarawak. Front Psychiatry 2023; 14:1244164. [PMID: 37965356 PMCID: PMC10642943 DOI: 10.3389/fpsyt.2023.1244164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Accepted: 10/04/2023] [Indexed: 11/16/2023] Open
Abstract
Objective Caregivers of children with Autism Spectrum Disorder (ASD) often experience emotional and psychological distress, as well as disruptions to family life and employment due to the challenges of caring for children with ASD. This study examines the relationship between problem behaviours and caregiver burden among children with ASD. Method A cross-sectional study using convenience sampling recruited 230 caregivers of children with ASD aged 4 to 18 years from selected autism centres in Kuching, Sarawak. The caregivers completed the Aberrant Behaviour Checklist-2 and the Zarit Burden Interview. Results Univariate analysis revealed a significant difference in caregiver burden for children with ASD receiving medications (p = 0.013), registered with the Social Welfare Department (p = 0.036), and having siblings with ASD (p = 0.046). About 40% of the children exhibited at least one domain of problem behaviour. More than half of the caregivers (53.9%) experienced burden, with the majority experiencing mild burden. Positive associations were seen between irritability (r = 0.458, p < 0.01), social withdrawal (r = 0.439, p < 0.01), stereotypic behaviour (r = 0.392, p < 0.01), hyperactivity/non-compliance (r = 0.467, p < 0.01), and caregiver burden. Child factors, including the duration of problem behaviour (r = 0.182, p = 0.007), medication use (eta = 0.187, p = 0.005), Social Welfare Department registration (eta = 0.138, p = 0.036), and the presence of siblings with ASD (eta = 0.130, p = 0.046) were associated with caregiver burden. Multiple linear regression showed that hyperactivity/noncompliance significantly predicted caregiver burden. Conclusion Specific problem behaviours in children with ASD were associated with caregiver burden. These results highlight the need for interventions for the child with ASD and their caregivers.
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Affiliation(s)
- Shi Yi Chua
- Department of Psychiatry, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
- Department of Psychiatry and Mental Health, Hospital Umum Sarawak, Kuching, Sarawak, Malaysia
| | - Fairuz Nazri Abd Rahman
- Department of Psychiatry, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
- Child and Adolescent Psychiatric Unit, UKM Specialist Children’s Hospital, Kuala Lumpur, Malaysia
| | - Selvasingam Ratnasingam
- Department of Psychiatry and Mental Health, Hospital Umum Sarawak, Kuching, Sarawak, Malaysia
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9
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Shui AM, Lampinen LA, Richdale A, Katz T. Predicting future sleep problems in young autistic children. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2023; 27:2063-2085. [PMID: 36755236 DOI: 10.1177/13623613231152963] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/10/2023]
Abstract
LAY ABSTRACT Sleep problems are common in autistic children and negatively impact daytime functioning. A method for predicting sleep problems could help with treatment and prevention of such problems. This study aimed to determine predictors of sleep problems among young autistic children. Study participants consisted of autistic children aged 2-5 years who did not have sleep problems at a first visit (Autism Treatment Network Registry) and had sleep data available at a subsequent visit (Registry Call-Back Assessment study). Sleep problems for five study cohorts of children were defined by different methods, including parent questionnaires and parent- or clinician-report of sleep problems. We found that self-injurious behavior, sensory issues, dental problems, and lower primary caregiver education level were significant risk factors of future sleep problems. These predictors may help clinicians provide prevention or earlier treatment for children who are at risk of developing sleep problems.
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Affiliation(s)
- Amy M Shui
- Massachusetts General Hospital, USA
- University of California, San Francisco, USA
| | | | | | - Terry Katz
- University of Colorado School of Medicine, USA
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Molcho-Haimovich A, Tikotzky L, Meiri G, Ilan M, Michaelovski A, Schtaierman H, Golan HM, Sadaka Y, Menashe I, Dinstein I. Sleep disturbances are associated with irritability in ASD children with sensory sensitivities. J Neurodev Disord 2023; 15:21. [PMID: 37480057 PMCID: PMC10362763 DOI: 10.1186/s11689-023-09491-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Accepted: 06/29/2023] [Indexed: 07/23/2023] Open
Abstract
BACKGROUND Parent reports suggest that 44-84% of children with ASD exhibit sleep disturbances that are of clinical concern. Previous studies have reported that, in children with ASD, the severity of sleep disturbances is associated with the severity of either sensory problems or aberrant behaviors, but none have performed combined analyses with measures of both sensory and aberrant behaviors symptom domains from the same children. METHODS We examined parent reports of 237 children with ASD, 1.4-8.7 years old, using the child sleep habits questionnaire (CSHQ), sensory profile (SP), and aberrant behaviors checklist (ABC). RESULTS The analyses revealed that sleep disturbances were most strongly associated with SP sensory sensitivity and ABC irritability scores. Together these scores explained 35% of the variance in total CSHQ scores. Moreover, sensory sensitivity scores moderated the association between irritability and sleep disturbances, indicating that sleep disturbances were significantly associated with irritability only in children with moderate to severe sensory sensitivities. CONCLUSION We suggest that the three symptom domains may interact and exacerbate each other such that successful intervention in one symptom domain may have positive impact on the others. Further intervention studies testing this hypothesis are highly warranted.
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Affiliation(s)
- Alona Molcho-Haimovich
- Department of Psychology, Ben-Gurion University of the Negev, Beer Sheva, Israel.
- The Azrieli National Centre for Autism and Neurodevelopment Research (ANCAN), Ben Gurion 1, Beer-Sheva, Israel.
| | - Liat Tikotzky
- Department of Psychology, Ben-Gurion University of the Negev, Beer Sheva, Israel
| | - Gal Meiri
- The Azrieli National Centre for Autism and Neurodevelopment Research (ANCAN), Ben Gurion 1, Beer-Sheva, Israel
- Pre-School Psychiatry Unit, Soroka University Medical Center, Beer Sheva, Israel
| | - Michal Ilan
- Department of Psychology, Ben-Gurion University of the Negev, Beer Sheva, Israel
- The Azrieli National Centre for Autism and Neurodevelopment Research (ANCAN), Ben Gurion 1, Beer-Sheva, Israel
- Pre-School Psychiatry Unit, Soroka University Medical Center, Beer Sheva, Israel
| | - Analya Michaelovski
- The Azrieli National Centre for Autism and Neurodevelopment Research (ANCAN), Ben Gurion 1, Beer-Sheva, Israel
- Zusman Child Development Center, Soroka University Medical Center, Beer Sheva, Israel
| | - Hen Schtaierman
- Child Development Center, Maccabi Health Services, Beer Sheva, Israel
| | - Hava M Golan
- The Azrieli National Centre for Autism and Neurodevelopment Research (ANCAN), Ben Gurion 1, Beer-Sheva, Israel
- Department of Physiology and Cell Biology, Faculty of Health Sciences, Ben Gurion University of the Negev, Beer Sheva, Israel
| | - Yair Sadaka
- Child Development Center, Ministry of Health, Beer Sheva, Israel
| | - Idan Menashe
- The Azrieli National Centre for Autism and Neurodevelopment Research (ANCAN), Ben Gurion 1, Beer-Sheva, Israel
- Public Health Department, Ben-Gurion University of the Negev, Beer Sheva, Israel
| | - Ilan Dinstein
- Department of Psychology, Ben-Gurion University of the Negev, Beer Sheva, Israel
- The Azrieli National Centre for Autism and Neurodevelopment Research (ANCAN), Ben Gurion 1, Beer-Sheva, Israel
- Cognitive & Brain Sciences Department, Ben-Gurion University of the Negev, Beer Sheva, Israel
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Wall CA, Shic F, Varanasi S, Roberts JE. Distinct social attention profiles in preschoolers with autism contrasted to fragile X syndrome. Autism Res 2023; 16:340-354. [PMID: 36408848 PMCID: PMC9957831 DOI: 10.1002/aur.2857] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Accepted: 11/11/2022] [Indexed: 11/22/2022]
Abstract
Social attention is a critical skill for learning and development. Social attention difficulties are present in both non-syndromic autism spectrum disorder (nsASD) and fragile X syndrome (FXS), and our understanding of these difficulties is complicated by heterogeneity in both disorders, including co-occurring diagnoses like intellectual disability and social anxiety. Existing research largely utilizes a single index of social attention and rarely includes children with intellectual impairment or uses a cross-syndrome approach. This study investigated whether multi-trait social attention profiles including naturalistic initial eye contact, facial attention, and social scene attention differ in preschool children with nsASD and FXS matched on developmental ability (DQ) and contrasted to neurotypical (NT) controls. The relationship between DQ, ASD severity, and social anxiety and social attention profiles was also examined. Initial eye contact related to social scene attention, implicating that naturalistic social attention is consistent with responses during experimental conditions. Reduced eye contact and lower social scene attention characterized nsASD and FXS. Children with nsASD displayed less facial attention than FXS and NT children, who did not differ. Lower DQ and elevated ASD severity associated with decreased eye contact in nsASD and FXS, and lower DQ was associated with lower social scene attention in FXS. Sex, social anxiety, and age were not associated with social attention. These findings suggest social attention profiles of children with nsASD are highly similar to, yet distinct from, children with FXS. Children with nsASD may present with a global social attention deficit whereas FXS profiles may reflect context-dependent social avoidance.
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Affiliation(s)
- Carla A. Wall
- Duke University Medical Center, Center for Autism and Brain Development, 2424 Erwin Road, Suite 501, Durham, NC 27705
| | - Frederick Shic
- University of Washington, Seattle Children’s Research Institute, 1920 Terry Ave, Seattle, WA 98101
| | - Sreeja Varanasi
- University of South Carolina, School of Medicine, 6311 Garners Ferry Road, Columbia, SC 29209
| | - Jane E. Roberts
- University of South Carolina, Department of Psychology, 1512 Pendleton Street, Suite #220, Columbia, SC 29208
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Lewis LF, Stevens K. The lived experience of meltdowns for autistic adults. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2023:13623613221145783. [PMID: 36632658 DOI: 10.1177/13623613221145783] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
LAY ABSTRACT There is not a lot known about what it feels like for autistic people to have a meltdown. Past research has focused on what meltdowns are like for parents and what meltdowns look like from the outside without understanding what it is like for the person having the meltdown. We asked 32 autistic adults about what it is like for them to have a meltdown. We asked them to tell us about their thoughts and feelings about having a meltdown. Then, we looked for themes in their responses that summarized the meltdown experience. Our findings showed that meltdowns hold different meaning to different people. During a meltdown, we found that most autistics described feeling overwhelmed by information, senses, and social and emotional stress. They often felt extreme emotions, such as anger, sadness, and fear, and had trouble with thinking and memory during the meltdown. Participants described trying to stay in control of themselves, often feeling like they were not themselves during meltdowns. They described the meltdown as a way of letting go of or releasing the extreme emotions they felt. Participants tried to stay away from things or people that might trigger a meltdown or tried to make sure they were alone if they felt a meltdown may be coming as a way of avoiding harm-including harm to their bodies, their emotions, and their relationships. These findings offer an important look into what it is like for autistic adults to have meltdowns from their own point of view.
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13
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Wall CA, Roberts JE. Negative affect and respiratory sinus arrhythmia are differentially related to social anxiety and autism features in autistic preschoolers contrasted to fragile X syndrome. Front Psychiatry 2023; 14:1151263. [PMID: 37020738 PMCID: PMC10067898 DOI: 10.3389/fpsyt.2023.1151263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Accepted: 03/06/2023] [Indexed: 04/07/2023] Open
Abstract
Introduction Autism spectrum disorder (ASD) is a highly heterogeneous and complex disorder with co-occurring disorders commonplace. This presents tremendous diagnostic challenges given the phenotypic overlap between autism and other diagnoses, including social anxiety, as well as variance in specific genetic disorders like fragile X syndrome (FXS). Biobehavioral measurement approaches integrate behavioral and biological data, and by so doing have the potential to address diagnostic challenges and shed light on the mechanisms underlying social impairments. Methods The present study utilized a biobehavioral approach to evaluate how biologically based indices of baseline respiratory sinus arrhythmia (RSA) and temperamental negative affect differ and predict autism and anxiety in a sample of 120 preschoolers with non-syndromic autism (nsASD) with co-occurring intellectual impairment, FXS, and neurotypical (NT) development. Results Results indicated that children with nsASD display elevated negative affect compared to both FXS and NT controls which did not differ from each other and females exhibited more negative affect relative to males. Interestingly, elevated negative affect predicted social anxiety, but not ASD in FXS. Baseline RSA did not differ across the groups; however, reduced RSA predicted elevated autism severity for the nsASD group but not those with FXS or NT development. Discussion Taken together, biobehavioral markers differentiated the groups in discrete ways that advance our understanding of autism and promote improved diagnostic clarity using objective measurement.
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Affiliation(s)
- Carla A. Wall
- Duke Center for Autism and Brain Development, Duke University Medical Center, Durham, NC, United States
- *Correspondence: Carla A. Wall,
| | - Jane E. Roberts
- Department of Psychology, University of South Carolina, Columbia, SC, United States
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14
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Weyland M, Maes P, Kissine M, Defresne P. Impact of Belgian COVID-19 lockdown restrictions on autistic individuals’ socio-communicative behaviors and their parents’ quality of life. PLoS One 2022; 17:e0273932. [PMID: 36044732 PMCID: PMC9433112 DOI: 10.1371/journal.pone.0273932] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Accepted: 08/17/2022] [Indexed: 11/19/2022] Open
Abstract
Background In the spring of 2020, Belgian authorities enforced a full lockdown period to contain the spread of the SARS-CoV-2 virus. This lockdown drastically disrupted the daily life of autistic individuals’ and that of their families. In the midst of these extraordinary circumstances, we assessed the impact of social restrictions on autistic individuals’ behavior and their parents’ or caregivers’ quality of life; we also sought to identify individual characteristics that may influence such changes. Methods We designed an online survey targeting caregivers living with an autistic child or adult. The questionnaire included 125 five-point Likert questions which targeted changes in families’ quality of life and in autistic individuals’ behavior, as well as factors likely to influence the extent and direction of these changes. Results We collected data from 209 French-speaking Belgian respondents. Respondents reported that the lockdown brought about a higher frequency of nonfunctional socio-communicative behaviors, as well as a decrease in families’ quality of life. Parents who had less access to respite care experienced a steeper decrease in their quality of life. Autistic individuals with comorbidities, and whose parents had less access to respite care and implemented fewer rules at home during lockdown were more likely to display nonfunctional socio-communicative behaviors. Conclusion COVID-19 lockdown restrictions had a negative impact on both autistic individuals and their parents.
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Affiliation(s)
- Marielle Weyland
- Service Métrologie et Sciences du Langage, Université de Mons, Mons, Belgium
- ACTE at LaDisco and ULB Neuroscience Institute, Université libre de Bruxelles, Brussels, Belgium
- * E-mail:
| | - Pauline Maes
- ACTE at LaDisco and ULB Neuroscience Institute, Université libre de Bruxelles, Brussels, Belgium
| | - Mikhail Kissine
- ACTE at LaDisco and ULB Neuroscience Institute, Université libre de Bruxelles, Brussels, Belgium
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15
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Reyes-Martín J, Simó-Pinatella D, Font-Roura J. Assessment of Challenging Behavior Exhibited by People with Intellectual and Developmental Disabilities: A Systematic Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19148701. [PMID: 35886552 PMCID: PMC9324269 DOI: 10.3390/ijerph19148701] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Revised: 07/11/2022] [Accepted: 07/12/2022] [Indexed: 11/16/2022]
Abstract
The assessment of challenging behavior exhibited by people with intellectual and developmental disabilities is essential for the planning of prevention and intervention programs. This review aimed to identify and analyze the standardized instruments that exclusively focus on the assessment of challenging behavior. We identified and organized 141 articles into four categories: original instrument studies, validation studies, relational studies, and intervention studies. The results identified 24 instruments that generally show high-quality psychometric properties and other utilities beyond the observation of the presence of challenging behavior and diagnostic categorization. Age, level of adaptive behavior, disability, presence of autism spectrum disorder, and medication are some of the variables that were found to be possibly related to the occurrence of challenging behavior. Additionally, the results suggest that interventions focused on supporting positive behavior or providing training on behavior to professionals and caregivers significantly reduced the occurrence of these behaviors. Instruments that help us to understand and measure the challenging behavior exhibited by people with intellectual and developmental disabilities are essential for the design of effective evaluation and intervention protocols.
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Affiliation(s)
- Juliana Reyes-Martín
- Facultat de Psicologia, Ciències de l’Educació i de l’Esport, Blanquerna, Ramon Llull University, 08022 Barcelona, Spain;
- Fundació Vallparadís, Mutua Terrassa, 08221 Barcelona, Spain
- Correspondence:
| | - David Simó-Pinatella
- Facultat de Psicologia, Ciències de l’Educació i de l’Esport, Blanquerna, Ramon Llull University, 08022 Barcelona, Spain;
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16
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Leader G, Mooney A, Chen JL, Whelan S, Naughton K, Maher L, Mannion A. The Co-Occurrence of Autism Spectrum Disorder and Cerebral Palsy and Associated Comorbid Conditions in Children and Adolescents. Dev Neurorehabil 2022; 25:289-297. [PMID: 34915821 DOI: 10.1080/17518423.2021.2011456] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND Comorbidity is the co-occurrence of two or more disorders in the same person. AIM This study investigated the frequency of comorbid conditions, in children and adolescents, with autism spectrum disorder (ASD), cerebral palsy (CP), and a comorbid diagnosis of ASD and CP. METHOD Ninety-six children and adolescents with ASD, CP, and both ASD and CP aged between 4 and 18 years participated in this study. Parents completed the Gastrointestinal Symptom Inventory, Children's Sleep Habits Questionnaire, Child Behavior Checklist, Social Communication Questionnaire, and the Vineland Adaptive Behavior Scales. RESULTS Results of ANOVA analyses revealed significant group differences in sleep problems, social communication difficulties, and adaptive behavior. Regression analysis found that the presence of an intellectual disability significantly predicted levels of adaptive behavior. CONCLUSION This research demonstrated the importance of studying comorbidities in children and adolescents with CP alone, ASD alone, and combined ASD and CP.
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Affiliation(s)
| | | | - June L Chen
- East China Normal University, Shanghai, China
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17
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Panditaratne S, Hronis A, Roberts R, Kneebone I. Participant experiences of Fearless Me! ©: Cognitive behaviour therapy for anxiety in children with intellectual disabilities. CURRENT PSYCHOLOGY 2022. [DOI: 10.1007/s12144-022-03215-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
AbstractResearch shows that almost half of children with intellectual disabilities (ID) experience mental ill-health at any given time point. However, traditional cognitive behaviour therapy (CBT) may not be appropriate for children with ID due to the cognitive deficits associated with their diagnosis. The Fearless Me! © CBT program for anxiety is adapted to accommodate the cognitive abilities of children with ID. The aim of the current study was to provide the first qualitative evaluation of the Fearless Me! © program by exploring participant experiences. Eight mother–child dyads were interviewed using a semi-structured protocol. The responses were transcribed and analysed using thematic analysis. Identified codes and themes were cross-checked with an independent researcher and discrepancies were resolved. Parents found the program to be positive and useful for acquiring knowledge. They commented on features of the program, significance of inter- and intra-personal factors and whether the program suited the capability of their child. They also discussed features of treatment outcomes. The qualitative results highlighted that experiences of the program varied. Themes identified included those relating to barriers and facilitators to participation and treatment-related change. The themes provide guidance for program revisions and can inform future delivery of the Fearless Me! © program.
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18
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Masi A, Moni MA, Azim SI, Choi B, Heussler H, Lin PI, Diaz AM, Eapen V. Clinical and behavioral attributes leading to sleep disorders in children on the autism spectrum. Autism Res 2022; 15:1274-1287. [PMID: 35596587 DOI: 10.1002/aur.2745] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Accepted: 04/16/2022] [Indexed: 11/07/2022]
Abstract
Sleep disorders are a common comorbid condition in children diagnosed with autism spectrum disorder ("autism"). However, the relationship between the clinical features of autism and sleep disorders remains unclear. A better understanding of the inherent autism-related characteristics linked to comorbid sleep disorders would improve comprehensive assessment and management. This study examined the relationship between sociodemographics, autism symptoms, sleep problems, cognitive status, behavioral attributes, and sensory profiles. Using data from 1268 participants who took part in the Australian Autism Biobank, sleep-related measurements using the Child Sleep Habits Questionnaire (CSHQ) were compared between autistic children aged 2 to 17 (N = 969), their siblings (N = 188), and unrelated children without an autism diagnosis (N = 111). The known relationship between sleep problems and autism was further explored by including scores from the Autism Diagnostic Observation Schedule-2, Mullen Scales of Early Learning, Vineland Adaptive Behavioral Scale-II and the Short Sensory Profile-2; which were included in analyses for autistic participants who had a completed CSHQ. Multiple regression models were used to identify clinical/behavioral variables associated with CSHQ subscales. The autism group had a significantly higher total CSHQ score than the sibling and comparison groups (p < 0.001), indicating worse sleep quality. Within the autism group, lower adaptive behaviors (i.e., VABS-II) and sensory issues (i.e., SSP-2 subclass scores) were positively associated with the severity of sleep problems (i.e., the CSHQ subclass scores) (p < 0.001). The significant functional impact of poor sleep on autistic children warrants an assessment of sleep as a critical part of a holistic approach to supporting autistic children and their families. LAY SUMMARY: Autistic children generally have co-occurring conditions. Sleep disorders impact approximately 50%-80% of autistic children. The impact on the quality of life for both the children and their families can be significant. This study compares sleep problems in autistic children and adolescents with their siblings and children without a diagnosis of autism, and investigates the relationship between specific autistic traits, daily life behaviors and sleep problems. The findings highlight the importance of a holistic assessment for autistic children and matching appropriate sleep intervention and supports where indicated.
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Affiliation(s)
- Anne Masi
- School of Psychiatry, Faculty of Medicine, UNSW Sydney, Kensington, New South Wales, Australia
| | - Mohammod Ali Moni
- School of Psychiatry, Faculty of Medicine, UNSW Sydney, Kensington, New South Wales, Australia
| | - Syeda Ishra Azim
- School of Psychiatry, Faculty of Medicine, UNSW Sydney, Kensington, New South Wales, Australia
| | - Byungkuk Choi
- School of Psychiatry, Faculty of Medicine, UNSW Sydney, Kensington, New South Wales, Australia
| | - Helen Heussler
- Centre for Children's Health Research, University of Queensland, South Brisbane, Queensland, Australia.,Child Development, Child and Youth Community Health Services, Queensland Children's Hospital, South Brisbane, Queensland, Australia
| | - Ping-I Lin
- School of Psychiatry, Faculty of Medicine, UNSW Sydney, Kensington, New South Wales, Australia.,Mental Health Research Unit, South Western Sydney Local Health District, Liverpool, New South Wales, Australia.,Ingham Institute, Liverpool Hospital, Liverpool, New South Wales, Australia
| | - Antonio Mendoza Diaz
- School of Psychiatry, Faculty of Medicine, UNSW Sydney, Kensington, New South Wales, Australia.,Academic Unit of Child Psychiatry, South Western Sydney Local Health District, Liverpool, New South Wales, Australia
| | - Valsamma Eapen
- School of Psychiatry, Faculty of Medicine, UNSW Sydney, Kensington, New South Wales, Australia.,Ingham Institute, Liverpool Hospital, Liverpool, New South Wales, Australia.,Academic Unit of Child Psychiatry, South Western Sydney Local Health District, Liverpool, New South Wales, Australia
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19
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Guller B, Yaylaci F, Eyuboglu D. Those in the shadow of the pandemic: impacts of the COVID-19 outbreak on the mental health of children with neurodevelopmental disorders and their parents. INTERNATIONAL JOURNAL OF DEVELOPMENTAL DISABILITIES 2022; 68:943-955. [PMID: 36568626 PMCID: PMC9788683 DOI: 10.1080/20473869.2021.1930827] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
This study aimed to investigate the emotional and behavioral responses of children with neurodevelopmental disorders and their parents during the recent novel coronavirus disease (COVID-19) pandemic and the associated factors. Our study included 299 children and adolescents with neurodevelopmental disorders and 299 mothers or fathers. Participant groups were as follows: autism spectrum disorder (n = 131, 43.8%); intellectual disability (n = 103, 34.4%); specific learning disorder (n = 46, 15.4%); and communication disorder (n = 19, 6.4%). A data form was created to investigate the emotional, behavioral, sleep problems, and appetite changes of the cases, and it was adapted for online application and conveyed to the parents in the form of emails. Our study indicated that children and adolescents' emotional problems were 44.5%, behavioral problems 33.4%, sleep problems 65.2%, and appetite problems 32.4%. Irritability (35.5%), hyperactivity (37.8%), stereotyped behavior (29.8%), delayed sleep phase (51.5%) were the most common problems reported by the parents. The frequencies of emotional and behavioral problems in the ASD group were higher than in the other groups (p < .05). In addition, the Hospital Anxiety Depression Scale (HADS) was used to determine the parents' anxiety and depression symptoms. Mean HADS anxiety and depression scores of parents were 8.5 ± 4.3 and 7.8 ± 4.2, respectively. Our study demonstrated that the COVID-19 pandemic and lockdown negatively affected children with neurodevelopmental disorders and their parents in many areas. It is necessary that these children and their families are evaluated and supported by local professionals, as the ongoing pandemic can exacerbate the current challenges. The findings of our study reflect the early period of the pandemic. For this reason, longitudinal studies about the long-term consequences of the pandemic are needed.
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Affiliation(s)
- Baris Guller
- Department of Child and Adolescent Psychiatry, Bursa Dörtcelik Child Hospital, Bursa, Turkey
- Correspondence to: Baris Guller, Bursa Dörtcelik Child Hospital, Department of Child and Adolescent Psychiatry, Ertugrul, Dogan Avcioglu st., 16120Nilufer/Bursa, Turkey.
| | - Ferhat Yaylaci
- Department of Child and Adolescent Psychiatry, Bursa Dörtcelik Child Hospital, Bursa, Turkey
| | - Damla Eyuboglu
- Faculty of Medicine, Department of Child and Adolescent Psychiatry, Eskisehir Osmangazi University, Eskisehir, Turkey
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20
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Matsuoka M, Matsuishi T, Nagamitsu S, Iwasaki M, Iemura A, Obara H, Yamashita Y, Maeda M, Kakuma T, Uchimura N. Sleep disturbance has the largest impact on children's behavior and emotions. Front Pediatr 2022; 10:1034057. [PMID: 36518780 PMCID: PMC9744255 DOI: 10.3389/fped.2022.1034057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Accepted: 11/11/2022] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE Children's behavior and emotions are affected by sleep disturbances, the parent-child relationship, media viewing time, and the social status of parents and caregivers. We conducted a questionnaire survey to identify the factors that have the greatest impact on children's behavior and emotions and how these factors relate to each other. METHODS A parental questionnaire survey was performed at a public elementary school. The questionnaire comprised questions on the family environment (e.g., family structure, media and game exposure, after-school lessons, and caregiver's work schedule) and physical information, the Strengths and Difficulties Questionnaire (SDQ), the Children's Sleep Habits Questionnaire (CSHQ), and the Pittsburgh Sleep Quality Index (PSQI) for parents' sleep condition. A path diagram was drawn to hypothesize the complex interrelationships among factors, and structural equation modeling was used to estimate the path coefficients. RESULT We identified several factors that significantly affected the SDQ score. The CSHQ total score had the largest impact, followed by after-school lessons, single-mother families, and children's sex. In addition, several indirect pathways that led to the CSHQ score (i.e., a pathway from time spent watching television to CSHQ score via children's bedtime and a pathway from single-mother family to CSHQ score via PSQI total score) significantly affected the SDQ score. CONCLUSION Children's sleep habits that were influenced by several environmental factors had the greatest impact on children's behavior and emotions, which suggested that children's behavioral problems can be improved by interventions focused on sleep habits, such as sleep hygiene instructions.
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Affiliation(s)
- Michiko Matsuoka
- Department of Pediatrics and Child Health, School of Medicine, Kurume University, Kurume, Japan.,Department of Neuropsychiatry, School of Medicine, Kurume University, Kurume, Japan
| | - Toyojiro Matsuishi
- Department of Pediatrics and Child Health, School of Medicine, Kurume University, Kurume, Japan.,Research Center for Children and Research Center for Rett Syndrome, St. Mary's Hospital, Kurume, Japan
| | - Shinichiro Nagamitsu
- Department of Pediatrics and Child Health, School of Medicine, Kurume University, Kurume, Japan.,Department of Pediatrics, Faculty of Medicine, Fukuoka University, Fukuoka, Japan
| | - Mizue Iwasaki
- Department of Pediatrics and Child Health, School of Medicine, Kurume University, Kurume, Japan
| | - Akiko Iemura
- Department of Pediatrics and Child Health, School of Medicine, Kurume University, Kurume, Japan
| | - Hitoshi Obara
- Biostatistics Center, School of Medicine, Kurume University, Kurume, Japan
| | - Yushiro Yamashita
- Department of Pediatrics and Child Health, School of Medicine, Kurume University, Kurume, Japan
| | - Masaharu Maeda
- Department of Neuropsychiatry, School of Medicine, Kurume University, Kurume, Japan.,Department of Disaster Psychiatry, Fukushima Medical University, Fukushima, Japan
| | - Tatsuyuki Kakuma
- Biostatistics Center, School of Medicine, Kurume University, Kurume, Japan
| | - Naohisa Uchimura
- Department of Neuropsychiatry, School of Medicine, Kurume University, Kurume, Japan
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21
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Chan MCH, Campbell M, Beyzaei N, Stockler S, Ipsiroglu OS. Disruptive Behaviors and Intellectual Disability: Creating a New Script. Front Psychiatry 2022; 13:851490. [PMID: 35873258 PMCID: PMC9304661 DOI: 10.3389/fpsyt.2022.851490] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2022] [Accepted: 06/09/2022] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Terms currently used to describe the so-called challenging and disruptive behaviors (CBDs) of children with intellectual disabilities (ID) have different connotations depending on guiding contextual frameworks, such as academic and cultural settings in which they are used. A non-judgmental approach, which does not attempt to establish existing categorical diagnoses, but which describes in a neutral way, is missing in the literature. Therefore, we tried to describe CDBs in youth with ID in an explorative study. METHODS Interviews with families investigated the CDBs of five youth with Down syndrome. At home, families tracked youth's sleep/wake behaviors and physical activity. Youth were observed in a summer school classroom. The collected information and suggested explanatory models for observed CDBs were reviewed with the families. RESULTS We grouped CDBs as challenging, if they were considered to be reactive or triggered, or unspecified, if no such explanatory model was available. A third category was created for light-hearted CDBs: goofy, acknowledging the right to laugh together with peers. We found some relationships between sleep, physical activity, and CDBs and developed an explorative approach, supporting a child-centered perspective on CDBs. CONCLUSION The controversial discussions on terminology and management of CDBs in the literature demonstrate the need for a non-judgmental approach. Such an explorative approach, allowing non-professionals to not label, has been missing. The fact that, up to now, the light-hearted behaviors of an individual with ID have not been integrated in commonly-used behavioral checklists as their natural right, proves our concept and indicates that a paradigm change from judgment-based to exploratory-driven approaches is needed.
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Affiliation(s)
- Melvin Chin-Hao Chan
- H-Behaviours Research Lab, BC Children's Hospital Research Institute, Vancouver, BC, Canada
| | - Mackenzie Campbell
- H-Behaviours Research Lab, BC Children's Hospital Research Institute, Vancouver, BC, Canada
| | - Nadia Beyzaei
- H-Behaviours Research Lab, BC Children's Hospital Research Institute, Vancouver, BC, Canada
| | - Sylvia Stockler
- H-Behaviours Research Lab, BC Children's Hospital Research Institute, Vancouver, BC, Canada.,Division of Biochemical Diseases, Department of Pediatrics, Faculty of Medicine, The University of British Columbia, Vancouver, BC, Canada
| | - Osman S Ipsiroglu
- H-Behaviours Research Lab, BC Children's Hospital Research Institute, Vancouver, BC, Canada.,Divisions of Developmental Pediatrics, Respirology, and Child and Adolescent Psychiatry, Departments of Pediatrics and Psychiatry, Faculty of Medicine, The University of British Columbia, Vancouver, BC, Canada
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22
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Ng R, Bjornsson HT, Fahrner JA, Harris J. Sleep disturbances correlate with behavioral problems among individuals with Wiedemann-Steiner syndrome. Front Genet 2022; 13:950082. [PMID: 36313433 PMCID: PMC9608624 DOI: 10.3389/fgene.2022.950082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2022] [Accepted: 08/22/2022] [Indexed: 11/13/2022] Open
Abstract
Wiedemann-Steiner syndrome (WSS) is a rare genetic disorder caused by mutation in KMT2A and characterized by neurodevelopmental delay. This study is the first prospective investigation to examine the sleep and behavioral phenotypes among those with WSS through parent-informant screening inventories. A total of 24 parents of children/adults with WSS (11F, Mean age = 12.71 years, SD = 8.17) completed the Strengths and Difficulties Questionnaire (SDQ) and 22 of these caregivers also completed the Modified Simonds and Parraga Sleep Questionnaire (MSPSQ). On average, the majority of those with WSS (83%) were rated to show borderline to clinical level of behavioral difficulties on the SDQ. Approximately 83% were rated in these ranges for hyperactivity, 63% for emotional problems, and 50% for conduct problems. When applying prior published clinical cut-off for risk of sleep disturbance among those with neurodevelopmental disorders, over 80% of our sample exceeded this limit on the MSPSQ. Largely, caregivers' ratings suggested restless sleep, rigid bedtime rituals, sleep reluctance and breathing through the mouth in sleep were most consistent problems observed. Partial correlations between sleep and behavioral domains showed elevated emotional problems were associated with parasomnia characteristics after controlling for age. Daytime drowsiness and activity were associated with more hyperactivity. Those with more night waking problems and delayed sleep onset were rated to show more severe conduct problems. Overall, these findings suggest dysfunctional sleep behaviors, hyperactivity, and affective problems are part of the neurobehavioral phenotype of WSS. Routine clinical care for those affected by WSS should include close monitoring of sleep and overactive behaviors.
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Affiliation(s)
- Rowena Ng
- Kennedy Krieger Institute, Baltimore, MD, United States.,Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Hans Tomas Bjornsson
- Department of Genetic Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, United States.,Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD, United States.,Faculty of Medicine, University of Iceland, Reykjavik, Iceland.,Landspitali University Hospital, Reykjavik, Iceland
| | - Jill A Fahrner
- Department of Genetic Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, United States.,Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Jacqueline Harris
- Kennedy Krieger Institute, Baltimore, MD, United States.,Department of Genetic Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, United States.,Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD, United States.,Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, United States
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23
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Esbensen AJ, Schworer EK, Hoffman EK, Wiley S. Child Sleep Linked to Child and Family Functioning in Children with Down Syndrome. Brain Sci 2021; 11:brainsci11091170. [PMID: 34573191 PMCID: PMC8465298 DOI: 10.3390/brainsci11091170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Revised: 08/25/2021] [Accepted: 08/29/2021] [Indexed: 11/16/2022] Open
Abstract
Sleep problems have a bi-directional impact on the daytime performance of children, parental well-being, and overall family functioning in the general population. Children with Down syndrome (DS) are at a high risk of sleep problems, yet the relationship between sleep problems, adaptive functioning, and family stress in children with DS is not well documented. We examined the relationship between sleep (i.e., duration and quality) and child and parent/family functioning. Sixty-six children with DS wore an actigraph for a week to assess their sleep duration and sleep efficiency. Their parents completed ratings on child sleep duration and parasomnias, child adaptive functioning, parental depression and sleep, and family stress. The parents' reports of their children's sleep duration were associated with parental depressive symptoms. The parents' reports of their children's restless sleep behaviors were associated with poorer performances in child-compliant/calm behaviors, worse parental sleep, and negative parental feelings and sibling relationships. The findings from actigraph measures of the children's sleep demonstrated that greater sleep efficiency was associated with greater child adaptive functioning and fewer parental depressive symptoms. The study findings provide preliminary evidence that sleep problems are related to child adaptive functioning, parental functioning, and family stress in children with DS.
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Affiliation(s)
- Anna J. Esbensen
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH 45267, USA;
- Division of Developmental and Behavioral Pediatrics, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH 45229, USA; (E.K.S.); (E.K.H.)
- Correspondence:
| | - Emily K. Schworer
- Division of Developmental and Behavioral Pediatrics, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH 45229, USA; (E.K.S.); (E.K.H.)
| | - Emily K. Hoffman
- Division of Developmental and Behavioral Pediatrics, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH 45229, USA; (E.K.S.); (E.K.H.)
| | - Susan Wiley
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH 45267, USA;
- Division of Developmental and Behavioral Pediatrics, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH 45229, USA; (E.K.S.); (E.K.H.)
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24
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McLay LL, France KG, Blampied NM, Hunter JE, van Deurs JR, Woodford EC, Gibbs R, Lang R. Collateral Child and Parent Effects of Function‑Based Behavioral Interventions for Sleep Problems in Children and Adolescents with Autism. J Autism Dev Disord 2021; 52:2258-2273. [PMID: 34110556 DOI: 10.1007/s10803-021-05116-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/27/2021] [Indexed: 11/25/2022]
Abstract
This study follows McLay et al., Journal of Autism and Developmental Disorders, (2020) to investigate whether the function-based behavioral sleep interventions received by 41 children and adolescents with autism spectrum disorder (ASD) produced collateral improvements in ASD severity, internalizing and externalizing symptoms and parent relationship quality, ratings of depression, anxiety and stress, and personal sleep quality. Concomitant with reduced sleep problem severity, improvements were found in children's internalizing and externalizing behavior and ASD symptom severity. Small improvements were also found in maternal sleep quality and parental stress. There was little change in parental relationship quality post-treatment, possibly reflecting high baseline scores. Overall, collateral benefits were generally small but positive, consistent with the limited extant research, and underscore the importance of investigating collateral effects across a range of variables.
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Affiliation(s)
- Laurie L McLay
- School of Health Sciences, University of Canterbury, Private bag 4800, Christchurch, New Zealand.
| | - Karyn G France
- School of Health Sciences, University of Canterbury, Private bag 4800, Christchurch, New Zealand
| | - Neville M Blampied
- Psychology Department, School of Psychology, Speech, and Hearing, University of Canterbury, Christchurch, New Zealand
| | - Jolene E Hunter
- School of Health Sciences, University of Canterbury, Private bag 4800, Christchurch, New Zealand
| | - Jenna R van Deurs
- School of Health Sciences, University of Canterbury, Private bag 4800, Christchurch, New Zealand
| | - Emma C Woodford
- School of Health Sciences, University of Canterbury, Private bag 4800, Christchurch, New Zealand
| | - Rosina Gibbs
- School of Health Sciences, University of Canterbury, Private bag 4800, Christchurch, New Zealand
| | - Russell Lang
- Department of Special Education, Center for Autism Research, Evaluation, and Support, Texas State University, San Marcos, TX, USA
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25
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Familial sleep and autism spectrum disorder: a pilot actigraphy study of sleep quality, quality of life and psychological distress. Ir J Psychol Med 2021; 39:261-271. [PMID: 33973508 DOI: 10.1017/ipm.2021.24] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVES Sleep problems are common among children with autism spectrum disorder (ASD) and can have a negative impact on the child's behaviour and daytime functioning. The current pilot study examined objective measurements of child and parent sleep as factors associated with the stress, anxiety, depressive symptoms, social support and quality of life of parents of children with ASD. METHODS Participants were nine children with ASD and their parents (nine mothers and three fathers). Participants wore an actigraph for 7 consecutive days and nights. Measures of sleep habits and quality were used to ascertain child and parent sleep. Measures of parenting stress, anxiety, depressive symptoms, quality of life and social support were collated. RESULTS Results indicated the emergence of high parental stress, anxiety and depressive symptoms. Significant correlations were observed between parent depressive symptoms, and both subjective sleep quality and child sleep disruptions. CONCLUSIONS The present study found that parental well-being is affected by child sleep problems.
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Al-Beltagi M. Autism medical comorbidities. World J Clin Pediatr 2021; 10:15-28. [PMID: 33972922 PMCID: PMC8085719 DOI: 10.5409/wjcp.v10.i3.15] [Citation(s) in RCA: 63] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2021] [Revised: 02/12/2021] [Accepted: 03/17/2021] [Indexed: 02/06/2023] Open
Abstract
Medical comorbidities are more common in children with autism spectrum disorders (ASD) than in the general population. Some genetic disorders are more common in children with ASD such as Fragile X syndrome, Down syndrome, Duchenne muscular dystrophy, neurofibromatosis type I, and tuberous sclerosis complex. Children with autism are also more prone to a variety of neurological disorders, including epilepsy, macrocephaly, hydrocephalus, cerebral palsy, migraine/headaches, and congenital abnormalities of the nervous system. Besides, sleep disorders are a significant problem in individuals with autism, occurring in about 80% of them. Gastrointestinal (GI) disorders are significantly more common in children with ASD; they occur in 46% to 84% of them. The most common GI problems observed in children with ASD are chronic constipation, chronic diarrhoea, gastroesophageal reflux and/or disease, nausea and/or vomiting, flatulence, chronic bloating, abdominal discomfort, ulcers, colitis, inflammatory bowel disease, food intolerance, and/or failure to thrive. Several categories of inborn-errors of metabolism have been observed in some patients with autism including mitochondrial disorders, disorders of creatine metabolism, selected amino acid disorders, disorders of folate or B12 metabolism, and selected lysosomal storage disorders. A significant proportion of children with ASD have evidence of persistent neuroinflammation, altered inflammatory responses, and immune abnormalities. Anti-brain antibodies may play an important pathoplastic mechanism in autism. Allergic disorders are significantly more common in individuals with ASD from all age groups. They influence the development and severity of symptoms. They could cause problematic behaviours in at least a significant subset of affected children. Therefore, it is important to consider the child with autism as a whole and not overlook possible symptoms as part of autism. The physician should rule out the presence of a medical condition before moving on to other interventions or therapies. Children who enjoy good health have a better chance of learning. This can apply to all children including those with autism.
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Affiliation(s)
- Mohammed Al-Beltagi
- Department of Pediatrics, University Medical Center, King Abdulla Medical City, Arabian Gulf University, Manama P.O. Box 26671, Bahrain, Bahrain
- Department of Pediatrics, Faculty of Medicine, Tanta University, Tanta 0000000, Al Gharbia, Egypt
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Al-Beltagi M. Autism medical comorbidities. World J Clin Pediatr 2021. [PMID: 33972922 DOI: 10.5409/wjcp.v10.i3.15.] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Medical comorbidities are more common in children with autism spectrum disorders (ASD) than in the general population. Some genetic disorders are more common in children with ASD such as Fragile X syndrome, Down syndrome, Duchenne muscular dystrophy, neurofibromatosis type I, and tuberous sclerosis complex. Children with autism are also more prone to a variety of neurological disorders, including epilepsy, macrocephaly, hydrocephalus, cerebral palsy, migraine/headaches, and congenital abnormalities of the nervous system. Besides, sleep disorders are a significant problem in individuals with autism, occurring in about 80% of them. Gastrointestinal (GI) disorders are significantly more common in children with ASD; they occur in 46% to 84% of them. The most common GI problems observed in children with ASD are chronic constipation, chronic diarrhoea, gastroesophageal reflux and/or disease, nausea and/or vomiting, flatulence, chronic bloating, abdominal discomfort, ulcers, colitis, inflammatory bowel disease, food intolerance, and/or failure to thrive. Several categories of inborn-errors of metabolism have been observed in some patients with autism including mitochondrial disorders, disorders of creatine metabolism, selected amino acid disorders, disorders of folate or B12 metabolism, and selected lysosomal storage disorders. A significant proportion of children with ASD have evidence of persistent neuroinflammation, altered inflammatory responses, and immune abnormalities. Anti-brain antibodies may play an important pathoplastic mechanism in autism. Allergic disorders are significantly more common in individuals with ASD from all age groups. They influence the development and severity of symptoms. They could cause problematic behaviours in at least a significant subset of affected children. Therefore, it is important to consider the child with autism as a whole and not overlook possible symptoms as part of autism. The physician should rule out the presence of a medical condition before moving on to other interventions or therapies. Children who enjoy good health have a better chance of learning. This can apply to all children including those with autism.
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Affiliation(s)
- Mohammed Al-Beltagi
- Department of Pediatrics, University Medical Center, King Abdulla Medical City, Arabian Gulf University, Manama P.O. Box 26671, Bahrain, Bahrain
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Gisbert Gustemps L, Lugo Marín J, Setien Ramos I, Ibañez Jimenez P, Romero Santo-Tomás O, Jurado Luque MJ, Ballester Navarro P, Esteve Cruella A, Díez Villoria E, Canal Bedia R, Ramos Quiroga JA. Sleep disturbances in autism spectrum disorder without intellectual impairment: relationship with executive function and psychiatric symptoms. Sleep Med 2021; 83:106-114. [PMID: 33991890 DOI: 10.1016/j.sleep.2021.04.022] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Revised: 04/13/2021] [Accepted: 04/15/2021] [Indexed: 11/26/2022]
Abstract
The autism spectrum disorder (ASD) is a neurodevelopmental condition, frequently accompanied by medical and psychiatric pathology. One of the most commonly found problems associated with ASD is sleep disturbances, which are estimated to affect approximately 80% of the people with ASD, not only during childhood but also in the adolescence and adult stages. Nevertheless, the relationship of these sleep difficulties with autism severity, as well as other associated impairments such as executive functioning and psychiatric disorders (eg, depression), has not yet been widely studied. The main objective of the present study was to explore the relationship between sleep disturbances, subjective measures of executive function, and psychiatric pathology in the ASD population. To reach that goal, a group of 89 participants with ASD (44 children/adolescents and 45 adults) was recruited and evaluated with self-reported measures of executive function performance and psychiatric pathology tests. Multivariate analysis showed a significant association between sleep disturbances and psychiatric symptoms in both ASD groups, with greater sleep disturbances predicting more severe psychiatric pathology. No significant association was found with executive function in any group. Limitations included a small sample size and lack of objective measures. Sleep problems seem to be associated with the severity of psychiatric pathology throughout the lifespan, increasing the chance of developing psychiatric symptoms when they were present. Improving sleep quality in ASD at all ages may result in preventing and/or decreasing psychiatric pathology in this population.
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Affiliation(s)
- Laura Gisbert Gustemps
- Department of Psychiatry, Hospital Universitari Vall d'Hebron, Barcelona, Catalonia, Spain; Group of Psychiatry, Mental Health and Addictions, Vall d'Hebron Research Institute (VHIR), Barcelona, Catalonia, Spain; Department of Psychiatry and Legal Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain.
| | - Jorge Lugo Marín
- Department of Psychiatry, Hospital Universitari Vall d'Hebron, Barcelona, Catalonia, Spain
| | - Imanol Setien Ramos
- Group of Psychiatry, Mental Health and Addictions, Vall d'Hebron Research Institute (VHIR), Barcelona, Catalonia, Spain
| | - Pol Ibañez Jimenez
- Group of Psychiatry, Mental Health and Addictions, Vall d'Hebron Research Institute (VHIR), Barcelona, Catalonia, Spain
| | | | | | - Pura Ballester Navarro
- Neuropharmacology on Pain and Functional Diversity (NED) Research Group, Alicante Institute of Sanitary and Biomedical Research (ISABIAL), Alicante, Spain; Department of Clinical Pharmacology, Organic Chemistry and Pediatrics, Miguel Hernández University of Elche, Elche, Spain
| | | | - Emiliano Díez Villoria
- Centro de Atención Integral al Autismo-InFoAutismo, INICO-Instituto Universitario de Integración en la Comunidad, University of Salamanca. Salamanca, Spain
| | - Ricardo Canal Bedia
- Biomedical Network Research Centre on Mental Health (CIBERSAM), Madrid, Spain
| | - Josep Antoni Ramos Quiroga
- Department of Psychiatry, Hospital Universitari Vall d'Hebron, Barcelona, Catalonia, Spain; Group of Psychiatry, Mental Health and Addictions, Vall d'Hebron Research Institute (VHIR), Barcelona, Catalonia, Spain; Department of Psychiatry and Legal Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain; Biomedical Network Research Centre on Mental Health (CIBERSAM), Madrid, Spain
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A Pilot Randomised Control Trial of Digitally-Mediated Social Stories for Children on the Autism Spectrum. J Autism Dev Disord 2021; 50:4243-4257. [PMID: 32266683 PMCID: PMC7677143 DOI: 10.1007/s10803-020-04490-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Social stories is a widely used intervention for children on the autism spectrum, particularly within an educational context. To date, systematic reviews and meta analyses of the research evaluating social stories has produced mixed results, often due to a lack of methodological rigour and variability in the development and delivery of the social stories. To address the gap in methodological rigour, a pilot Randomised Control Trial (RCT) was conducted, incorporating a social stories intervention group (n = 9 children on the autism spectrum) and an attentional control group who received a poem (n = 6 children on the autism spectrum) using a digital platform to address variability. Digitally-mediated social stories were found to be effective in producing beneficial changes in behaviour outcomes, which were sustained at a six-week follow up.
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Horiuchi F, Kawabe K, Oka Y, Nakachi K, Hosokawa R, Ueno SI. The Association between Autistic Traits and Sleep Habits/Problems in Toddlers. Dev Neuropsychol 2020; 45:485-495. [DOI: 10.1080/87565641.2020.1865357] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Affiliation(s)
- Fumie Horiuchi
- Department of Neuropsychiatry, Ehime University Graduate School of Medicine, Toon City, Ehime, Japan
- Center for Child Health, Behavior and Development, Ehime University Hospital, Toon City, Ehime, Japan
| | - Kentaro Kawabe
- Department of Neuropsychiatry, Ehime University Graduate School of Medicine, Toon City, Ehime, Japan
- Center for Child Health, Behavior and Development, Ehime University Hospital, Toon City, Ehime, Japan
| | - Yasunori Oka
- Center for Sleep Medicine, Ehime University Hospital, Toon City, Ehime, Japan
| | - Kiwamu Nakachi
- Department of Neuropsychiatry, Ehime University Graduate School of Medicine, Toon City, Ehime, Japan
- Center for Child Health, Behavior and Development, Ehime University Hospital, Toon City, Ehime, Japan
| | - Rie Hosokawa
- Department of Neuropsychiatry, Ehime University Graduate School of Medicine, Toon City, Ehime, Japan
- Center for Child Health, Behavior and Development, Ehime University Hospital, Toon City, Ehime, Japan
| | - Shu-Ichi Ueno
- Department of Neuropsychiatry, Ehime University Graduate School of Medicine, Toon City, Ehime, Japan
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Uygun SD, Çakmak FH, Canlı M, Temeltürk RD, Efe A, Gürel Y, Açıkel SB, Çetinkaya M. Psychotropic Drug Use in Children with Autism Spectrum Disorder Admitted to a Training and Research Hospital Outpatient Clinic: A Retrospective Cross-Sectional Study. JOURNAL OF CHILD SCIENCE 2020. [DOI: 10.1055/s-0040-1721679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
AbstractThis study aimed to examine demographic and clinical variables, psychiatric comorbidities, the prevalence of psychotropic drug use, relationships between drug use, demographic and clinical variables, and predictors of drug use in children with autism spectrum disorder (ASD) admitted to a training and research hospital outpatient clinic. Four hundred and eleven children with ASD admitted to the Department of Child and Adolescent Psychiatry, Dr. Sami Ulus Maternity and Children's Health and Diseases Training and Research Hospital, between October 1, 2019 and December 31, 2019, were retrospectively reviewed. Demographic and clinical variables, psychiatric comorbidities, and characteristics of drug use for the cases were recorded. Psychotropic drug use was found in 34.3% (n = 141) of the cases. Our results revealed male sex and psychiatric comorbidity as predictors of psychotropic drug use. Antipsychotics were the most prescribed drugs, and the most common psychiatric comorbidity was conduct disorder. Also, children with ASD who had been toilet-trained, and could express sentences but were illiterate, were using psychotropic drugs more often than others. Future multicentered, large clinic-based studies from training and research hospitals should focus on trends of treatment in psychiatric comorbidities accompanying ASD, and constitute a systematic approach for the psychopharmacological treatment of these cases.
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Affiliation(s)
- Sabide Duygu Uygun
- Department of Child and Adolescent Psychiatry, University of Health Sciences, Dr. Sami Ulus Maternity and Children's Health and Diseases Training and Research Hospital, Ankara, Turkey
| | - Fatma Hülya Çakmak
- Department of Child and Adolescent Psychiatry, University of Health Sciences, Dr. Sami Ulus Maternity and Children's Health and Diseases Training and Research Hospital, Ankara, Turkey
| | - Merve Canlı
- Department of Child and Adolescent Psychiatry, University of Health Sciences, Dr. Sami Ulus Maternity and Children's Health and Diseases Training and Research Hospital, Ankara, Turkey
| | - Rahime Duygu Temeltürk
- Department of Child and Adolescent Psychiatry, University of Health Sciences, Dr. Sami Ulus Maternity and Children's Health and Diseases Training and Research Hospital, Ankara, Turkey
| | - Ayşegül Efe
- Department of Child and Adolescent Psychiatry, University of Health Sciences, Dr. Sami Ulus Maternity and Children's Health and Diseases Training and Research Hospital, Ankara, Turkey
| | - Yusuf Gürel
- Department of Child and Adolescent Psychiatry, University of Health Sciences, Dr. Sami Ulus Maternity and Children's Health and Diseases Training and Research Hospital, Ankara, Turkey
| | - Sadettin Burak Açıkel
- Department of Child and Adolescent Psychiatry, University of Health Sciences, Dr. Sami Ulus Maternity and Children's Health and Diseases Training and Research Hospital, Ankara, Turkey
| | - Miray Çetinkaya
- Department of Child and Adolescent Psychiatry, University of Health Sciences, Dr. Sami Ulus Maternity and Children's Health and Diseases Training and Research Hospital, Ankara, Turkey
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Kildahl AN, Bakken TL, Matre EAW, Hellerud JMA, Engebretsen MH, Helverschou SB. Case study: identification of anxiety and subsequent intervention in an adolescent male with autism, severe intellectual disability and self-injurious behaviour. INTERNATIONAL JOURNAL OF DEVELOPMENTAL DISABILITIES 2020; 67:327-338. [PMID: 34552728 PMCID: PMC8451636 DOI: 10.1080/20473869.2020.1850160] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/20/2020] [Revised: 11/07/2020] [Accepted: 11/07/2020] [Indexed: 05/12/2023]
Abstract
Introduction: Anxiety disorders are highly prevalent in individuals with autism spectrum disorder (ASD), but knowledge is limited regarding identification and treatment of these disorders in individuals with ASD and more severe levels of intellectual disability (ID). The current case study aims to explore and describe the inpatient, psychiatric assessment in an adolescent male with ASD, severe ID and self-injurious behaviour (SIB) who was diagnosed with a co-occurring anxiety disorder. The study further aims to explore the implications of this diagnosis for subsequent intervention and care, including management of SIB. Materials and methods: Case study including multimodal, psychiatric assessment and subsequent intervention. Results: Following changes in care strategies attempting to incorporate the understanding of anxiety/trauma as contributing to SIB, a reduction of SIB was observed, and this reduced frequency was maintained when the patient was discharged from the inpatient setting. Conclusions: Though no causal inferences are possible, these experiences indicate that further research is needed regarding possible associations between SIB and anxiety in individuals with ASD, including implications for treatment. Experiences from the current case further indicate that it is possible to recognize and diagnose anxiety disorder in complex cases involving ASD, severe ID, limited verbal language skills, and severe SIB.
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Affiliation(s)
- Arvid Nikolai Kildahl
- Regional Section Mental Health, Intellectual Disabilities/Autism, Oslo University Hospital, Oslo, Norway
- NevSom Norwegian Centre of Expertise for Neurodevelopmental Disorders and Hypersomnias, Oslo University Hospital, Oslo, Norway
| | - Trine Lise Bakken
- Regional Section Mental Health, Intellectual Disabilities/Autism, Oslo University Hospital, Oslo, Norway
| | | | | | - Maria Hagen Engebretsen
- Regional Section Mental Health, Intellectual Disabilities/Autism, Oslo University Hospital, Oslo, Norway
| | - Sissel Berge Helverschou
- NevSom Norwegian Centre of Expertise for Neurodevelopmental Disorders and Hypersomnias, Oslo University Hospital, Oslo, Norway
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Kamara D, Beauchaine TP. A Review of Sleep Disturbances among Infants and Children with Neurodevelopmental Disorders. REVIEW JOURNAL OF AUTISM AND DEVELOPMENTAL DISORDERS 2020; 7:278-294. [PMID: 33344102 PMCID: PMC7747783 DOI: 10.1007/s40489-019-00193-8] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Accepted: 12/04/2019] [Indexed: 02/06/2023]
Abstract
Sleep problems are common among children with neurodevelopmental disorders (NDDs). We review sleep disturbance in three major NDDs: autism spectrum disorder, Down syndrome, and fetal alcohol spectrum disorder (FASD). We review associations with functional impairment, discuss how patterns of sleep disturbance inform understanding of etiology, and theorize about mechanisms of impairment. Sleep disturbance is a transdiagnostic feature of NDDs. Caregivers report high rates of sleep problems, including difficulty falling or staying asleep. Polysomnography data reveal differences in sleep architecture and increased rates of sleep disorders. Sleep disturbance is associated with functional impairment and stress among families. Further research is needed to elucidate mechanisms of impairment and develop more effective interventions. Despite significant sleep disturbance in FASD, limited research is available.
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Affiliation(s)
- Dana Kamara
- The Ohio State University, Department of Psychology, 1835 Neil Ave., Columbus, OH 43210
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Hallett V, Mueller J, Breese L, Hollett M, Beresford B, Irvine A, Pickles A, Slonims V, Scott S, Charman T, Simonoff E. Introducing ‘Predictive Parenting’: A Feasibility Study of a New Group Parenting Intervention Targeting Emotional and Behavioral Difficulties in Children with Autism Spectrum Disorder. J Autism Dev Disord 2020; 51:323-333. [DOI: 10.1007/s10803-020-04442-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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Agar G, Oliver C, Trickett J, Licence L, Richards C. Sleep disorders in children with Angelman and Smith-Magenis syndromes: The assessment of potential causes of disrupted settling and night time waking. RESEARCH IN DEVELOPMENTAL DISABILITIES 2020; 97:103555. [PMID: 31838315 DOI: 10.1016/j.ridd.2019.103555] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/29/2019] [Revised: 11/27/2019] [Accepted: 12/04/2019] [Indexed: 06/10/2023]
Abstract
BACKGROUND Sleep problems are common in Smith-Magenis (SMS) and Angelman syndromes (AS). Effectiveness of interventions depends on appropriate assessment, complicated by compromised self-report and health and behaviour difficulties. Studying settling and waking in these syndromes could inform assessment. AIMS To describe settling and waking behaviours in children at high-risk of sleep and health problems, using direct observation. METHODS AND PROCEDURES Video and actigraphy data were collected for 12 participants with AS (Mean age = 8.02, SD = 2.81) and 11 with SMS (Mean age = 8.80, SD = 2.18). Settling (30 min prior to sleep onset) and night waking were coded for nineteen behaviours relating to pain, challenging behaviour and caregiver interaction. Lag sequential analyses were conducted for pain-related behaviours. OUTCOMES AND RESULTS Percentage of time spent in behaviours was calculated. Parent-child interactions (0.00-9.93 %) and challenging behaviours (0 %) were rare at settling and waking in both groups. In the AS group, pain-related behaviours were more likely to occur before waking than by chance (p < 0.001). CONCLUSIONS AND IMPLICATIONS Findings highlight the importance of considering pain as a cause of sleep problems in AS. The principle and methodology could be extended to individuals with ID experiencing sleep problems.
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Affiliation(s)
- Georgie Agar
- Cerebra Centre for Neurodevelopmental Disorders, University of Birmingham, UK.
| | - Chris Oliver
- Cerebra Centre for Neurodevelopmental Disorders, University of Birmingham, UK
| | - Jayne Trickett
- Cerebra Centre for Neurodevelopmental Disorders, University of Birmingham, UK
| | - Lucy Licence
- Cerebra Centre for Neurodevelopmental Disorders, University of Birmingham, UK
| | - Caroline Richards
- Cerebra Centre for Neurodevelopmental Disorders, University of Birmingham, UK; School of Psychology, 52 Pritchatts Road, University of Birmingham, UK
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The Developmental Behaviour Checklist (DBC) Profile in Young Children on the Autism Spectrum: The Impact of Child and Family Factors. J Autism Dev Disord 2019; 49:3426-3439. [PMID: 31115773 DOI: 10.1007/s10803-019-04067-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
High levels of emotional/behavioural difficulties are frequently reported in children on the autism spectrum. However, given the diversity in profiles, there is a need to explore such behaviours in relation to individual factors. Parents of 130 children aged 4-5 on the autism spectrum completed measures of behaviour and adaptive behaviour. Hierarchical multiple regressions explored child and family characteristics in relation to children's emotional/behavioural presentation. Different aspects of the behavioural profile were associated with different factors, with child autism characteristics, medication use, and parent mental health making significant unique contributions to a range of behavioural subscales. Understanding individual profiles beyond total scores is therefore needed to truly understand the emotional and behavioural profile of specific subgroups.
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Kirkpatrick B, Gilroy SP, Leader G. Qualitative study on parents’ perspectives of the familial impact of living with a child with autism spectrum disorder who experiences insomnia. Sleep Med 2019; 62:59-68. [DOI: 10.1016/j.sleep.2019.01.032] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2018] [Revised: 12/04/2018] [Accepted: 01/23/2019] [Indexed: 12/17/2022]
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Wall CA, Hogan AL, Will EA, McQuillin S, Kelleher BL, Roberts JE. Early negative affect in males and females with fragile X syndrome: implications for anxiety and autism. J Neurodev Disord 2019; 11:22. [PMID: 31519170 PMCID: PMC6744625 DOI: 10.1186/s11689-019-9284-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Accepted: 08/29/2019] [Indexed: 01/24/2023] Open
Abstract
Background Fragile X syndrome (FXS) is a genetic disorder that is highly comorbid with anxiety and autism spectrum disorder (ASD). Elevated negative affect in young children has been associated with increased risk for both anxiety and ASD; however, these relations remain poorly understood in FXS. Methods The present prospective longitudinal study examined the trajectory of negative affect from infancy through preschool in males and females with FXS and typical development and its relation to anxiety and ASD. Results Results indicate a complex association reflecting group, developmental, and sex effects. Specifically, the group with FXS displayed a trajectory of increasing negative affect across age that was distinct from the typical controls. This atypical trajectory of negative affect in FXS was driven by sex effects in that males showed lower negative affect during infancy followed by steep increases across the toddler and preschool years whereas the females displayed a flatter trajectory. Finally, elevated negative affect predicted anxiety symptoms in males, but not females, with no relationship to ASD in males or females with FXS. Conclusions The current work addresses the importance of studying the development of psychopathology in a specific neurogenetic population. Temperamental negative affect was shown to be an important early marker for anxiety in young children with FXS, with subtle differences observed between males and females.
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Affiliation(s)
- Carla A Wall
- Department of Psychology, University of South Carolina, 1512 Pendleton Street, Barnwell College, Suite #220, Columbia, SC, 29208, USA.
| | - Abigail L Hogan
- Department of Psychology, University of South Carolina, 1512 Pendleton Street, Barnwell College, Suite #220, Columbia, SC, 29208, USA
| | - Elizabeth A Will
- Department of Psychology, University of South Carolina, 1512 Pendleton Street, Barnwell College, Suite #220, Columbia, SC, 29208, USA
| | - Samuel McQuillin
- Department of Psychology, University of South Carolina, 1512 Pendleton Street, Barnwell College, Suite #220, Columbia, SC, 29208, USA
| | - Bridgette L Kelleher
- Department of Psychological Sciences, Purdue University, 703 Third Street, West Lafayette, IN, 47907-2081, USA
| | - Jane E Roberts
- Department of Psychology, University of South Carolina, 1512 Pendleton Street, Barnwell College, Suite #220, Columbia, SC, 29208, USA
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Sleep problems and anxiety from 2 to 8 years and the influence of autistic traits: a longitudinal study. Eur Child Adolesc Psychiatry 2019; 28:1117-1127. [PMID: 30659385 DOI: 10.1007/s00787-019-01275-y] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2018] [Accepted: 01/03/2019] [Indexed: 12/28/2022]
Abstract
Whether or not childhood sleep problems and anxiety occur simultaneously, or one precedes the other, and any effect of autistic traits on this relationship remains unclear. We investigated longitudinal associations between sleep and anxiety at 2 years and sleep and anxiety at 8 years controlling for demographic variables. We also examined the additional influence of autistic traits at 2 years on sleep problems and anxiety at 8 years. Participants were from the Western Australian Pregnancy Cohort (Raine) Study, where 2900 pregnant women were recruited between 1989 and 1991 and their children assessed every 2-3 years thereafter. Demographic information was provided at 16-18 weeks gestation. Children's sleep and anxiety at 2 and 8 years and autistic traits at 2 years were measured using the Child Behavior Checklist. Hierarchical multiple regression models tested the prediction of both anxiety and sleep problems at 8 years. Sleep problems at 2 years and 8 years, anxiety at 2 years, and autistic traits at 2 years were significantly associated with anxiety at 8 years. Sleep problems at 2 years and anxiety at 8 years were significantly related to sleep problems at 8 years. Each of these models explained about 20% of variance. Childhood sleep problems, anxiety and autistic traits are interrelated and can occur concurrently in young children, but the best predictor of poor sleep in middle childhood is concurrent anxiety and vice versa. Anxiety and sleep problems may be an early indicator of autism in young children and early autistic traits may also contribute to anxiety problems later in childhood.
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40
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Mckenzie K, Murray G, Murray A, Martin R, Tanfield Y, Delahunty L, Hutton L, Murray KR, O'hare A. Screening for intellectual disability with the Child and Adolescent Intellectual Screening Questionnaire: a modified Delphi approach. Dev Med Child Neurol 2019; 61:979-983. [PMID: 30592303 DOI: 10.1111/dmcn.14139] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/03/2018] [Indexed: 11/29/2022]
Abstract
AIM To develop a consensus framework to evaluate the impact of screening for intellectual disability, using the Child and Adolescent Intellectual Disability Screening Questionnaire (CAIDS-Q) in paediatric neurodevelopment clinics. METHOD A modified Delphi survey with four phases (literature review; initial development of framework [participants=11 parents, 8 professionals]; qualitative interviews [participants=4 parents, 15 professionals]; questionnaire development [participants=31 parents, 14 professionals] was used to develop the consensus framework. The framework was used to evaluate the impact of screening on six paediatricians and 31 parents of children who had participated in a previous paediatric screening project. RESULTS Twelve of the original 20 items were retained based on levels of endorsement of 60 per cent or above. Direct benefits of using the CAIDS-Q were: indicating the child's level of functioning, increasing awareness of intellectual disability, helping to identify children with intellectual disability, and identifying potentially vulnerable children. Benefits related to subsequent diagnostic assessment were: promoting greater understanding of the child, identification of support needs, and receipt of support, particularly for the child at school. INTERPRETATION The use of the CAIDS-Q had a number of direct and indirect benefits for children, families, and services as reported by parents and paediatricians. WHAT THIS PAPER ADDS A 12-item framework was developed to evaluate the impact of screening for intellectual disability. Direct benefits of the Child and Adolescent Intellectual Disability Screening Questionnaire include increasing awareness and identification of intellectual disability. Indirect benefits included increased identification of support needs and receipt of support.
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Affiliation(s)
- Karen Mckenzie
- Department of Psychology, Northumbria University, Newcastle upon Tyne, UK.,Department of Clinical Psychology and Community Nursing, NHS Lothian, Edinburgh, UK
| | - George Murray
- Department of Clinical Psychology and Community Nursing, NHS Lothian, Edinburgh, UK
| | - Aja Murray
- Salvesen Mindroom Centre and Department of Psychology, Edinburgh University, Edinburgh, UK
| | - Rachel Martin
- Department of Psychology, Northumbria University, Newcastle upon Tyne, UK
| | - Yasmin Tanfield
- Department of Psychology, Northumbria University, Newcastle upon Tyne, UK
| | - Lauren Delahunty
- Salvesen Mindroom Centre and Department of Psychology, Edinburgh University, Edinburgh, UK
| | - Linda Hutton
- Department of Psychology, Northumbria University, Newcastle upon Tyne, UK
| | - Kara R Murray
- Department of Clinical Psychology and Community Nursing, NHS Lothian, Edinburgh, UK
| | - Anne O'hare
- Salvesen Mindroom Centre and Department of Psychology, Edinburgh University, Edinburgh, UK
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41
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Cross AJ, Goharpey N, Laycock R, Crewther SG. Anxiety as a Common Biomarker for School Children With Additional Health and Developmental Needs Irrespective of Diagnosis. Front Psychol 2019; 10:1420. [PMID: 31293480 PMCID: PMC6598107 DOI: 10.3389/fpsyg.2019.01420] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2018] [Accepted: 06/03/2019] [Indexed: 12/28/2022] Open
Abstract
Currently very little evidence is available regarding the biological characteristics and common comorbid behaviors that are associated with children characterized by learning difficulties who require additional support at school. These children are usually referred to as having Additional Health and Developmental Needs by the Australian Government and the associated public education system more broadly though the problems may arise from academic, social and/or emotional stressors and may or may not include children with clinically diagnosed Neurodevelopmental Disorders. Thus, the aim of this study was to investigate the relationship between anxiety levels (Spence Children's Anxiety Scale- Parent Report), autism traits (Autism Spectrum Quotient - Child Version) and sleep quality (Sleep Disturbance Scale for Children) in children with Additional Health and Developmental Needs without an intellectual disability, but with either a diagnosis of Autism Spectrum Disorder (ASD) (N = 25), Speech and Language Impairment (N = 37) or Other Diagnosis (N = 22). Our results demonstrated that these children with Additional Health and Developmental Needs showed atypically high levels of anxiety and impaired sleep quality, with the ASD group reporting more impairments associated with comorbid anxiety and sleep quality than either of the other clinically diagnosed groups. In fact, greater anxiety level was associated with a greater number of autism traits and poorer sleep quality regardless of diagnostic group suggesting that anxiety is a common experience for children with Additional Health and Developmental Needs. It is suggested that assessment of anxiety, sleep behaviors and autism traits may be useful markers for early identification of children within this population, thus providing scope for early and targeted intervention.
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Affiliation(s)
- Alana Jade Cross
- School of Psychology and Public Health, La Trobe University, Melbourne, VIC, Australia
| | - Nahal Goharpey
- School of Psychology and Public Health, La Trobe University, Melbourne, VIC, Australia
| | - Robin Laycock
- School of Psychology and Public Health, La Trobe University, Melbourne, VIC, Australia
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Carmassi C, Palagini L, Caruso D, Masci I, Nobili L, Vita A, Dell'Osso L. Systematic Review of Sleep Disturbances and Circadian Sleep Desynchronization in Autism Spectrum Disorder: Toward an Integrative Model of a Self-Reinforcing Loop. Front Psychiatry 2019; 10:366. [PMID: 31244687 PMCID: PMC6581070 DOI: 10.3389/fpsyt.2019.00366] [Citation(s) in RCA: 105] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2019] [Accepted: 05/13/2019] [Indexed: 12/13/2022] Open
Abstract
Background: A compelling number of studies, conducted in both children and adults, have reported an association between sleep disturbances/circadian sleep alterations and autism spectrum disorder (ASD); however, the data are sparse and the nature of this link is still unclear. The present review aimed to systematically collect the literature data relevant on sleep disturbances and circadian sleep dysrhythmicity related to ASD across all ages and to provide an integrative theoretical framework of their association. Methods: A systematic review of the MEDLINE, PubMed, and Cochrane databases was conducted from November 2018 to February 2019. The search strategies used were MeSH headings and keywords for "sleep-wake circadian rhythms" OR "circadian sleep disorders" OR "sleep-wake pattern" OR "sleep disorders" OR "melatonin" AND "autism spectrum disorder" OR "autism". Results: One hundred and three studies were identified, 15 regarded circadian sleep dysrhythmicity, 74 regarded sleep disturbances, and 17 regarded melatonin alterations in children and adults with ASD. Our findings suggested that autistic subjects frequently present sleep disturbances in particular short sleep duration, low sleep quality/efficiency, and circadian sleep desynchronization such as delayed phases and/or eveningness. Sleep disturbances and circadian sleep alterations have been related to the severity of autistic symptoms. Genetic studies have shown polymorphisms in circadian CLOCK genes and in genes involved in melatonin pathways in subjects with ASD. Conclusions: Sleep disturbances and circadian sleep alterations are frequent in subjects with autistic symptoms. These subjects have shown polymorphisms in clock genes expression and in genes involved in melatonin production. The impairment of circadian sleep regulation may increase the individual's vulnerability to develop symptoms of ASD by altering the sleep regulation in toto, which plays a key role in normal brain development. Even though controversies and "research gaps" are present in literature at this point, we may hypothesize a bidirectional relation between circadian sleep dysfunction and ASD. In particular, circadian sleep dysrhythmicity may predispose to develop ASD symptoms and vice versa within a self-reinforcing feedback loop. By targeting sleep disturbances and circadian sleep dysrhythmicity, we may improve treatment strategies for both children and adults with ASD.
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Affiliation(s)
- Claudia Carmassi
- Department of Clinical and Experimental Medicine, Psychiatry Division, University of Pisa, Pisa, Italy
| | - Laura Palagini
- Department of Clinical and Experimental Medicine, Psychiatry Division, University of Pisa, Pisa, Italy
| | - Danila Caruso
- Department of Clinical and Experimental Medicine, Psychiatry Division, University of Pisa, Pisa, Italy
| | - Isabella Masci
- Department of Clinical and Experimental Medicine, Psychiatry Division, University of Pisa, Pisa, Italy
| | - Lino Nobili
- Child Neuropsychiatry Unit, IRCCS G. Gaslini Institute, Genova, Italy.,Department of Neuroscience-Rehabilitation-Ophthalmology-Genetics-Child and Maternal Health (DINOGMI), University of Genova, Genova, Italy
| | - Antonio Vita
- Psychiatry Division, Department of Clinical and Experimental Medicine, University of Brescia, Brescia, Italy
| | - Liliana Dell'Osso
- Department of Clinical and Experimental Medicine, Psychiatry Division, University of Pisa, Pisa, Italy
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43
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Gagnon K, Godbout R. Melatonin and Comorbidities in Children with Autism Spectrum Disorder. CURRENT DEVELOPMENTAL DISORDERS REPORTS 2018; 5:197-206. [PMID: 30148039 PMCID: PMC6096870 DOI: 10.1007/s40474-018-0147-0] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
PURPOSE OF REVIEW Melatonin is used to treat sleep difficulties associated with autism spectrum disorder (ASD). There are growing evidence that melatonin could have an effect on other symptoms than sleep, such as anxiety, depression, pain, and gastrointestinal dysfunctions. Interestingly, these symptoms frequently are found as comorbid conditions in individuals with ASD. We aimed to highlight the potential effect of melatonin on these symptoms. RECENT FINDINGS Animal and human studies show that melatonin reduces anxiety. Regarding the effect of melatonin on pain, animal studies are promising, but results remain heterogeneous in humans. Both animal and human studies have found that melatonin can have a positive effect on gastrointestinal dysfunction. SUMMARY Melatonin has the potential to act on a wide variety of symptoms associated with ASD. However, other than sleep difficulties, no studies exist on melatonin as a treatment for ASD comorbid conditions. Such investigations should be on the research agenda because melatonin could improve a multitude of ASD comorbidities and, consequently, improve well-being.
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Affiliation(s)
- Katia Gagnon
- Sleep Laboratory & Clinic, Hôpital Rivière-des-Prairies, CIUSSS du Nord-de-l’Île-de-Montréal, 7070 Boul. Perras, Montréal, Québec H1E 1A4 Canada
- Department of Psychiatry, Université de Montréal, Montréal, Québec Canada
| | - Roger Godbout
- Sleep Laboratory & Clinic, Hôpital Rivière-des-Prairies, CIUSSS du Nord-de-l’Île-de-Montréal, 7070 Boul. Perras, Montréal, Québec H1E 1A4 Canada
- Department of Psychiatry, Université de Montréal, Montréal, Québec Canada
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44
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Trickett J, Heald M, Oliver C, Richards C. A cross-syndrome cohort comparison of sleep disturbance in children with Smith-Magenis syndrome, Angelman syndrome, autism spectrum disorder and tuberous sclerosis complex. J Neurodev Disord 2018; 10:9. [PMID: 29490614 PMCID: PMC5831859 DOI: 10.1186/s11689-018-9226-0] [Citation(s) in RCA: 49] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2017] [Accepted: 02/01/2018] [Indexed: 12/15/2022] Open
Abstract
Background Sleep disturbance is common in children with neurodevelopmental disorders, with high rates identified in children with Smith-Magenis syndrome (SMS), Angelman syndrome (AS), autism spectrum disorder (ASD) and tuberous sclerosis complex (TSC). Phenotypic sleep profiles for these groups may implicate different pathways to sleep disturbance. At present, cross-group comparisons that might elucidate putative phenotypic sleep characteristics are limited by measurement differences between studies. In this study, a standardised questionnaire was administered across groups affording comparison of the prevalence and profile of sleep disturbance between groups and contrast to chronologically age-matched typically developing (TD) peers. Methods The modified version of Simonds and Parraga’s sleep questionnaire, adapted for use in children with intellectual disabilities, was employed to assess sleep disturbance profiles in children aged 2–15 years with SMS (n = 26), AS (n = 70), ASD (n = 30), TSC (n = 20) and a TD contrast group (n = 47). Associations between sleep disturbance and age, obesity, health conditions and overactivity/impulsivity were explored for each neurodevelopmental disorder group. Results Children with SMS displayed severe night waking (81%) and early morning waking (73%). In contrast, children with ASD experienced difficulties with sleep onset (30%) and sleep maintenance (43%). Fewer children with ASD (43%) and AS (46%) experienced severe night waking compared to children with SMS (both p < .01). Higher sleep-disordered breathing scores were identified for children with SMS (p < .001) and AS (p < .001) compared to the TD group. Sleep disturbance in children with AS and TSC was associated with poorer health. Children experiencing symptoms indicative of gastro-oesophageal reflux had significantly higher sleep-disordered breathing scores in the AS, SMS and ASD groups (all p < .01). A number of associations between overactivity, impulsivity, gastro-oesophageal reflux, age and sleep disturbance were found for certain groups. Conclusions These data reveal syndrome-specific profiles of sleep disturbance. The divergent associations between sleep parameters and person characteristics, specifically symptoms of gastro-oesophageal reflux, overactivity and impulsivity and age, implicate aetiology-specific mechanisms underpinning sleep disturbance. The differences in prevalence, severity and mechanisms implicated in sleep disturbance between groups support a syndrome-sensitive approach to assessment and treatment of sleep disturbance in children with neurodevelopmental disorders. Electronic supplementary material The online version of this article (10.1186/s11689-018-9226-0) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- J Trickett
- Department of Health Sciences, College of Life Sciences, George Davies Centre, University of Leicester, Leicester, LE1 7RH, UK. .,Cerebra Centre for Neurodevelopmental Disorders, School of Psychology, University of Birmingham, Birmingham, B15 2TT, UK.
| | - M Heald
- Cerebra Centre for Neurodevelopmental Disorders, School of Psychology, University of Birmingham, Birmingham, B15 2TT, UK
| | - C Oliver
- Cerebra Centre for Neurodevelopmental Disorders, School of Psychology, University of Birmingham, Birmingham, B15 2TT, UK
| | - C Richards
- Cerebra Centre for Neurodevelopmental Disorders, School of Psychology, University of Birmingham, Birmingham, B15 2TT, UK
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45
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Esbensen AJ, Hoffman EK, Beebe DW, Byars KC, Epstein J. Links between sleep and daytime behaviour problems in children with Down syndrome. JOURNAL OF INTELLECTUAL DISABILITY RESEARCH : JIDR 2018; 62:115-125. [PMID: 29282827 PMCID: PMC5775033 DOI: 10.1111/jir.12463] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/22/2017] [Revised: 10/11/2017] [Accepted: 11/29/2017] [Indexed: 05/27/2023]
Abstract
BACKGROUND In the general population, sleep problems have an impact on daytime performance. Despite sleep problems being common among children with Down syndrome, the impact of sleep problems on daytime behaviours in school-age children with Down syndrome is an understudied topic. Our study examined the relationship between parent-reported and actigraphy-measured sleep duration and sleep quality with parent and teacher reports of daytime behaviour problems among school-age children with Down syndrome. METHOD Thirty school-age children with Down syndrome wore an actigraph watch for a week at home at night. Their parent completed ratings of the child's sleep during that same week. Their parent and teacher completed a battery of measures to assess daytime behaviour. RESULTS Parent reports of restless sleep behaviours on the Children's Sleep Habits Questionnaire, but not actigraph-measured sleep efficiency, was predictive of parent and teacher behavioural concerns on the Nisonger Child Behaviour Rating Form and the Vanderbilt ADHD Rating Scales. Actigraph-measured sleep period and parent-reported sleep duration on the Children's Sleep Habits Questionnaire was predictive of daytime parent-reported inattention. Actigraph-measured sleep period was predictive of parent-reported hyperactivity/impulsivity. CONCLUSION The study findings suggest that sleep problems have complex relationships to both parent-reported and teacher-reported daytime behaviour concerns in children with Down syndrome. These findings have implications for understanding the factors impacting behavioural concerns and their treatment in school-age children with Down syndrome.
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Affiliation(s)
- A J Esbensen
- Division of Developmental and Behavioral Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - E K Hoffman
- Division of Developmental and Behavioral Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - D W Beebe
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - K C Byars
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - J Epstein
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
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46
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Cohen S, Fulcher BD, Rajaratnam SMW, Conduit R, Sullivan JP, St Hilaire MA, Phillips AJK, Loddenkemper T, Kothare SV, McConnell K, Braga‐Kenyon P, Ahearn W, Shlesinger A, Potter J, Bird F, Cornish KM, Lockley SW. Sleep patterns predictive of daytime challenging behavior in individuals with low‐functioning autism. Autism Res 2017; 11:391-403. [DOI: 10.1002/aur.1899] [Citation(s) in RCA: 55] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2017] [Revised: 11/05/2017] [Accepted: 11/06/2017] [Indexed: 11/08/2022]
Affiliation(s)
- Simonne Cohen
- Monash Institute of Cognitive and Clinical NeurosciencesSchool of Psychological Sciences, Monash UniversityMelbourne Australia
| | - Ben D. Fulcher
- Monash Institute of Cognitive and Clinical NeurosciencesSchool of Psychological Sciences, Monash UniversityMelbourne Australia
- School of Physics, Sydney UniversityPhysics Road Camperdown, NSW, 2006 Australia
| | - Shantha M. W. Rajaratnam
- Monash Institute of Cognitive and Clinical NeurosciencesSchool of Psychological Sciences, Monash UniversityMelbourne Australia
- Division of Sleep and Circadian Disorders, Brigham and Women's HospitalBoston Massachusetts
- Division of Sleep MedicineHarvard Medical SchoolBoston Massachusetts
| | - Russell Conduit
- School of Health SciencesRoyal Melbourne Institute of TechnologyMelbourne Australia
| | - Jason P. Sullivan
- Division of Sleep and Circadian Disorders, Brigham and Women's HospitalBoston Massachusetts
| | - Melissa A. St Hilaire
- Division of Sleep and Circadian Disorders, Brigham and Women's HospitalBoston Massachusetts
- Division of Sleep MedicineHarvard Medical SchoolBoston Massachusetts
| | - Andrew J. K. Phillips
- Monash Institute of Cognitive and Clinical NeurosciencesSchool of Psychological Sciences, Monash UniversityMelbourne Australia
- Division of Sleep and Circadian Disorders, Brigham and Women's HospitalBoston Massachusetts
- Division of Sleep MedicineHarvard Medical SchoolBoston Massachusetts
| | - Tobias Loddenkemper
- Division of Sleep MedicineHarvard Medical SchoolBoston Massachusetts
- Boston Children's HospitalBoston Massachusetts
| | - Sanjeev V. Kothare
- Division of Sleep MedicineHarvard Medical SchoolBoston Massachusetts
- Boston Children's HospitalBoston Massachusetts
- New York University Langone Medical SchoolNew York New York
| | | | - Paula Braga‐Kenyon
- New England Center for ChildrenSouthborough Massachusetts
- North Eastern UniversityBoston Massachusetts
- Melmark New EnglandAndover Massachusetts
| | - William Ahearn
- New England Center for ChildrenSouthborough Massachusetts
| | | | | | | | - Kim M. Cornish
- Monash Institute of Cognitive and Clinical NeurosciencesSchool of Psychological Sciences, Monash UniversityMelbourne Australia
| | - Steven W. Lockley
- Monash Institute of Cognitive and Clinical NeurosciencesSchool of Psychological Sciences, Monash UniversityMelbourne Australia
- Division of Sleep and Circadian Disorders, Brigham and Women's HospitalBoston Massachusetts
- Division of Sleep MedicineHarvard Medical SchoolBoston Massachusetts
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McLay L, France K, Blampied N, Hunter J. Using functional behavioral assessment to treat sleep problems in two children with autism and vocal stereotypy. INTERNATIONAL JOURNAL OF DEVELOPMENTAL DISABILITIES 2017; 65:175-184. [PMID: 34141338 PMCID: PMC8115474 DOI: 10.1080/20473869.2017.1376411] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Objectives: Sleep problems are prevalent among children with autism spectrum disorder (ASD) and are often accompanied by stereotypies, the function of which may be difficult to determine. Functional behavioral assessment (FBA) is an evidence-based approach to assessing and treating challenging behaviors, however, it has scarcely been used with sleep problems. This study investigates the effectiveness of FBA-based treatments for sleep disturbance (SD) in children with ASD, the short- and long-term maintenance of these effects, and parents' perspectives on the assessment and treatment process. Method: Two case studies used FBA to inform treatments for SD in two children with ASD and stereotypic behavior. The sleep-competing behaviors appeared to be multi-functional and included sleep interfering vocal stereotypy. The parents of each child implemented individualized, multi-component treatment packages. Results: Results demonstrate a reduction in SD for each participant, though delayed sleep onset latency remained for one participant. These results were maintained at short- and long-term follow-up. The interventions had high social validity. Conclusion: The implications of these findings for future research, and the assessment and treatment of SD in children with ASD and vocal stereotypy are discussed.
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Affiliation(s)
- Laurie McLay
- School of Health Sciences, University of Canterbury, Christchurch, New Zealand
| | - Karyn France
- School of Health Sciences, University of Canterbury, Christchurch, New Zealand
| | - Neville Blampied
- Psychology Department, University of Canterbury, Christchurch, New Zealand
| | - Jolene Hunter
- School of Health Sciences, University of Canterbury, Christchurch, New Zealand
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48
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Larue C, Goulet MH, Prevost MJ, Dumais A, Bellavance J. Identification and Analysis of Factors Contributing to the Reduction in Seclusion and Restraint for a Population with Intellectual Disability. JOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES 2016; 31:e212-e222. [PMID: 27910254 DOI: 10.1111/jar.12309] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/03/2016] [Indexed: 12/01/2022]
Abstract
BACKGROUND A cohort of 11 patients with an intellectual disability and a psychiatric diagnosis present severe behavioural disorders in psychiatric hospital of Quebec in 2009. Control-measure use for this clientele has now been reduced. How do management personnel, families and care teams explain the changes? What clinical interventions did management and care providers implement that contributed to the reduction? METHOD A retrospective case study was conducted. Five focus groups were held with people involved in their care, and the patient files were examined. RESULTS The factors contributing to this change were the cohesion of the care providers, the involvement of the families and the efforts to determine the function of the behaviour. IMPLICATIONS This study may inspire other care teams to try new approaches in dealing with patients with severe behavioural disorders. Also, the model of factors and interventions supporting a reduction in seclusion and restraint measures may inspire future studies.
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Affiliation(s)
- Caroline Larue
- Faculty of Nursing, Université de Montréal, Montreal, Canada.,Quebec Nursing Intervention Research Network (RRISIQ), Montreal, Canada.,Centre de recherche de l'Institut universitaire en santé mentale de Montréal (CRIUSMM), Montreal, Canada
| | - Marie-Hélène Goulet
- Faculty of Nursing, Université de Montréal, Montreal, Canada.,Quebec Nursing Intervention Research Network (RRISIQ), Montreal, Canada.,Centre de recherche de l'Institut universitaire en santé mentale de Montréal (CRIUSMM), Montreal, Canada
| | | | - Alexandre Dumais
- Centre de recherche de l'Institut universitaire en santé mentale de Montréal (CRIUSMM), Montreal, Canada.,Institut Philippe-Pinel de Montréal, Montreal, Canada
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49
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Chiu YL, Kao S, Tou SW, Lin FG. Effects of heterogeneous risk factors on psychological distress in adolescents with autism and victimization experiences in Taiwan. Disabil Rehabil 2016; 40:42-51. [PMID: 27782753 DOI: 10.1080/09638288.2016.1242173] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
PURPOSE To investigate the prevalence of various types of bullying victimization among adolescents with autism spectrum disorder (ASD) and examine the effects of victimization on the mental health of adolescents with ASD. METHODS The sample was collected from the Special Needs Education Longitudinal Study (SNELS) database released in 2011. Variables comprising seven psychological distress (PD) items and four types of bullying victimization and family-, school-, and peer-related factors were included in a multivariate regression analysis. RESULTS Exclusion and verbal bullying were most frequently reported, 72.4% of students with ASD experiencing exclusion bullying and 66% of them experiencing verbal bullying. Among the victims, delayed bedtime, use of medication, and conflicts with parents significantly increased PD. By contrast, good relationships with parents and friends and liking school environments relieved PD symptoms. Furthermore, delayed bedtime after 12 a.m. enhanced the effects of exclusion victimization on PD in the participants. CONCLUSIONS Our results indicated that bullying victimization among adolescents with ASD was a risk factor for their psychological well-being. Nevertheless, good parent-adolescent and interpeer relationships improved their mental health. Our results can serve as a reference in implementing strategies for motivating parents and teachers to pay more attention to the needs of adolescents with ASD. Implications for Rehabilitation More than 80% of adolescents with autism experience at least one type of bullying victimization. Bullying victimization attributes to a major factor influencing mental health of adolescents with autism. Good parent-adolescent and interpeer relationships can play beneficial roles in improving mental health of the adolescents.
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Affiliation(s)
- Yu-Lung Chiu
- a Graduate Institute of Medical Sciences, National Defense Medical Center , Taipei , Taiwan, ROC.,b School of Public Health , National Defense Medical Center , Taipei , Taiwan, ROC
| | - Senyeong Kao
- b School of Public Health , National Defense Medical Center , Taipei , Taiwan, ROC
| | - Shao-Wen Tou
- b School of Public Health , National Defense Medical Center , Taipei , Taiwan, ROC
| | - Fu-Gong Lin
- b School of Public Health , National Defense Medical Center , Taipei , Taiwan, ROC
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50
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Ozgoli G, Sheikhan Z, Soleimani F, Nasiri M, Amiri S. Prevalence of Sleep Disorders Among Children 4 - 6 Years Old in Tehran Province, Iran. IRANIAN RED CRESCENT MEDICAL JOURNAL 2016; 18:e22052. [PMID: 27651942 PMCID: PMC5020400 DOI: 10.5812/ircmj.22052] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/21/2014] [Revised: 04/21/2015] [Accepted: 05/11/2015] [Indexed: 11/16/2022]
Abstract
BACKGROUND Sleep patterns may change over a person's lifetime; however, the quantity and quality of sleep always depend on individual factors such as age, sex, and psychological and environmental factors. In children, sleep is as important as development. Quantitative sleep problems related to sleep onset and qualitative sleep disorders such as frequent awakenings may lead to insufficient sleep. OBJECTIVES This study aimed to assess the prevalence of sleep disorders among children 4 - 6 years old attending the health centers of Shahid Beheshti University of Medical Sciences, Tehran, Iran, in 2013. PATIENTS AND METHODS This was a cross-sectional study on 400 children selected using a multistage sampling method. Data were collected by interviews. The questionnaire included two sections: a demographic section with questions about the demographic characteristics of the children and parents and a children's sleep habit questionnaire (CSHQ). Data were analyzed by SPSS 16 and different statistical tests were used (P < 0.05). RESULTS The mean age of the children was 64.27 ± 9.3 months. The prevalence of sleep disorders was 36.25%. Sleep disorders were significantly associated with age, height, body mass index, residence of children, father's occupation, mother's diseases, father's drug abuse, and parents' marital status (P < 0.05). CONCLUSIONS Sleep disorders in children threaten growth and development, and are dangerous for their health. Sleep disorders should be considered in the differential diagnosis of children's learning and behavioral problems.
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Affiliation(s)
- Giti Ozgoli
- Behavioral Sciences Research Center, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran
| | - Zohre Sheikhan
- Department of Midwifery and Reproductive Health, Faculty of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran
- Corresponding Author: Zohre Sheikhan, Department of Midwifery and Reproductive Health, Faculty of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran. Tel: +98-02188202512, Fax: +98-02188202512, E-mail:
| | - Farin Soleimani
- Pediatric Nero-rehabilitation Research Center, University of Social Welfare and Rehabilitation Sciences, Tehran, IR Iran
| | - Malihe Nasiri
- Department of Biostatistics, Faculty of Paramedic, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran
| | - Saba Amiri
- Department of Midwifery and Reproductive Health, Faculty of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran
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