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Galion AW, Farmer JG, Connolly HV, Allhusen VD, Bennett A, Coury DL, Lam J, Neumeyer AM, Sohl K, Witmans M, Malow BA. A Practice Pathway for the Treatment of Night Wakings in Children with Autism Spectrum Disorder. J Autism Dev Disord 2024; 54:2926-2945. [PMID: 37358787 PMCID: PMC11300650 DOI: 10.1007/s10803-023-06026-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/26/2023] [Indexed: 06/27/2023]
Abstract
Children with autism spectrum disorder (ASD) report high rates of sleep problems. In 2012, the Autism Treatment Network/ Autism Intervention Research Network on Physical Health (ATN/AIR-P) Sleep Committee developed a pathway to address these concerns. Since its publication, ATN/AIR-P clinicians and parents have identified night wakings as a refractory problem unaddressed by the pathway. We reviewed the existing literature and identified 76 scholarly articles that provided data on night waking in children with ASD. Based on the available literature, we propose an updated practice pathway to identify and treat night wakings in children with ASD.
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Affiliation(s)
- Anjalee W Galion
- Division of Neurology, Children's Hospital of Orange County, 1201 W. La Veta Avenue, Orange, CA, 92868, USA.
| | - Justin G Farmer
- Massachusetts General Hospital for Children, Boston, MA, USA
| | | | - Virginia D Allhusen
- Division of Neurology, Children's Hospital of Orange County, 1201 W. La Veta Avenue, Orange, CA, 92868, USA
| | - Amanda Bennett
- Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | | | - Janet Lam
- Kennedy Krieger Institute, Baltimore, MD, USA
| | - Ann M Neumeyer
- Massachusetts General Hospital for Children, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Kristin Sohl
- University of Missouri School of Medicine, Columbia, MO, USA
| | | | - Beth A Malow
- Vanderbilt University Medical Center, Nashville, TN, USA
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2
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Caioni G, Merola C, Perugini M, Angelozzi G, Amorena M, Benedetti E, Lucon-Xiccato T, Bertolucci C. Sodium valproate effects on the morphological and neurobehavioral phenotype of zebrafish. ENVIRONMENTAL TOXICOLOGY AND PHARMACOLOGY 2024; 110:104500. [PMID: 38977114 DOI: 10.1016/j.etap.2024.104500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/07/2024] [Revised: 06/21/2024] [Accepted: 07/04/2024] [Indexed: 07/10/2024]
Abstract
The anticonvulsant sodium valproate (SV) is frequently administered as a medicament but bears several negative effects in case of exposure during development. We analyzed extensively these early development effects of using the zebrafish model. Zebrafish embryos were exposed as eggs to two sublethal concentrations of SV, 10 and 25 mg/L. A general embryo toxicity analysis revealed extended anomalies in the cardiovascular system, and in the craniofacial and the spinal skeleton, as well as high mortality, in the embryos exposed to SV. The teratogenic potential of SV was confirmed in hacthed larvae by morphometric and cartilage profile analysis. Last, neurobehavioral impairments due to SV were highlighted in subjects' activity, anxiety, response to stimulations, habituation learning, and daily synchronization of locomotor activity, overall mirroring typical phenotypes associated with autistic spectrum disorders. In conclusion, our results confirmed the presence of extended and multifaced impacts of exposure to SV during development.
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Affiliation(s)
- Giulia Caioni
- Department of Life, Health and Environmental Sciences, University of L'Aquila, L'Aquila 67100, Italy; Department of Bioscience and Technology for Food, Agriculture and Environment, University of Teramo, Italy
| | - Carmine Merola
- Department of Bioscience and Technology for Food, Agriculture and Environment, University of Teramo, Italy
| | - Monia Perugini
- Department of Bioscience and Technology for Food, Agriculture and Environment, University of Teramo, Italy.
| | - Giovanni Angelozzi
- Department of Bioscience and Technology for Food, Agriculture and Environment, University of Teramo, Italy
| | - Michele Amorena
- Department of Bioscience and Technology for Food, Agriculture and Environment, University of Teramo, Italy
| | - Elisabetta Benedetti
- Department of Life, Health and Environmental Sciences, University of L'Aquila, L'Aquila 67100, Italy
| | - Tyrone Lucon-Xiccato
- Department of Life Sciences and Biotechnology, University of Ferrara, Ferrara, Italy
| | - Cristiano Bertolucci
- Department of Life Sciences and Biotechnology, University of Ferrara, Ferrara, Italy
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Minhas A, Whitlock K, Rosenfelt C, Shatto J, Finlay B, Zwicker J, Lippe S, Jacquemont S, Hagerman R, Murias K, Bolduc FV. Analyzing the Quality of Life in Individuals with Fragile X Syndrome in Relation to Sleep and Mental Health. J Autism Dev Disord 2024:10.1007/s10803-024-06317-2. [PMID: 38653851 DOI: 10.1007/s10803-024-06317-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/06/2024] [Indexed: 04/25/2024]
Abstract
The purpose of this paper was to examine the physical, emotional, social and school functioning domains of quality of life of individuals with Fragile X Syndrome, in relation to mental health and sleep patterns to gain a better understanding of how these aspects are affected by the disorder. This study included 119 individuals with Fragile X Syndrome who were given different cognitive examinations by a neuropsychologist or by parent-proxy questionnaires. This study focused on the Pediatric Quality of Life Inventory (PedsQoL), the Anxiety, Depression and Mood Scale (ADAMS), the Children's Sleep Habits Questionnaire (CSHQ), but did include other cognitive tests (Vineland Adaptive Behaviour Scales, Nonverbal IQ, Autism Diagnostic Observation Schedule). We identified significant associations between decreases in emotional, social and school domains of PedsQoL and the ADAMS subtests of Generalized Anxiety, Manic/Hyperactivity and Obsessive/Compulsivity, with the subtest of Depressed Mood having associations with lower physical and emotional domains. We also identified a significant impact between CSHQ subtests of Sleep Anxiety, Night Wakings, Daytime Sleepiness, and Parasomnia with the emotional and school domains of PedsQoL. There were associations connecting school functioning with Bedtime Resistance, and additional associations connecting emotional functioning with Sleep Duration and Sleep Onset Delay. Physical functioning was also associated with Sleep Anxiety. Our study shows how mental health and sleep defects impact improper sleep patterns and mental health which leads to decreases in the quality of life for individuals with FXS, and how it is important to screen for these symptoms in order to alleviate issues.
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Affiliation(s)
- Amrita Minhas
- Department of Pediatrics, University of Alberta, Edmonton, AB, Canada
| | - Kerri Whitlock
- Department of Pediatrics, University of Alberta, Edmonton, AB, Canada
| | - Cory Rosenfelt
- Department of Pediatrics, University of Alberta, Edmonton, AB, Canada
| | - Julie Shatto
- Department of Pediatrics, University of Alberta, Edmonton, AB, Canada
| | - Brittany Finlay
- School of Public Policy, University of Calgary, Calgary, AB, Canada
| | - Jennifer Zwicker
- School of Public Policy, University of Calgary, Calgary, AB, Canada
| | - Sarah Lippe
- Hopital Sainte-Justine, Universite de Montreal, Montreal, QC, Canada
| | | | - Randi Hagerman
- MIND Institute, University of California, Sacramento, CA, USA
| | - Kara Murias
- Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Francois V Bolduc
- Department of Pediatrics, University of Alberta, Edmonton, AB, Canada.
- Department of Medical Genetics, University of Alberta, Edmonton, AB, Canada.
- Women and Children Health Research Institute, University of Alberta, Edmonton, AB, Canada.
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Polfuss M, Bandini LG, Ravelli MN, Huang Z, Moosreiner A, Schoeller DA, Huang CC, Ding D, Berry C, Marston E, Hussain A, Shriver TC, Sawin KJ. Energy expenditure and weight-related behaviors in youth with Down syndrome: a protocol. Front Pediatr 2023; 11:1151797. [PMID: 37547107 PMCID: PMC10397728 DOI: 10.3389/fped.2023.1151797] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Accepted: 07/05/2023] [Indexed: 08/08/2023] Open
Abstract
Background The consequences of obesity are ominous, yet healthcare professionals are not adequately preventing or treating obesity in youth with Down syndrome (DS). Total daily energy expenditure (TDEE) is the energy expended in 24 h through physical activity and life-sustaining physiologic processes. An individual's TDEE is essential for determining the daily caloric intake needed to maintain or change body weight. Successful prevention and treatment of obesity in youth with DS is severely compromised by the lack of data on TDEE and information on weight-related behaviors for this high-risk population. This manuscript describes the protocol for the federally funded study that is in process to determine daily energy expenditure in a large cohort of children with DS. Methods This observational cross-sectional study will include a national sample of 230 youth with DS, stratified by age (5-11 and 12-18 years of age) and sex. Doubly Labeled Water analysis will provide the criterion body fat%, fat-free mass, and TDEE. To increase accessibility and decrease the burden on participants, the entire study, including obtaining consent and data collection, is conducted virtually within the participant's home environment on weekdays and weekends. The study team supervises all data collection via a video conferencing platform, e.g., Zoom. This study will (1) examine and determine average TDEE based on age and sex, (2) develop a prediction equation based on measured TDEE to predict energy requirements with a best-fit model based on fat-free mass, sex, age, and height and/or weight, and (3) use 24-hour dietary recalls, a nutrition and physical activity screener, wearable devices, and sleep questionnaire to describe the patterns and quality of dietary intake, sleep, and physical activity status in youth with DS. Discussion The lack of accurate information on energy expenditure and weight-related behaviors in youth with DS significantly impedes the successful prevention and treatment of obesity for this vulnerable population. The findings of this study will provide a further understanding of weight-related behaviors as obesity risk factors, currently not well understood for this population. This study will advance the science of weight management in individuals with disabilities and shift clinical practice paradigms.
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Affiliation(s)
- Michele Polfuss
- College of Nursing, University of Wisconsin - Milwaukee, Milwaukee, WI, United States
- Department of Nursing Research and Evidence-Based Practice, Children’s Wisconsin, Milwaukee, WI, United States
| | - Linda G. Bandini
- Eunice Kennedy Shriver Center, University of Massachusetts Chan Medical School, Worcester, MA, United States
| | - Michele N. Ravelli
- Isotope Ratio Mass Spectrometry Laboratory, Biotechnology Center, University of Wisconsin, Madison, WI, United States
| | - Zijian Huang
- Department of Rehabilitation Science and Technology, University of Pittsburgh, Pittsburgh, PA, United States
| | - Andrea Moosreiner
- Clinical and Translational Science Institute of Southeast Wisconsin, Medical College of Wisconsin, Milwaukee, WI, United States
| | - Dale A. Schoeller
- Isotope Ratio Mass Spectrometry Laboratory, Biotechnology Center, University of Wisconsin, Madison, WI, United States
| | - Chiang-Ching Huang
- Zilber School of Public Health, University of Wisconsin – Milwaukee, Milwaukee, WI, United States
| | - Dan Ding
- Department of Rehabilitation Science and Technology, University of Pittsburgh, Pittsburgh, PA, United States
| | - Cristen Berry
- Pediatric Translational Research Unit, Children’s Wisconsin, Milwaukee, WI, United States
| | - Emma Marston
- College of Nursing, University of Wisconsin - Milwaukee, Milwaukee, WI, United States
| | - Azeem Hussain
- Zilber School of Public Health, University of Wisconsin – Milwaukee, Milwaukee, WI, United States
| | - Timothy C. Shriver
- Isotope Ratio Mass Spectrometry Laboratory, Biotechnology Center, University of Wisconsin, Madison, WI, United States
| | - Kathleen J. Sawin
- College of Nursing, University of Wisconsin - Milwaukee, Milwaukee, WI, United States
- Department of Nursing Research and Evidence-Based Practice, Children’s Wisconsin, Milwaukee, WI, United States
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Maurer JJ, Choi A, An I, Sathi N, Chung S. Sleep disturbances in autism spectrum disorder: Animal models, neural mechanisms, and therapeutics. Neurobiol Sleep Circadian Rhythms 2023; 14:100095. [PMID: 37188242 PMCID: PMC10176270 DOI: 10.1016/j.nbscr.2023.100095] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Revised: 03/16/2023] [Accepted: 04/08/2023] [Indexed: 05/17/2023] Open
Abstract
Sleep is crucial for brain development. Sleep disturbances are prevalent in children with autism spectrum disorder (ASD). Strikingly, these sleep problems are positively correlated with the severity of ASD core symptoms such as deficits in social skills and stereotypic behavior, indicating that sleep problems and the behavioral characteristics of ASD may be related. In this review, we will discuss sleep disturbances in children with ASD and highlight mouse models to study sleep disturbances and behavioral phenotypes in ASD. In addition, we will review neuromodulators controlling sleep and wakefulness and how these neuromodulatory systems are disrupted in animal models and patients with ASD. Lastly, we will address how the therapeutic interventions for patients with ASD improve various aspects of sleep. Together, gaining mechanistic insights into the neural mechanisms underlying sleep disturbances in children with ASD will help us to develop better therapeutic interventions.
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Bin Eid W, Lim M, Gabrieli G, Kölbel M, Halstead E, Esposito G, Dimitriou D. Alterations in Cortisol Profiles among Mothers of Children with ASD Related to Poor Child Sleep Quality. Healthcare (Basel) 2022; 10:healthcare10040666. [PMID: 35455843 PMCID: PMC9032515 DOI: 10.3390/healthcare10040666] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Revised: 03/29/2022] [Accepted: 03/30/2022] [Indexed: 11/25/2022] Open
Abstract
Caregivers of children with autism spectrum disorder (ASD) experience poorer sleep, but studies have not yet used objective measures to investigate how child and caregiver sleep affect each other. In this study, 29 mothers and their child with ASD aged between 6 and 16 years were recruited. Questionnaires measuring child autism, maternal depression, and maternal and child sleep quality were administered. Cortisol salivary samples were also obtained from the mothers over the course of a day. Results revealed that maternal depression is significantly correlated with their subjective sleep quality, sleep latency and daytime dysfunction. Child sleep quality was also found to be significantly correlated with ASD severity. In terms of maternal cortisol profiles, a significant number of mothers showed a flattened diurnal cortisol expression, and children of mothers with a flattened cortisol profile had significantly more sleep problems. Overall, results suggest that maternal and child sleep are affected by the child’s disability but also are mutually related. Future studies may consider employing measures such as actigraphy or somnography to quantify sleep quality and establish causal pathways between sleep, cortisol expression and caregiver and child outcomes. The present study has clinical implications in examining family sleep when considering treatment for ASD.
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Affiliation(s)
- Wasmiah Bin Eid
- Sleep Education and Research Laboratory, UCL Institute of Education, London WC1H 0AA, UK; (W.B.E.); (M.K.); (E.H.)
| | - Mengyu Lim
- Psychology Program, School of Social Sciences, Nanyang Technological University, 48 Nanyang Avenue, Singapore 639818, Singapore; (M.L.); (G.G.)
| | - Giulio Gabrieli
- Psychology Program, School of Social Sciences, Nanyang Technological University, 48 Nanyang Avenue, Singapore 639818, Singapore; (M.L.); (G.G.)
| | - Melanie Kölbel
- Sleep Education and Research Laboratory, UCL Institute of Education, London WC1H 0AA, UK; (W.B.E.); (M.K.); (E.H.)
- Department of Developmental Neurosciences Unit, UCL Great Ormond Street Institute of Child Health, London WC1N 1EH, UK
| | - Elizabeth Halstead
- Sleep Education and Research Laboratory, UCL Institute of Education, London WC1H 0AA, UK; (W.B.E.); (M.K.); (E.H.)
| | - Gianluca Esposito
- Affiliative Behaviour and Physiology Lab, Department of Psychology and Cognitive Science, University of Trento, Corso Bettini, 84, I-38068 Trento, Italy;
| | - Dagmara Dimitriou
- Sleep Education and Research Laboratory, UCL Institute of Education, London WC1H 0AA, UK; (W.B.E.); (M.K.); (E.H.)
- Correspondence:
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7
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Shui AM, Richdale AL, Katz T. Evaluating sleep quality using the CSHQ-Autism. Sleep Med 2021; 87:69-76. [PMID: 34534745 DOI: 10.1016/j.sleep.2021.08.022] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Revised: 08/16/2021] [Accepted: 08/22/2021] [Indexed: 01/06/2023]
Abstract
BACKGROUND Sleep problems are common in autistic children and adversely impact daytime functioning. The Children's Sleep Habits Questionnaire (CSHQ) [39] was developed from a community-based sample of children and has validated a cut-off score of 41. Katz et al. [50] developed an abbreviated 23-item four-factor version of the CSHQ, which may be useful when assessing sleep in autistic children. However, a cut-off value has not yet been developed. OBJECTIVE Our objective was to develop and validate a cut-off for the CSHQ-autism total score in order to identify sleep problems among autistic children. We hypothesized that the derived cut-off value for the CSHQ-autism would perform better than the original CSHQ cut at 41 on validation in a sample of autistic children. METHODS Age-specific cut-off values were developed and validated using receiver operating characteristic analysis. RESULTS The derived cut-off values for the CSHQ-autism total score were 34, 35, 33, and 35 for the 2-3, 4-10, 11-17, and 2-17 years age groups, respectively. On validation, all cut-off values performed with moderate to high sensitivity (76.6-82.4%) and moderate specificity (69.1-75.5%), while the original CSHQ cut at 41 had high sensitivity (89.9-93.0%) but low specificity (42.6-57.7%). Using McNemar's tests, the CSHQ-autism had significantly higher specificity but lower sensitivity than the original CSHQ cut at 41 in all age groups. CONCLUSIONS The CSHQ-autism cut-off values performed better overall than the original CSHQ cut at 41 in a sample of autistic children. The CSHQ-autism cut-off can help identify sleep problems among autistic children.
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Affiliation(s)
- Amy M Shui
- Biostatistics Center, Massachusetts General Hospital, 50 Staniford Street, Suite 560, Boston, MA, 02114, USA; Department of Epidemiology and Biostatistics, University of California San Francisco, 550 16th Street, 2(nd)Floor, San Francisco, CA, 94158, USA.
| | - Amanda L Richdale
- Olga Tennison Autism Research Centre, School of Psychology and Public Health, La Trobe University, Kingsbury Drive, Bundoora, VIC, 3086, Australia.
| | - Terry Katz
- Department of Pediatrics, University of Colorado School of Medicine, 13123 E, 16(th)Avenue, Aurora, CO, 80045, USA.
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Schroder CM, Banaschewski T, Fuentes J, Hill CM, Hvolby A, Posserud MB, Bruni O. Pediatric prolonged-release melatonin for insomnia in children and adolescents with autism spectrum disorders. Expert Opin Pharmacother 2021; 22:2445-2454. [PMID: 34314281 DOI: 10.1080/14656566.2021.1959549] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Introduction: Insomnia is common among children and adolescents with Autism spectrum disorder (ASD). The first drug licensed for insomnia in this population, a pediatric-appropriate prolonged-release melatonin (PedPRM) formulation is described.Areas covered: Literature search on PedPRM efficacy and safety profile in clinical trials, and a proposed decision-making algorithm to optimize outcome in the treatment of insomnia in children and adolescents with ASD.Expert opinion: PedPRM treatment effectively improves sleep onset, duration and consolidation, and daytime externalizing behaviors in children and adolescents with ASD and subsequently caregivers' quality of life and satisfaction with their children's sleep. The coated, odorless and taste-free mini-tablets are well-accepted in this population who often have sensory hypersensitivity and problems swallowing standard tablet preparations. The most frequent long-term treatment-related adverse events were fatigue (6.3%), somnolence (6.3%), and mood swings (4.2%) with no evidence of delay in height, BMI, or pubertal development, or withdrawal effects. The starting dose is 2 mg once daily independent of age or weight, escalated to 5-10 mg/day if predefined treatment success criteria are unmet. Slow melatonin metabolizers (~10% of children), may require lower doses. Given its long-term efficacy, safety and acceptance, PedPRM may ameliorate long-term consequences of insomnia in this population.
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Affiliation(s)
- Carmen M Schroder
- Department of Child and Adolescent Psychiatry & Excellence Centre for Autism and Neurodevelopmental Disorders STRAS&ND, Strasbourg University Hospitals & University of Strasbourg Medical School, 67000 Strasbourg, France; CNRS UPR 3212, Institute for Cellular and Integrative Neurosciences; Sleep Disorders Center& International Research Center for ChronoSomnology, Strasbourg, France
| | - Tobias Banaschewski
- Department of Child and Adolescent Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - Joaquin Fuentes
- Child and Adolescent Psychiatry Unit, Service of Child and Adolescent Psychiatry, Policlínica Gipuzkoa and GAUTENA Autism Society, San Sebastián, Spain
| | - Catherine Mary Hill
- School of Clinical Experimental Sciences, Faculty of Medicine, University of Southampton, and Southampton Children's Hospital Department of Sleep Medicine, Southampton, UK
| | - Allan Hvolby
- Department of Child and Adolescent Psychiatry, Psychiatry in Region of South Denmark, Esbjerg, and Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
| | - Maj-Britt Posserud
- Department of Clinical Medicine, Faculty of Medicine, University of Bergen, Bergen, Norway
| | - Oliviero Bruni
- Department of Developmental and Social Psychology, Sapienza University, Rome, Italy
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Feng S, Huang H, Wang N, Wei Y, Liu Y, Qin D. Sleep Disorders in Children With Autism Spectrum Disorder: Insights From Animal Models, Especially Non-human Primate Model. Front Behav Neurosci 2021; 15:673372. [PMID: 34093147 PMCID: PMC8173056 DOI: 10.3389/fnbeh.2021.673372] [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: 02/27/2021] [Accepted: 04/16/2021] [Indexed: 02/05/2023] Open
Abstract
Autism Spectrum Disorder (ASD) is a heterogeneous neurodevelopmental disorder with deficient social skills, communication deficits and repetitive behaviors. The prevalence of ASD has increased among children in recent years. Children with ASD experience more sleep problems, and sleep appears to be essential for the survival and integrity of most living organisms, especially for typical synaptic development and brain plasticity. Many methods have been used to assess sleep problems over past decades such as sleep diaries and parent-reported questionnaires, electroencephalography, actigraphy and videosomnography. A substantial number of rodent and non-human primate models of ASD have been generated. Many of these animal models exhibited sleep disorders at an early age. The aim of this review is to examine and discuss sleep disorders in children with ASD. Toward this aim, we evaluated the prevalence, clinical characteristics, phenotypic analyses, and pathophysiological brain mechanisms of ASD. We highlight the current state of animal models for ASD and explore their implications and prospects for investigating sleep disorders associated with ASD.
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Affiliation(s)
- Shufei Feng
- Department of Pediatric Rehabilitation Medicine, Kunming Children’s Hospital, Kunming, China
- State Key Laboratory of Primate Biomedical Research, Institute of Primate Translational Medicine, Kunming University of Science and Technology, Kunming, China
| | - Haoyu Huang
- Department of Pediatric Rehabilitation Medicine, Kunming Children’s Hospital, Kunming, China
| | - Na Wang
- School of Basic Medical Sciences, Yunnan University of Chinese Medicine, Kunming, China
| | - Yuanyuan Wei
- School of Basic Medical Sciences, Yunnan University of Chinese Medicine, Kunming, China
| | - Yun Liu
- Department of Pediatric Rehabilitation Medicine, Kunming Children’s Hospital, Kunming, China
| | - Dongdong Qin
- Department of Pediatric Rehabilitation Medicine, Kunming Children’s Hospital, Kunming, China
- State Key Laboratory of Primate Biomedical Research, Institute of Primate Translational Medicine, Kunming University of Science and Technology, Kunming, China
- School of Basic Medical Sciences, Yunnan University of Chinese Medicine, Kunming, China
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10
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Stafford CF, Ward C, Ward SLD, Sanchez-Lara PA. Characterization of sleep habits of children with Sotos syndrome. Am J Med Genet A 2021; 185:2815-2820. [PMID: 33893755 DOI: 10.1002/ajmg.a.62212] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Revised: 02/18/2021] [Indexed: 11/08/2022]
Abstract
Sotos syndrome (SS) is a genetic disorder characterized by accelerated growth in childhood, developmental deficits, and characteristic craniofacial features. While clinicians and parents have reported unusual sleep habits, only one study by Rutter and Cole in 1991 mentioned sleep complaints (Rutter and Cole, Developmental Medicine and Child Neurology, 1991, 33, 898-902). This study aimed to characterize the sleep habits of individuals with SS. We performed a cross-sectional study of individuals with a definite, probable, or possible diagnosis of Sotos syndrome. Participants were asked to complete the Children's Sleep Habits Questionnaire (CHSQ). We compared our data to historical data available from the literature. Subjects with SS showed more sleep disturbance than typically developing individuals (TD), although their sleep onset was less likely to be delayed and their sleep duration was longer. Participants with SS also showed different sleep patterns compared to children with other forms of intellectual and developmental disabilities (IDD). Individuals with SS exhibited early bed and rise times, frequently used transitional objects, displayed repetitive motion at sleep onset, and did not show a decrease in sleep duration with age. The majority of participants fell asleep at the same time each night, in their own bed, and within 20 min, and rarely showed signs of sleepwalking or night terrors. These results improve our understanding of sleep habits of individuals with SS and may be used to guide treatment and provide normalization for children with SS.
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Affiliation(s)
| | - Carrie Ward
- Keck School of Medicine of University of Southern California, Los Angeles, California, USA
| | - Sally L D Ward
- Keck School of Medicine of University of Southern California, Los Angeles, California, USA
| | - Pedro A Sanchez-Lara
- Department of Pediatrics, Cedars-Sinai Medical Center, Los Angeles, California, USA.,David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California, USA
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11
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Dai Y, Liu J. Parental perceived child sleep problems: A concept analysis. J SPEC PEDIATR NURS 2021; 26:e12327. [PMID: 33493387 DOI: 10.1111/jspn.12327] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Revised: 12/15/2020] [Accepted: 01/05/2021] [Indexed: 02/05/2023]
Abstract
PURPOSE This paper aims to delineate a conceptual analysis of parental perceived child sleep problems. DESIGN AND METHODS Rodger's evolutionary approach to concept analysis was employed. A systematic literature search of PubMed, CINAHL, Medline, and PsycINFO was conducted from inception to June 2020. Peer-reviewed papers written in English focusing on parental perception of their children's sleep problems were included. RESULTS A total of 47 papers were included for analysis. Parental perceived child sleep problems can be defined as parental reliance on their observations and beliefs, and perceived locus of control to appraise an array of children's sleep-related signs and behaviors, which may contain bias but still reflects certain aspects of children's sleep health status. A wide range of physiological, psychosocial, familial, environmental, and cultural factors may contribute to parental perceived child sleep problems, which may further contribute to parent-child dyads' physical and mental health as well as the whole family's general wellness. PRACTICE IMPLICATIONS Defining the concept of parental perceived child sleep problems facilitate health professionals a foundation for consistent use, understanding, and evaluation of parent-reported child sleep outcome. Future research on the standard conceptual and operational definition of parental perceived child sleep problem, and its potential antecedents and consequences is warranted. The characteristic of parental perceived sleep problems, together with child sleep history and objective sleep measures should be integrated to evaluate child sleep health.
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Affiliation(s)
- Ying Dai
- Schools of Nursing, Leonard Davis Institute, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Jianghong Liu
- Schools of Nursing and Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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12
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Rana M, Kothare S, DeBassio W. The Assessment and Treatment of Sleep Abnormalities in Children and Adolescents with Autism Spectrum Disorder: A Review. JOURNAL OF THE CANADIAN ACADEMY OF CHILD AND ADOLESCENT PSYCHIATRY = JOURNAL DE L'ACADEMIE CANADIENNE DE PSYCHIATRIE DE L'ENFANT ET DE L'ADOLESCENT 2021; 30:25-35. [PMID: 33552170 PMCID: PMC7837521] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 08/18/2019] [Accepted: 10/25/2020] [Indexed: 06/12/2023]
Abstract
OBJECTIVE To summarize causes, evaluation methods, and treatment of sleep disturbance in children and adolescents with autism spectrum disorder (ASD). METHODS A narrative literature and synthesis approach was used. RESULTS/DISCUSSION Sleep disturbances in this population are common and include insomnia, parasomnias, circadian rhythm disorders, and sleep-related movement disorders. Multiple factors may contribute to the higher rates of sleep disturbances in persons with ASD. Unfortunately, there are not evidence-based guidelines specific for the management of these sleep disorders in this population. There is also a lack of controlled clinical studies. Nevertheless, assessment of sleep problems using both subjective and objective methods are recommended to develop an individualized approach. Behavioural interventions are preferred first line treatment for insomnia. As adjunctive measures, pharmacotherapy may be warranted and choice should be guided based on accompanying symptoms. The most commonly used pharmacotherapy for sleep disturbance, primarily insomnia, include melatonin and alpha agonists. Not all currently used medications are approved for use for children and adolescents.
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Affiliation(s)
- Mandeep Rana
- Department of Pediatrics, Division of Pediatric Neurology and Sleep Medicine, Boston University School of Medicine, Boston Medical Center, Boston, Massachusetts, USA
| | - Sanjeev Kothare
- Department of Pediatrics, Division of Pediatric Neurology, Cohen Children's Medical Center, Zucker School of Medicine Hofstra/Northwell, New York, USA
| | - William DeBassio
- Department of Pediatrics, Division of Pediatric Neurology and Sleep Medicine, Boston University School of Medicine, Boston Medical Center, Boston, Massachusetts, USA
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13
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McLay LK, Schluter PJ, Eggleston MJF, Woodford EC, Bowden N. Melatonin dispensing among New Zealand children aged 0-18 years with autism: a nationwide cross-sectional study. Sleep Med 2021; 80:184-192. [PMID: 33601231 DOI: 10.1016/j.sleep.2021.01.028] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Revised: 01/14/2021] [Accepted: 01/18/2021] [Indexed: 10/22/2022]
Abstract
OBJECTIVE/BACKGROUND Sleep problems in children on the autism spectrum are prevalent and persistent. Such problems are the result of a combination of biopsychosocial factors, including abnormal melatonin secretion. Exogenous melatonin is an empirically supported and popular treatment for sleep problems. However, we know little about rates of melatonin dispensing and associated variables. This study investigated rates of melatonin dispensing and the sociodemographic and child characteristics associated with its use in New Zealand. METHODS This nationwide cross-sectional study used linked administrative health data obtained via the Integrated Data Infrastructure (IDI). Data were obtained for 11,202, 0-18 year old children on the autism spectrum. Descriptive data, and adjusted and unadjusted risk ratios, were calculated for sociodemographic and child characteristics. RESULTS Melatonin is accessed by almost one quarter of children on the autism spectrum in New Zealand, with higher observed rates among females and those aged between 5 and 11 years, of European ethnicity, and presenting with co-occurring mental health conditions. CONCLUSIONS Findings are largely consistent with research investigating both sleep disturbances and psychotropic drug use among children on the autism spectrum. High rates of melatonin use, age- and sex-related differences in its use, and the complexity associated with the presence of co-occurring conditions necessitates development of practice guidelines for melatonin dispensing. Further investigation into the duration of melatonin use and the interaction between child characteristics, co-occurring conditions, sociodemographic variables and melatonin dispensing is warranted.
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Affiliation(s)
- L K McLay
- School of Health Sciences, University of Canterbury - Te Whare Wānanga o Waitaha, Christchurch, New Zealand.
| | - P J Schluter
- School of Health Sciences, University of Canterbury - Te Whare Wānanga o Waitaha, Christchurch, New Zealand; School of Clinical Medicine, Primary Care Clinical Unit, The University of Queensland, Brisbane, Australia.
| | - M J F Eggleston
- Mental Health Division, Canterbury District Health Board, New Zealand.
| | - E C Woodford
- School of Health Sciences, University of Canterbury - Te Whare Wānanga o Waitaha, Christchurch, New Zealand
| | - N Bowden
- A Better Start National Science Challenge, New Zealand; Department of Women's and Children's Health, University of Otago, New Zealand.
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14
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Associations Between Child Sleep Problem Severity and Maternal Well-Being in Children with Autism Spectrum Disorder. J Autism Dev Disord 2020; 51:2500-2510. [PMID: 33033970 DOI: 10.1007/s10803-020-04726-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
This study investigated whether sleep problem severity in children with autism spectrum disorder was associated with maternal well-being. Mothers of 234 children reported on their mental health (Kessler Psychological Distress Scale), parenting stress (Parenting Stress Index-4-SF), health-related quality of life (HRQoL; Assessment of Quality of Life-4D) and their child's sleep (Children's Sleep Habits Questionnaire-ASD). Analyses revealed sleep initiation and duration problem severity scores were associated with increased mental health difficulties. Specific child sleep problems were not associated with parenting stress or HRQoL. This study revealed the importance of considering sleep and the family system when assessing maternal well-being. Future research considering parent, child and family factors will be important to informing a family focused approach to mental health.
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15
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Papadopoulos N, Sciberras E, Hiscock H, Williams K, McGillivray J, Mihalopoulos C, Engel L, Fuller-Tyszkiewicz M, Bellows ST, Marks D, Howlin P, Rinehart N. Sleeping sound with autism spectrum disorder (ASD): study protocol for an efficacy randomised controlled trial of a tailored brief behavioural sleep intervention for ASD. BMJ Open 2019; 9:e029767. [PMID: 31748288 PMCID: PMC6887021 DOI: 10.1136/bmjopen-2019-029767] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Revised: 07/25/2019] [Accepted: 09/09/2019] [Indexed: 12/22/2022] Open
Abstract
INTRODUCTION Sleep problems are a characteristic feature of children with autism spectrum disorder (ASD) with 40% to 80% of children experiencing sleep difficulties. Sleep problems have been found to have a pervasive impact on a child's socio-emotional functioning, as well as on parents' psychological functioning. The Sleeping Sound ASD project aims to evaluate the efficacy of a brief behavioural sleep intervention in reducing ASD children's sleep problems in a fully powered randomised controlled trial (RCT). Intervention impact on child and family functioning is also assessed. METHODS AND ANALYSIS The RCT aims to recruit 234 children with a diagnosis of ASD, aged 5-13 years, who experience moderate to severe sleep problems. Participants are recruited from paediatrician clinics in Victoria, Australia, and via social media. Families interested in the study are screened for eligibility via phone, and then asked to complete a baseline survey online, assessing child sleep problems, and child and family functioning. Participants are then randomised to the intervention group or treatment as usual comparator group. Families in the intervention group attend two face-to-face sessions and a follow-up phone call with a trained clinician, where families are provided with individually tailored behavioural sleep strategies to help manage the child's sleep problems. Teacher reports of sleep, behavioural and social functioning are collected, and cognitive ability assessed to provide measures blind to treatment group. The primary outcome is children's sleep problems as measured by the Children's Sleep Habits Questionnaire at 3 months post-randomisation. Secondary outcomes include parent and child quality of life; child social, emotional, behavioural and cognitive functioning; and parenting stress and parent mental health. Cost-effectiveness of the intervention is also evaluated. ETHICS AND DISSEMINATION Findings from this study will be published in peer-reviewed journals and disseminated at national and international conferences, local networks and online. TRIAL REGISTRATION NUMBER ISRCTN14077107 (ISRCTN registry dated on 3 March 2017).
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Affiliation(s)
| | - Emma Sciberras
- Deakin University, Geelong, Victoria, Australia
- Murdoch Children's Research Institute, Parkville, Victoria, Australia
- Department of Paediatrics, The University of Melbourne, Melbourne, Victoria, Australia
| | - Harriet Hiscock
- Murdoch Children's Research Institute, Parkville, Victoria, Australia
- The Royal Children's Hospital, Parkville, Victoria, Australia
| | - Katrina Williams
- Murdoch Children's Research Institute, Parkville, Victoria, Australia
- Department of Paediatrics, The University of Melbourne, Melbourne, Victoria, Australia
- The Royal Children's Hospital, Parkville, Victoria, Australia
| | | | | | - Lidia Engel
- Deakin University, Geelong, Victoria, Australia
| | | | | | - Deborah Marks
- Deakin University, Geelong, Victoria, Australia
- The Royal Children's Hospital, Parkville, Victoria, Australia
| | - Patricia Howlin
- Brain and Mind Centre, University of Sydney, Camperdown, New South Wales, Australia
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
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16
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Schroder CM, Malow BA, Maras A, Melmed RD, Findling RL, Breddy J, Nir T, Shahmoon S, Zisapel N, Gringras P. Pediatric Prolonged-Release Melatonin for Sleep in Children with Autism Spectrum Disorder: Impact on Child Behavior and Caregiver's Quality of Life. J Autism Dev Disord 2019; 49:3218-3230. [PMID: 31079275 PMCID: PMC6647439 DOI: 10.1007/s10803-019-04046-5] [Citation(s) in RCA: 59] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
A randomized, 13-weeks, placebo-controlled double-blind study in 125 subjects aged 2-17.5 years with Autism Spectrum Disorder or Smith-Magenis syndrome and insomnia demonstrated efficacy and safety of easily-swallowed prolonged-release melatonin mini-tablets (PedPRM; 2-5 mg) in improving sleep duration and onset. Treatment effects on child behavior and caregiver's quality of life were evaluated. PedPRM treatment resulted in significant improvement in externalizing but not internalizing behavior (Strengths and Difficulties questionnaire; SDQ) compared to placebo (p = 0.021) with clinically-relevant improvements in 53.7% of PedPRM-treated versus 27.6% of placebo-treated subjects (p = 0.008). Caregivers' quality of life also improved with PedPRM versus placebo (p = 0.010) and correlated with the change in total SDQ (p = 0.0005). PedPRM alleviates insomnia-related difficulties, particularly externalizing behavior in the children, subsequently improving caregivers' quality of life.
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Affiliation(s)
- Carmen M Schroder
- Department of Child and Adolescent Psychiatry & CIRCSom, Strasbourg University Hospital, Strasbourg, France.,CNRS UPR 3212, Institute of Cellular and Integrative Neurosciences, Strasbourg, France
| | - Beth A Malow
- Sleep Division, Department of Neurology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Athanasios Maras
- Yulius Academy, Yulius Mental Health Organization, Dordrecht, Delft, The Netherlands
| | - Raun D Melmed
- Southwest Autism Research and Resource Center, Scottsdale, Phoenix, AZ, USA
| | - Robert L Findling
- Department of Psychiatry and Behavioral Sciences, Kennedy Krieger Institute/Johns Hopkins University, Baltimore, MD, USA
| | | | - Tali Nir
- Neurim Pharmaceuticals Ltd, Tel Aviv, Israel
| | | | | | - Paul Gringras
- Children's Sleep Medicine, Evelina London Children's Hospital, Guy's and St Thomas', London, UK
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17
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Martin CA, Papadopoulos N, Chellew T, Rinehart NJ, Sciberras E. Associations between parenting stress, parent mental health and child sleep problems for children with ADHD and ASD: Systematic review. RESEARCH IN DEVELOPMENTAL DISABILITIES 2019; 93:103463. [PMID: 31446370 DOI: 10.1016/j.ridd.2019.103463] [Citation(s) in RCA: 63] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Revised: 07/08/2019] [Accepted: 08/12/2019] [Indexed: 05/27/2023]
Abstract
BACKGROUND Children with attention-deficit/hyperactivity disorder (ADHD) and autism spectrum disorder (ASD) experience high rates of sleep problems. Their parents experience higher parenting stress and more mental health difficulties than parents of typically developing children. AIM To examine the association between child sleep problems, parenting stress and parent mental health for children with ADHD or ASD. METHODS MEDLINE Complete, EMBASE, PsycINFO and CINAHL Complete databases were searched. Studies needed to include: children aged 5-18 with ADHD or ASD, a child sleep measure, and a parenting stress or adult mental health measure. RESULTS Eleven studies were identified (four ADHD, seven ASD). Six studies examined parenting stress (five cross-sectional, one longitudinal) and five found associations, of varying strengths, with child sleep problems. Six studies examined parent mental health (four cross-sectional, two longitudinal) and five found associations, of differing magnitudes, with child sleep problems. CONCLUSIONS These studies demonstrate child sleep problems are associated with poorer parent mental health and higher parenting stress. IMPLICATIONS Future longitudinal research including multiple measurements of child sleep problems and family functioning is required to clarify the directionality of associations. Such knowledge is key in adapting sleep interventions to better meet the needs of children with ADHD or ASD and their families.
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Affiliation(s)
- Christina A Martin
- Deakin University, 1 Gheringhap Street, Geelong, Victoria, Australia 3220.
| | | | - Tayla Chellew
- Deakin University, 1 Gheringhap Street, Geelong, Victoria, Australia 3220
| | - Nicole J Rinehart
- Deakin University, 1 Gheringhap Street, Geelong, Victoria, Australia 3220
| | - Emma Sciberras
- Deakin University, 1 Gheringhap Street, Geelong, Victoria, Australia 3220; Murdoch Children's Research Institute, Royal Children's Hospital, 50 Flemington Rd, Parkville, Victoria, Australia 3052; The University of Melbourne, Grattan St, Parkville, Victoria, Australia 301
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18
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Peverill S, Smith IM, Duku E, Szatmari P, Mirenda P, Vaillancourt T, Volden J, Zwaigenbaum L, Bennett T, Elsabbagh M, Georgiades S, Ungar WJ. Developmental Trajectories of Feeding Problems in Children with Autism Spectrum Disorder. J Pediatr Psychol 2019; 44:988-998. [PMID: 31089730 PMCID: PMC6705712 DOI: 10.1093/jpepsy/jsz033] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2018] [Revised: 03/17/2019] [Accepted: 04/18/2019] [Indexed: 12/28/2022] Open
Abstract
OBJECTIVE Although feeding problems are a common concern in children with autism spectrum disorder (ASD), few longitudinal studies have examined their persistence over time. The purpose of this study was to examine the developmental progression of feeding problems across four time points in preschoolers with ASD. METHODS Group-based trajectory analyses revealed four distinct trajectories of feeding problems in our sample (N = 396). RESULTS The majority of children showed levels of feeding problems that were low from the outset and stable (Group 1; 26.3%) or moderate and declining over time (Group 2; 38.9%). A third group (26.5%) showed high levels of feeding problems as preschoolers that declined to the average range by school age. Few participants (8.3%) showed evidence of severe chronic feeding problems. Feeding problems were more highly correlated with general behavior problems than with autism symptom severity. CONCLUSIONS Overall, our findings demonstrated that in our sample of children with ASD, most feeding problems remitted over time, but a small subgroup showed chronic feeding problems into school age. It is important to consider and assess feeding problems in ASD against the backdrop of typical development, as many children with ASD may show improvement with age.
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Affiliation(s)
- Sarah Peverill
- Department of Psychology and Neuroscience, Dalhousie University
| | | | | | | | - Pat Mirenda
- Department of Educational & Counselling Psychology and Special Education, University of British Columbia
| | | | - Joanne Volden
- Faculty of Rehabilitation Medicine, University of Alberta
| | | | | | | | | | - Wendy J Ungar
- Child Evaluative Health Sciences, Hospital for Sick Children
- Institute for Health Policy, Management and Evaluation, University of Toronto
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19
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Modification of the Children's Sleep Habits Questionnaire for Children with Autism Spectrum Disorder. J Autism Dev Disord 2019; 48:2629-2641. [PMID: 29500758 DOI: 10.1007/s10803-018-3520-2] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Sleep problems are common in children with autism spectrum disorder (ASD) and adversely impact daytime functioning. Although no questionnaires have been developed to assess sleep in children with ASD, the 33-item Children's Sleep Habits Questionnaire (CSHQ) is widely used in this population. We examined the factor structure of the CSHQ in 2872 children (age 4-10 years) enrolled in the Autism Treatment Network. A four-factor solution (Sleep Initiation and Duration, Sleep Anxiety/Co-Sleeping, Night Waking/Parasomnias, and Daytime Alertness) with 5-6 items per factor explained 75% of the total variation. Ten items failed to load on any factor. This abbreviated 23-item four-factor version of this measure may be useful when assessing sleep in children with ASD.
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20
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Valicenti-McDermott M, Lawson K, Hottinger K, Seijo R, Schechtman M, Shulman L, Shinnar S. Sleep Problems in Children With Autism and Other Developmental Disabilities: A Brief Report. J Child Neurol 2019; 34:387-393. [PMID: 30880542 DOI: 10.1177/0883073819836541] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Sleep problems in children with autism and the association with child behavioral problems was studied in an ethnically diverse population, in a cross-sectional study with structured interview. Sample included 50 families of children with autism and 50 families of children with other developmental disabilities, matched by age/gender. Interview included Child Sleep Habits Questionnaire and Aberrant Behavior Checklist. In this ethnically diverse sample, at least 78% of families of children with autism reported significant sleep problems compared to 34% of families of children with other developmental disabilities. Specifically, children with autism reported more frequent bedtime resistance, sleep anxiety, and night wakings than children with other developmental disabilities. Across groups, sleep problems were related to child behavioral difficulties, including irritability and hyperactivity, although this association did not reach significance for the group with autism. Specifics in terms of the nature of sleep disorders will help our understanding and design of effective treatment options.
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Affiliation(s)
- Maria Valicenti-McDermott
- 1 RFK Children's Evaluation and Rehabilitation Center, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Katharine Lawson
- 1 RFK Children's Evaluation and Rehabilitation Center, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Kathryn Hottinger
- 1 RFK Children's Evaluation and Rehabilitation Center, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Rosa Seijo
- 1 RFK Children's Evaluation and Rehabilitation Center, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Merryl Schechtman
- 1 RFK Children's Evaluation and Rehabilitation Center, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Lisa Shulman
- 1 RFK Children's Evaluation and Rehabilitation Center, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Shlomo Shinnar
- 1 RFK Children's Evaluation and Rehabilitation Center, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA.,2 Saul R. Korey Department of Neurology Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
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21
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Benson S, Bender AM, Wickenheiser H, Naylor A, Clarke M, Samuels CH, Werthner P. Differences in sleep patterns, sleepiness, and physical activity levels between young adults with autism spectrum disorder and typically developing controls. Dev Neurorehabil 2019; 22:164-173. [PMID: 30067414 DOI: 10.1080/17518423.2018.1501777] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
OBJECTIVE To investigate the differences in sleep, sleepiness, and physical activity (PA) between young adults with autism spectrum disorder (ASD) and typically developing controls (TDC). METHOD Actigraphic data and questionnaires on sleep, sleepiness, and PA were compared between fifteen adults with ASD (ADOS range 7-19; ages 22.8 ± 4.5 years) and TDC. RESULTS In comparison to the TDC group, the ASD group slept longer on average per night but took longer to fall asleep. In relationship to PA levels, the objective PA levels were lower in the ASD group than the TDC group. Fewer wake minutes during the sleep period in the ASD sample were associated with more PA the following day. CONCLUSION The findings support previous research that demonstrates differences in sleep parameters and PA between ASD and TDC. Interventions aimed at increasing PA in an ASD population may be beneficial for improved sleep.
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Affiliation(s)
- Sarah Benson
- a Faculty of Kinesiology , University of Calgary
| | - Amy M Bender
- b Centre for Sleep, Faculty of Kinesiology , University of Calgary
| | | | | | | | - Charles H Samuels
- d Centre for Sleep & Human Performance , Faculty of Medicine, University of Calgary
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22
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Reynolds AM, Soke GN, Sabourin KR, Hepburn S, Katz T, Wiggins LD, Schieve LA, Levy SE. Sleep Problems in 2- to 5-Year-Olds With Autism Spectrum Disorder and Other Developmental Delays. Pediatrics 2019; 143:e20180492. [PMID: 30745433 PMCID: PMC6398427 DOI: 10.1542/peds.2018-0492] [Citation(s) in RCA: 76] [Impact Index Per Article: 15.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/03/2018] [Indexed: 11/24/2022] Open
Abstract
: media-1vid110.1542/5984243260001PEDS-VA_2018-0492Video Abstract BACKGROUND: Sleep problems can impact daytime behavior, quality of life, and overall health. We compared sleep habits in young children with autism spectrum disorder (ASD) and other developmental delays and disorders and in children from the general population (POP). METHODS We included 2- to 5-year-old children whose parent completed all items on the Children's Sleep Habits Questionnaire (CSHQ) in a multisite case-control study: 522 children with ASD; 228 children with other developmental delays and disorders with autism spectrum disorder characteristics (DD w/ASD); 534 children with other developmental delays and disorders without autism spectrum disorder characteristics (DD w/o ASD); and 703 POP. Multivariable analysis of variance compared CSHQ mean total score (TS) and subscale scores between groups. Logistic regression analysis examined group differences by using TS cutoffs of 41 and 48. Analyses were adjusted for covariates. RESULTS Mean CSHQ TS for children in each group: ASD (48.5); DD w/ASD (50.4); DD w/o ASD (44.4); and POP (43.3). Differences between children with ASD and both children with DD w/o ASD and POP were statistically significant. Using a TS cutoff of 48, the proportion of children with sleep problems was significantly higher in children in the ASD group versus DD w/o ASD and POP groups (adjusted odds ratios [95% confidence intervals]: 2.12 [1.57 to 2.87] and 2.37 [1.75 to 3.22], respectively). CONCLUSIONS Sleep problems are more than twice as common in young children with ASD and DD w/ASD. Screening for sleep problems is important in young children to facilitate provision of appropriate interventions.
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Affiliation(s)
- Ann M. Reynolds
- Department of Pediatrics, University of Colorado
School of Medicine, Children's Hospital Colorado, Aurora, Colorado
| | - Gnakub N. Soke
- National Center on Birth Defects and Developmental
Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia;
and
| | - Katherine R. Sabourin
- Department of Pediatrics, University of Colorado
School of Medicine, Children's Hospital Colorado, Aurora, Colorado
| | - Susan Hepburn
- Department of Pediatrics, University of Colorado
School of Medicine, Children's Hospital Colorado, Aurora, Colorado
| | - Terry Katz
- Department of Pediatrics, University of Colorado
School of Medicine, Children's Hospital Colorado, Aurora, Colorado
| | - Lisa D. Wiggins
- National Center on Birth Defects and Developmental
Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia;
and
| | - Laura A. Schieve
- National Center on Birth Defects and Developmental
Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia;
and
| | - Susan E. Levy
- Department of Pediatrics, Perelman School of Medicine
at University of Pennsylvania, Children’s Hospital of Philadelphia,
Philadelphia, Pennsylvania
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23
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Subjective Assessment of Sleep in Infantile Autism: A Comparative Study. Behav Sci (Basel) 2019; 9:bs9020012. [PMID: 30678363 PMCID: PMC6406878 DOI: 10.3390/bs9020012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2018] [Revised: 01/17/2019] [Accepted: 01/18/2019] [Indexed: 11/16/2022] Open
Abstract
Sleep disturbances are very common in children with autism; it is for this reason that instruments that facilitate their evaluation are necessary. Objectives: Perform sleep assessment from a subjective perspective in a group of children with primary autism and compare them with a control group, using the Sleep Habits in Children Survey (CSHQ), with the purpose of determining sleep disturbances according to the subscales used. Method: A prospective cross-sectional study was conducted in a group of 21 patients with primary autism. For the evaluation of sleep disturbances, we chose the CSHQ survey. The differences between the independent groups were calculated by applying a Mann–Whitney U test. Results: In the group of children with autism, higher values of the total scale were observed in comparison with the control group (p = 0.00) which It is congruent with a large sleep dysfunction. Significant differences were observed for all subscales (p = 0.00), with the exception of the subscale number 7. Conclusions: A high presence of sleep disturbances was observed in children with primary autism, with the exception of sleep breathing disorders, which did not show significant differences between the groups.
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24
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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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Sleep Problems and Their Correlates in Children with Autism Spectrum Disorder: An Indian Study. J Autism Dev Disord 2018; 49:1169-1181. [DOI: 10.1007/s10803-018-3820-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Empirical research evaluating the effects of non-traditional approaches to enhancing sleep in typical and clinical children and young people. Sleep Med Rev 2018; 39:69-81. [DOI: 10.1016/j.smrv.2017.07.004] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2017] [Revised: 07/12/2017] [Accepted: 07/18/2017] [Indexed: 12/20/2022]
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Johnson CR, Smith T, DeMand A, Lecavalier L, Evans V, Gurka M, Swiezy N, Bearss K, Scahill L. Exploring sleep quality of young children with autism spectrum disorder and disruptive behaviors. Sleep Med 2018; 44:61-66. [PMID: 29530371 PMCID: PMC5853135 DOI: 10.1016/j.sleep.2018.01.008] [Citation(s) in RCA: 67] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2017] [Revised: 01/17/2018] [Accepted: 01/18/2018] [Indexed: 12/12/2022]
Abstract
BACKGROUND AND PURPOSE Sleep disturbances in autism spectrum disorder (ASD) are common and may impair daytime functioning as well as add to parental burden. In this well characterized sample of young children with ASD and disruptive behaviors, we examine the association of age and IQ in sleep disturbances using the Child Sleep Habits Questionnaire modified for ASD (CSHQ-ASD). We also test whether children with poor sleep have greater daytime behavioral problems than those with better sleep. Finally, we examine whether parental stress is higher in children with greater disruptive behaviors and sleep disturbances. PARTICIPANTS AND METHODS One hundred and seventy-seven children with complete data out of 180 (mean age 4.7) with ASD participated in a randomized clinical trial. Parents completed the CSHQ-ASD and several other measures at study enrollment. The sample was divided into "poor sleepers" (upper quartile on the total score of the CSHQ-ASD) and "good sleepers" (lower quartile) for comparisons. Analyses were conducted to evaluate group differences on age, IQ, daytime disruptive behavior, social disability and parental stress. RESULTS The two groups of young children with ASD, good sleepers versus poor sleepers, were not different on age or cognitive level. Children in the poor sleeping group had significantly higher daytime behavioral problems including irritability, hyperactivity, social withdrawal and stereotypical behaviors. Parents in this group reported significantly higher levels of stress. CONCLUSIONS The finding of no age difference between good and poor sleepers in young children with ASD and disruptive behaviors suggests that sleep problems are unlikely to resolve as might be expected in typically developing children. Likewise, the good and poor sleepers did not significantly differ in IQ. These findings add strong support for the need to screen for sleep disturbances in all children with ASD, regardless of age and cognitive level. Poor sleepers exhibited significantly greater daytime behavioral problems and parents of children in this group reported significantly higher levels of stress. Above and beyond the co-occurring disruptive behavior, poor sleep quality appears to pose substantial additive burden on child and parents.
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Affiliation(s)
- Cynthia R Johnson
- University of Florida, Department of Clinical & Health Psychology, USA.
| | | | | | | | - Victoria Evans
- University of Florida, Department of Clinical & Health Psychology, USA
| | - Matthew Gurka
- University of Florida, Department of Clinical & Health Psychology, USA
| | | | - Karen Bearss
- Seattle Children's Hospital & University of Washington, USA
| | - Lawrence Scahill
- Marcus Autism Center, Children's Healthcare of Atlanta & Emory University, USA
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Köse S, Yılmaz H, Ocakoğlu FT, Özbaran NB. Sleep problems in children with autism spectrum disorder and intellectual disability without autism spectrum disorder. Sleep Med 2017; 40:69-77. [PMID: 29221782 DOI: 10.1016/j.sleep.2017.09.021] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2017] [Revised: 08/31/2017] [Accepted: 09/02/2017] [Indexed: 10/18/2022]
Abstract
OBJECTIVE The objective of this study was to evaluate the sleep problems and their correlations in children with autism spectrum disorder (ASD), intellectual disability without ASD (ID), and typically developing children (TDC). METHODS This study included 142 children (48 with ASD, 46 with ID, 48 with TDC) aged between 2 and 18 years old. Parents of the children completed the Childhood Sleep Habits Questionnaire (CSHQ) in order to evaluate sleep disturbances. The sociodemographic and clinical information were noted on a data form for each child. RESULTS The mean total score of CSHQ was 41.56, 47.89 and 51.78 respectively in TDC, ASD and ID groups. While the total CSHQ score was significantly lower in TDC, there was no significant difference between ID and ASD groups (p = 0.09). It was revealed that children having a neurodevelopmental disorder had a 2.8-fold increased risk of sleep disturbance, history of sleep disorder in the parents had a 3.1-fold increased risk, psychiatric comorbidity in the child had a 3.3-fold increased risk, and co-sleeping with parents had 13.1-fold increased risk. However, in the binary regression analysis, co-sleeping with parents and family history of sleep problems significantly increased the risk of sleep disturbance. CONCLUSION Sleep disturbances are more frequent in children with ASD and ID than TDC. Co-sleeping with parents and family history of sleep problems increase the risk of sleep disturbances. Thus, behavioral techniques especially focusing on co-sleeping problems and focusing on parents' sleep habits may improve the sleep disturbances in children with ID and ASD.
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Affiliation(s)
- Sezen Köse
- Ege University School of Medicine, Department of Child and Adolescent Psychiatry, Turkey
| | - Helin Yılmaz
- Ege University School of Medicine, Department of Child and Adolescent Psychiatry, Turkey.
| | - F Tuna Ocakoğlu
- Ege University School of Medicine, Department of Child and Adolescent Psychiatry, Turkey
| | - N Burcu Özbaran
- Ege University School of Medicine, Department of Child and Adolescent Psychiatry, Turkey
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Tian Y, Zhang ZC, Han J. Drosophila Studies on Autism Spectrum Disorders. Neurosci Bull 2017; 33:737-746. [PMID: 28795356 DOI: 10.1007/s12264-017-0166-6] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2017] [Accepted: 04/23/2017] [Indexed: 02/07/2023] Open
Abstract
In the past decade, numerous genes associated with autism spectrum disorders (ASDs) have been identified. These genes encode key regulators of synaptogenesis, synaptic function, and synaptic plasticity. Drosophila is a prominent model system for ASD studies to define novel genes linked to ASDs and decipher their molecular roles in synaptogenesis, synaptic function, synaptic plasticity, and neural circuit assembly and consolidation. Here, we review Drosophila studies on ASD genes that regulate synaptogenesis, synaptic function, and synaptic plasticity through modulating chromatin remodeling, transcription, protein synthesis and degradation, cytoskeleton dynamics, and synaptic scaffolding.
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Affiliation(s)
- Yao Tian
- Institute of Life Sciences, The Key Laboratory of Developmental Genes and Human Disease, Southeast University, Nanjing, 210096, China
| | - Zi Chao Zhang
- Institute of Life Sciences, The Key Laboratory of Developmental Genes and Human Disease, Southeast University, Nanjing, 210096, China
| | - Junhai Han
- Institute of Life Sciences, The Key Laboratory of Developmental Genes and Human Disease, Southeast University, Nanjing, 210096, China.
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Moore M, Evans V, Hanvey G, Johnson C. Assessment of Sleep in Children with Autism Spectrum Disorder. CHILDREN-BASEL 2017; 4:children4080072. [PMID: 28786962 PMCID: PMC5575594 DOI: 10.3390/children4080072] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/16/2017] [Revised: 07/23/2017] [Accepted: 08/02/2017] [Indexed: 01/30/2023]
Abstract
Sleep disturbances in children with autism spectrum disorder (ASD) are significantly more prevalent than found in typically developing (TD) children. Given the detrimental impact of poor sleep on cognitive, emotional, and behavioral functioning, it is imperative to screen and assess for sleep disturbances in this population. In this paper, we describe the screening and assessment process, as well as specific measures commonly used for assessing sleep in children with ASD. Advantages and limitations for use in children with ASD are discussed. While subjective measures, such as parent-report questionnaires and sleep diaries, are the most widely used, more objective measures such as actigraphy, polysomnography, and videosomnography provide additional valuable information for both diagnostic purposes and treatment planning. These objective measures, nonetheless, are limited by cost, availability, and feasibility of use with children with ASD. The current review provides an argument for the complementary uses of both subjective and objective measures of sleep specifically for use in children with ASD.
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Affiliation(s)
- Makeda Moore
- Department of Clinical & Health Psychology, University of Florida, 1225 Center Dr., Room 3130, P.O. Box 100165, Gainesville, FL 32610, USA.
| | - Victoria Evans
- Department of Clinical & Health Psychology, University of Florida, 1225 Center Dr., Room 3130, P.O. Box 100165, Gainesville, FL 32610, USA.
| | - Grace Hanvey
- Department of Clinical & Health Psychology, University of Florida, 1225 Center Dr., Room 3130, P.O. Box 100165, Gainesville, FL 32610, USA.
| | - Cynthia Johnson
- Department of Clinical & Health Psychology, University of Florida, 1225 Center Dr., Room 3130, P.O. Box 100165, Gainesville, FL 32610, USA.
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Becker SP, Isaacson PA, Servera M, Sáez B, Burns GL. Mother-father agreement and one-year stability of children's sleep functioning. Sleep Med 2017; 36:29-34. [PMID: 28735917 DOI: 10.1016/j.sleep.2017.04.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2017] [Revised: 04/06/2017] [Accepted: 04/16/2017] [Indexed: 11/17/2022]
Abstract
OBJECTIVES To (1) evaluate mother-father agreement of total sleep problems and specific sleep problem domains and (2) examine the one-year stability of children's sleep functioning, including cross-rater stability. METHODS A community-based sample of 519 children (51% boys) in Spain was assessed in third grade and again 1 year later. At each time-point, both mothers and fathers provided ratings of sleep functioning using the Children's Sleep Habits Questionnaire (CSHQ). RESULTS Sleep scores did not differ between mothers' and fathers' ratings. Cross-sectionally (at both time-points) and longitudinally (from grade 3 to grade 4), strong agreement was found between mothers' and fathers' ratings of total sleep problems, sleep habits, night wakings, and parasomnias. Lower agreement was found for daytime sleepiness and sleep onset delay. There was large effect size stability for both mothers' and fathers' ratings over the one-year period on the total sleep disturbance scale and most sleep subscales. CONCLUSIONS This study provides the first evidence of strong mother-father agreement on subjective ratings of children's sleep functioning, both concurrently and over a one-year period, for overall sleep problems and certain sleep domains. However, agreement was far from identical, and further studies are needed to evaluate reasons for discrepancy and whether mother-father discrepancy in sleep functioning predicts children's functioning. More studies are needed that systematically include both mothers' and fathers' perspectives regarding children's sleep.
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Affiliation(s)
- Stephen P Becker
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA; Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA.
| | - Paul A Isaacson
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Mateu Servera
- Research Institute on Health Sciences, University of the Balearic Islands, Palma, Spain
| | - Belén Sáez
- Research Institute on Health Sciences, University of the Balearic Islands, Palma, Spain
| | - G Leonard Burns
- Department of Psychology, Washington State University, Pullman, WA, USA
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Bonuck KA, Goodlin-Jones BL, Schechter C, Owens J. Modified Children's sleep habits questionnaire for behavioral sleep problems: A validation study. Sleep Health 2017; 3:136-141. [PMID: 28526249 DOI: 10.1016/j.sleh.2017.03.009] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2016] [Revised: 03/26/2017] [Accepted: 03/27/2017] [Indexed: 01/26/2023]
Abstract
OBJECTIVES Behavioral sleep problems (BSPs) are prevalent and consequential in young children. There is a need for screening tools that identify BSPs-which are often rooted in the parent-young child relationship-and typically respond to behavior management. Such a tool would increase capacity to identify and treat BSPs. We sought to validate a short-form version of the widely used Children's Sleep Habits Questionnaire (SF-CSHQ) that omitted items that would not be responsive to behavioral strategies. METHODS The original 33-item CSHQ elicits parent report of "behaviorally-based" and "medically-based" sleep items (eg, parasomnias and sleep disordered breathing). We conducted analyses to develop a SF-CSHQ that excludes its "medically-based" items, to determine (a) the SF-CSHQ threshold score corresponding to the full CSHQ clinical cut-off score (≥41), and (b) preliminary validity of this SF-CSHQ. Data were re-analyzed from the original data that established the CSHQ's psychometric properties in 4-10 year olds, and a second dataset that established its validity in 24-66 month olds. RESULTS In both datasets, a threshold score of 30 had correlations of 0.90-0.94 with the original cut-off. This 23-item SF-CSHQ cut-off functioned as well as the full CSHQ cut-off in discriminating between children with vs without a parent-reported behavioral sleep problem, and with vs without prolonged sleep latency (per actigraphy). CONCLUSION We established preliminary validity of modified version of the widely-used CSHQ. This SF-CSHQ may be useful for widening screening and first-line guidance for behavioral sleep problems in young children, among professionals who are not sleep medicine specialists.
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Affiliation(s)
- Karen A Bonuck
- Department of Family and Social Medicine, Albert Einstein College of Medicine, 1300 Morris Park Avenue, Bronx, NY 10461.
| | - Beth L Goodlin-Jones
- Department of Psychiatry & Behavioral Sciences, UC Davis MIND Institute, Sacramento, CA 95817
| | - Clyde Schechter
- Department of Family and Social Medicine, Albert Einstein College of Medicine, 1300 Morris Park Avenue, Bronx, NY 10461
| | - Judith Owens
- Department of Neurology, Harvard Medical School, 25 Shattuck Street, Boston, MA 02115
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Levin A, Scher A. Sleep Problems in Young Children with Autism Spectrum Disorders: A Study of Parenting Stress, Mothers' Sleep-Related Cognitions, and Bedtime Behaviors. CNS Neurosci Ther 2016; 22:921-927. [PMID: 27753226 DOI: 10.1111/cns.12651] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2016] [Revised: 09/16/2016] [Accepted: 09/20/2016] [Indexed: 11/26/2022] Open
Abstract
INTRODUCTION Disrupted sleep is common among children with autism spectrum disorder (ASD). AIMS Our goal was to (1) examine the contribution of sleep problems to parenting stress in children with ASD as compared to typically developing (TD) and (2) to address maternal sleep-related cognitions and behaviors in both groups. METHODS Mothers of 34 ASD (mean age = 39.29 months, SD = 5.22) and 31 TD children (mean age = 36.23 months, SD = 5.75) completed questionnaires measuring maternal stress, sleep-related cognitions and settling to sleep interactions, and the child's sleep problems; mothers in the ASD group completed a symptom severity questionnaire. RESULTS In accord with previous research, children with ASD had more sleep problems compared to the TD group, and their mothers reported higher levels of stress. In the ASD group, sleep problems contributed to the experience of maternal stress, over and above symptom severity. Across groups, maternal cognitions and bedtime interactions were significantly associated with children's sleep problems. CONCLUSION The results highlight the interplay between sleep-related cognitions, bedtime interactions, and sleep problems and underscore the contribution of disrupted sleep to mothers' experience of parenting stress. As sleep problems in ASD children are common, clinicians are advised to include sleep in consultations with parents.
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Affiliation(s)
- Anat Levin
- Department of Counseling and Human Development, University of Haifa, Haifa, Israel
| | - Anat Scher
- Department of Counseling and Human Development, University of Haifa, Haifa, Israel.
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McLay LLK, France K. Empirical research evaluating non-traditional approaches to managing sleep problems in children with autism. Dev Neurorehabil 2016; 19:123-34. [PMID: 24724691 DOI: 10.3109/17518423.2014.904452] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE This paper examines the efficacy of non-behavioural and non-pharmacological approaches to the treatment of sleep disturbance in individuals with autism spectrum disorder. METHODS A systematic search of electronic databases and reference lists identified eight studies that met inclusion criteria. Studies were evaluated according to (a) treatment used, (b) participants, (c) experimental design, (d) baseline measures, (e) dependent variables, (f) follow-up measures, (g) reliability and treatment integrity, (h) results and certainty of evidence and (i) implications for treatment. RESULTS Positive outcomes were reported for the use of massage therapy and vitamin supplements. Aromatherapy was reported to have no effect on sleep. No studies were found that examined other non-traditional treatment approaches, nor did any of the studies provide conclusive evidence. CONCLUSIONS The limited corpus of evidence and the methodological limitations suggests that the efficacy of non-traditional approaches to treatment of sleep problems in individuals with autism is yet to be demonstrated.
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Affiliation(s)
| | - Karyn France
- a School of Health Sciences, University of Canterbury , Christchurch , New Zealand
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35
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Prevalence of Diagnosed Sleep Disorders and Related Diagnostic and Surgical Procedures in Children with Autism Spectrum Disorders. J Dev Behav Pediatr 2016; 37:377-84. [PMID: 26982246 DOI: 10.1097/dbp.0000000000000248] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Sleep disorders are common and important comorbid conditions in children with autism spectrum disorder (ASD) and can contribute to cognitive and behavioral problems. Sleep-disordered breathing (SDB) is a diagnosable and treatable cause of behavioral problems in children. We aimed to quantify the relative risk for children with ASD versus controls of being diagnosed with sleep disorders including SDB and undergoing related diagnostic and surgical procedures. METHOD This retrospective case-cohort study included 48,762 children with ASD aged 2 to 18 years enrolled in the military health system (MHS) from 2000 to 2013. Children with ASD were matched 1:5 by birthdate, sex, and enrollment time to children without an ASD diagnosis. The MHS database was queried for International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) codes for sleep disorders or ICD-9-CM and Current Procedural Terminology codes for diagnostic and surgical procedures. Relative risks (RR) and 95% confidence intervals (CI) were determined with binary Poisson regression conditional on the match and adjusting for confounders. RESULTS Children with ASD were at higher risk of receiving any sleep disorder diagnosis (RR: 1.97 [95% CI, 1.91-2.02]) including SDB (RR: 1.96 [95% CI, 1.88-2.05]). Children with ASD also were at increased risk of undergoing polysomnography (RR: 3.74 [95% CI, 3.56-3.93]) and sleep disorder-related surgery (RR: 1.50 [95% CI, 1.46-1.54]). CONCLUSION Children with ASD are more likely to be given a sleep disorder diagnosis including SDB and are more likely to undergo related diagnostic and surgical procedures compared with controls without ASD.
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36
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Sleep Disturbances and Associated Factors in Chinese Children with Autism Spectrum Disorder: A Retrospective and Cross-Sectional Study. Child Psychiatry Hum Dev 2016; 47:248-58. [PMID: 26072264 DOI: 10.1007/s10578-015-0561-z] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Sleep disturbances in children with autism spectrum disorder (ASD) exist worldwide, but little is known about this issue in non-Western cultures. This study aimed to characterize sleep disturbances in Chinese children with ASD and to examine associated sociodemographic factors and emotional/behavioral problems. Parents of 60 Chinese children with ASD (aged 6-17 years) from Shenzhen, China completed the Children's Sleep Habits Questionnaire (CSHQ), and the Strengths and Difficulties Questionnaire (SDQ). Sleep disturbances were severe and common, with rates of 70.0% for overall disturbances and 15.0% (daytime sleepiness) to 40.0% (sleep duration) for specific domains. The severity and rate of sleep disturbances were higher compared to previous studies in typically developing children from the same region of China and American children with ASD, respectively. Further, there were significant correlations between most CSHQ and SDQ domains. Female gender, older parental age, higher hyperactivity, and poorer prosocial behavior were associated with increased overall sleep disturbances.
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Hirata I, Mohri I, Kato-Nishimura K, Tachibana M, Kuwada A, Kagitani-Shimono K, Ohno Y, Ozono K, Taniike M. Sleep problems are more frequent and associated with problematic behaviors in preschoolers with autism spectrum disorder. RESEARCH IN DEVELOPMENTAL DISABILITIES 2016; 49-50:86-99. [PMID: 26672680 DOI: 10.1016/j.ridd.2015.11.002] [Citation(s) in RCA: 58] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/06/2015] [Revised: 11/05/2015] [Accepted: 11/07/2015] [Indexed: 06/05/2023]
Abstract
BACKGROUND Children with autism spectrum disorder (ASD) often suffer from sleep problems that in turn correlate with behavioral problems. However, in Japan, there have been few studies of sleep problems in children with ASD. AIMS This study compared sleep problems in preschoolers from the community and preschoolers with ASD in Japan, and examined whether sleep problems were related to problematic behaviors in ASD preschoolers. METHODS AND PROCEDURES Sleep problems were assessed in 965 community and 193 ASD preschoolers using the Japanese Sleep Questionnaire for Preschoolers, which was developed to assess sleep problems in Japanese preschoolers. Behavioral problems were assessed in 107 ASD preschoolers using the Child Behavior Checklist. OUTCOMES AND RESULTS Compared with community preschoolers, ASD preschoolers experienced significantly more sleep problems, including obstructive sleep apnea and parasomnias. ASD preschoolers with sleep problems exhibited more behavioral problems than those without sleep problems. The severity of sleep problems, especially insomnia, was significantly correlated with behavioral problems in ASD preschoolers. CONCLUSIONS AND IMPLICATIONS The present study suggests that sleep problems, especially obstructive sleep apnea, are more common in ASD preschoolers than in community preschoolers. The study also shows that sleep problems, especially insomnia, are related to problematic behavior in ASD preschoolers.
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Affiliation(s)
- Ikuko Hirata
- Department of Pediatrics, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka 5650871, Japan
| | - Ikuko Mohri
- Department of Pediatrics, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka 5650871, Japan; Department of Child Development, United Graduate School of Child Development, Osaka University, 2-2 Yamadaoka, Suita, Osaka 5650871, Japan; Research Center for Children's Mental Development, United Graduate School of Child Development, Osaka University, 2-2 Yamadaoka, Suita, Osaka 5650871, Japan
| | - Kumi Kato-Nishimura
- Research Center for Children's Mental Development, United Graduate School of Child Development, Osaka University, 2-2 Yamadaoka, Suita, Osaka 5650871, Japan
| | - Masaya Tachibana
- Department of Child Development, United Graduate School of Child Development, Osaka University, 2-2 Yamadaoka, Suita, Osaka 5650871, Japan
| | - Ayano Kuwada
- Department of Child Development, United Graduate School of Child Development, Osaka University, 2-2 Yamadaoka, Suita, Osaka 5650871, Japan
| | - Kuriko Kagitani-Shimono
- Department of Pediatrics, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka 5650871, Japan; Department of Child Development, United Graduate School of Child Development, Osaka University, 2-2 Yamadaoka, Suita, Osaka 5650871, Japan
| | - Yuko Ohno
- Department of Health Sciences, Osaka University Graduate School of Medicine, 1-7 Yamadaoka, Suita, Osaka 5650871, Japan
| | - Keiichi Ozono
- Department of Pediatrics, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka 5650871, Japan
| | - Masako Taniike
- Department of Pediatrics, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka 5650871, Japan; Department of Child Development, United Graduate School of Child Development, Osaka University, 2-2 Yamadaoka, Suita, Osaka 5650871, Japan; Research Center for Children's Mental Development, United Graduate School of Child Development, Osaka University, 2-2 Yamadaoka, Suita, Osaka 5650871, Japan.
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Valicenti-McDermott M, Lawson K, Hottinger K, Seijo R, Schechtman M, Shulman L, Shinnar S. Parental Stress in Families of Children With Autism and Other Developmental Disabilities. J Child Neurol 2015; 30:1728-35. [PMID: 25862740 DOI: 10.1177/0883073815579705] [Citation(s) in RCA: 73] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2014] [Accepted: 03/04/2015] [Indexed: 01/09/2023]
Abstract
The level of parental stress in families of children with autism and other developmental disabilities and its association with child comorbid symptoms was studied in an ethnically diverse population, in a cross-sectional study with structured interview. The sample included 50 families of children with autism and 50 families of children with other developmental disabilities, matched by age/gender. Interview included Parenting Stress Index-Short Form, Gastrointestinal Questionnaire, Child Sleep Habits Questionnaire, and Aberrant Behavior Checklist. In this ethnically diverse sample, parental stress was significantly higher for the autism group and for non-Hispanic and US-born mothers. In both study groups, parental stress was related to child irritability. Parental stress was also related to gastrointestinal problems in the autism group and to sleep difficulties in the developmental disabilities group. Targeting child irritability may be particularly important in reducing parental stress for families of children with autism and other developmental disabilities.
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Affiliation(s)
- Maria Valicenti-McDermott
- Children's Evaluation and Rehabilitation Center, R. F. Kennedy Center of Excellence in Developmental Disabilities, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Katharine Lawson
- Children's Evaluation and Rehabilitation Center, R. F. Kennedy Center of Excellence in Developmental Disabilities, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Kathryn Hottinger
- Children's Evaluation and Rehabilitation Center, R. F. Kennedy Center of Excellence in Developmental Disabilities, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Rosa Seijo
- Children's Evaluation and Rehabilitation Center, R. F. Kennedy Center of Excellence in Developmental Disabilities, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Merryl Schechtman
- Children's Evaluation and Rehabilitation Center, R. F. Kennedy Center of Excellence in Developmental Disabilities, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Lisa Shulman
- Children's Evaluation and Rehabilitation Center, R. F. Kennedy Center of Excellence in Developmental Disabilities, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Shlomo Shinnar
- Children's Evaluation and Rehabilitation Center, R. F. Kennedy Center of Excellence in Developmental Disabilities, Albert Einstein College of Medicine, Bronx, NY, USA Saul R. Korey Department of Neurology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
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Ammanuel S, Chan WC, Adler DA, Lakshamanan BM, Gupta SS, Ewen JB, Johnston MV, Marcus CL, Naidu S, Kadam SD. Heightened Delta Power during Slow-Wave-Sleep in Patients with Rett Syndrome Associated with Poor Sleep Efficiency. PLoS One 2015; 10:e0138113. [PMID: 26444000 PMCID: PMC4596813 DOI: 10.1371/journal.pone.0138113] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2015] [Accepted: 08/25/2015] [Indexed: 12/31/2022] Open
Abstract
Sleep problems are commonly reported in Rett syndrome (RTT); however the electroencephalographic (EEG) biomarkers underlying sleep dysfunction are poorly understood. The aim of this study was to analyze the temporal evolution of quantitative EEG (qEEG) biomarkers in overnight EEGs recorded from girls (2-9 yrs. old) diagnosed with RTT using a non-traditional automated protocol. In this study, EEG spectral analysis identified high delta power cycles representing slow wave sleep (SWS) in 8-9h overnight sleep EEGs from the frontal, central and occipital leads (AP axis), comparing age-matched girls with and without RTT. Automated algorithms quantitated the area under the curve (AUC) within identified SWS cycles for each spectral frequency wave form. Both age-matched RTT and control EEGs showed similar increasing trends for recorded delta wave power in the EEG leads along the antero-posterior (AP). RTT EEGs had significantly fewer numbers of SWS sleep cycles; therefore, the overall time spent in SWS was also significantly lower in RTT. In contrast, the AUC for delta power within each SWS cycle was significantly heightened in RTT and remained heightened over consecutive cycles unlike control EEGs that showed an overnight decrement of delta power in consecutive cycles. Gamma wave power associated with these SWS cycles was similar to controls. However, the negative correlation of gamma power with age (r = -.59; p<0.01) detected in controls (2-5 yrs. vs. 6-9 yrs.) was lost in RTT. Poor % SWS (i.e., time spent in SWS overnight) in RTT was also driven by the younger age-group. Incidence of seizures in RTT was associated with significantly lower number of SWS cycles. Therefore, qEEG biomarkers of SWS in RTT evolved temporally and correlated significantly with clinical severity.
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Affiliation(s)
- Simon Ammanuel
- Neuroscience Laboratory, Hugo Moser Research Institute at Kennedy Krieger, Baltimore, Maryland, United States of America
- Department of Biomedical Engineering, Whiting School of Engineering,Johns Hopkins University, Baltimore, Maryland, United States of America
| | - Wesley C. Chan
- Neuroscience Laboratory, Hugo Moser Research Institute at Kennedy Krieger, Baltimore, Maryland, United States of America
- Department of Biomedical Engineering, Whiting School of Engineering,Johns Hopkins University, Baltimore, Maryland, United States of America
| | - Daniel A. Adler
- Neuroscience Laboratory, Hugo Moser Research Institute at Kennedy Krieger, Baltimore, Maryland, United States of America
- Department of Biomedical Engineering, Whiting School of Engineering,Johns Hopkins University, Baltimore, Maryland, United States of America
| | - Balaji M. Lakshamanan
- Department of Neurology and Developmental Medicine, Hugo Moser Research Institute at Kennedy Krieger, Baltimore, Maryland, United States of America
| | - Siddharth S. Gupta
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America
- Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America
| | - Joshua B. Ewen
- Department of Neurology and Developmental Medicine, Hugo Moser Research Institute at Kennedy Krieger, Baltimore, Maryland, United States of America
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America
| | - Michael V. Johnston
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America
- Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America
| | - Carole L. Marcus
- Sleep Center, The Children’s Hospital of Philadelphia, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania, United States of America
| | - Sakkubai Naidu
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America
- Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America
| | - Shilpa D. Kadam
- Neuroscience Laboratory, Hugo Moser Research Institute at Kennedy Krieger, Baltimore, Maryland, United States of America
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America
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Kelmanson IA. [Sleep disturbances in children with autistic spectrum disorders]. Zh Nevrol Psikhiatr Im S S Korsakova 2015; 115:102-107. [PMID: 26322364 DOI: 10.17116/jnevro201511541102-107] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
An association between sleep disorders and autistic spectrum disorders in children is considered. Characteristic variants of sleep disorders, including resistance to going to bed, frequent night awakenings, parasomnias, changes in sleep structure, primarily, the decrease in the percentage of rapid eye movement sleep, are presented. Attention is focused on the possibility of the direct relationship between sleep disturbance and the pathogenesis of autistic spectrum disorders. A role of pathological alterations in the production of neuromediators and morphological changes in the brain structures characteristic of autistic spectrum disorders in the genesis of sleep disorders in children is discussed. Possible non-pharmacological and pharmacological approaches are suggested.
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Affiliation(s)
- I A Kelmanson
- Raoul Wallenberg Institute of Special Education and Psychology of International University for Family and Child, St. Petersburg
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Singh K, Zimmerman AW. Sleep in Autism Spectrum Disorder and Attention Deficit Hyperactivity Disorder. Semin Pediatr Neurol 2015; 22:113-25. [PMID: 26072341 DOI: 10.1016/j.spen.2015.03.006] [Citation(s) in RCA: 75] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Sleep problems are common in autism spectrum disorder (ASD) and attention deficit hyperactivity disorder (ADHD). Sleep problems in these disorders may not only worsen daytime behaviors and core symptoms of ASD and ADHD but also contribute to parental stress levels. Therefore, the presence of sleep problems in ASD and ADHD requires prompt attention and management. This article is presented in 2 sections, one each for ASD and ADHD. First, a detailed literature review about the burden and prevalence of different types of sleep disorders is presented, followed by the pathophysiology and etiology of the sleep problems and evaluation and management of sleep disorders in ASD and ADHD.
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Affiliation(s)
- Kanwaljit Singh
- Department of Pediatrics, University of Massachusetts Medical School, Worcester, MA
| | - Andrew W Zimmerman
- Department of Pediatrics, University of Massachusetts Medical School, Worcester, MA.
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McGregor KK, Alper RM. Sleep Disorders as a Risk to Language Learning and Use. EBP BRIEFS 2015; 10:1-21. [PMID: 26664651 PMCID: PMC4672866] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
CLINICAL QUESTION Are people with sleep disorders at higher risk for language learning deficits than healthy sleepers? METHOD Scoping Review. STUDY SOURCES PubMed, Google Scholar, Trip Database, ClinicalTrials.gov. SEARCH TERMS sleep disorders AND language AND learning; sleep disorders language learning -deprivation -epilepsy; sleep disorders AND verbal learning. NUMBER OF INCLUDED STUDIES 36. PRIMARY RESULTS Children and adults with sleep disorders were at a higher risk for language problems than healthy sleepers. The language problems typically co-occurred with problems of attention and executive function (in children and adults), behavior (in children), and visual-spatial processing (in adults). Effects were typically small. Language problems seldom rose to a level of clinical concern but there were exceptions involving phonological deficits in children with sleep-disordered breathing and verbal memory deficits among adults with sleep-disordered breathing or idiopathic REM sleep behavior disorder. CONCLUSIONS Case history interviews should include questions about limited sleep, poor-quality sleep, snoring, and excessive daytime sleepiness. Medical referrals for clients with suspected sleep disorders are prudent.
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Sleep differences among children with autism spectrum disorders and typically developing peers: a meta-analysis. J Dev Behav Pediatr 2015; 36:166-77. [PMID: 25741949 DOI: 10.1097/dbp.0000000000000140] [Citation(s) in RCA: 112] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
OBJECTIVE Sleep problems such as difficulties in sleep initiation, nighttime awakening, and shortened sleep time are often subjectively reported in children with autism spectrum disorder (ASD). However, results of objective studies have been mixed. Our goal was to evaluate the existing data from objective measures using a systematic approach to identify and describe the differences in sleep parameters by comparing total sleep time (TST), sleep latency (SL), and sleep efficiency (SE) in children with ASD with those of typically developing (TD) peers. METHODS Studies that used objective measures such as actigraphy or polysomnography (PSG) to describe the sleep parameters of TST, SL, and SE in children with ASD compared with children with TD were identified. A meta-analysis was performed for the 10 studies that met inclusion criteria with evaluation of differences in means using random effects models. A total of 343 children with ASD and 221 children with TD were included. Assessments for sources of heterogeneity and publication bias were undertaken. RESULTS TST for children with ASD was on average 32.8 minutes less per day (95% confidence interval [CI]: 16.6-49.0 minutes) than their TD peers. Average SL was 10.9 minutes longer (95% CI: 6.7-15.0 minutes), and average SE was 1.9% less (95% CI: 0.7%-3.1%) than their TD peers. Notable heterogeneity was found within studies for TST, and mild heterogeneity was found for SE. Concurrent intellectual disability was a moderator of TST. Children with ASD and normal intelligence had a small and nonsignificant decrease in TST as compared with TD peers, whereas those with ASD and intellectual disability (ID) had a significant decrease in TST as compared with TD peers. The magnitude of the difference in mean SL and SE increased as compared with TD peers as age increased. Studies that used PSG and those that did not include children on medications were more likely to report mean decreases in SE. CONCLUSIONS Children with ASD have small but measurable objective differences in their sleep parameters that are consistent with subjective reporting. Children with ASD have shorter TST, longer SL periods, and decreased SE as compared with TD peers. Concurrent ID, medication use, method of data collection, and age of subjects significantly moderated these results. The decrease in TST in children with ASD and normal intelligence was not significant as compared with TD peers, suggesting that ID may help explain the shortened TST in children with ASD.
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Allen SL, Smith IM, Duku E, Vaillancourt T, Szatmari P, Bryson S, Fombonne E, Volden J, Waddell C, Zwaigenbaum L, Roberts W, Mirenda P, Bennett T, Elsabbagh M, Georgiades S. Behavioral Pediatrics Feeding Assessment Scale in Young Children With Autism Spectrum Disorder: Psychometrics and Associations With Child and Parent Variables. J Pediatr Psychol 2015; 40:581-90. [PMID: 25725217 DOI: 10.1093/jpepsy/jsv006] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2014] [Accepted: 01/11/2015] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE The factor structure and validity of the Behavioral Pediatrics Feeding Assessment Scale (BPFAS; Crist & Napier-Phillips, 2001) were examined in preschoolers with autism spectrum disorder (ASD). METHODS Confirmatory factor analysis was used to examine the original BPFAS five-factor model, the fit of each latent variable, and a rival one-factor model. None of the models was adequate, thus a categorical exploratory factor analysis (CEFA) was conducted. Correlations were used to examine relations between the BPFAS and concurrent variables of interest. RESULTS The CEFA identified an acceptable three-factor model. Correlational analyses indicated that feeding problems were positively related to parent-reported autism symptoms, behavior problems, sleep problems, and parenting stress, but largely unrelated to performance-based indices of autism symptom severity, language, and cognitive abilities, as well as child age. CONCLUSION These results provide evidence supporting the use of the identified BPFAS three-factor model for samples of young children with ASD.
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Affiliation(s)
- Stephanie L Allen
- Dalhousie University, IWK Health Centre, McMaster University, University of Ottawa, University of Toronto, Oregon Health and Sciences University, University of Alberta, Simon Fraser University, University of British Columbia, and McGill University
| | - Isabel M Smith
- Dalhousie University, IWK Health Centre, McMaster University, University of Ottawa, University of Toronto, Oregon Health and Sciences University, University of Alberta, Simon Fraser University, University of British Columbia, and McGill University Dalhousie University, IWK Health Centre, McMaster University, University of Ottawa, University of Toronto, Oregon Health and Sciences University, University of Alberta, Simon Fraser University, University of British Columbia, and McGill University
| | - Eric Duku
- Dalhousie University, IWK Health Centre, McMaster University, University of Ottawa, University of Toronto, Oregon Health and Sciences University, University of Alberta, Simon Fraser University, University of British Columbia, and McGill University
| | - Tracy Vaillancourt
- Dalhousie University, IWK Health Centre, McMaster University, University of Ottawa, University of Toronto, Oregon Health and Sciences University, University of Alberta, Simon Fraser University, University of British Columbia, and McGill University
| | - Peter Szatmari
- Dalhousie University, IWK Health Centre, McMaster University, University of Ottawa, University of Toronto, Oregon Health and Sciences University, University of Alberta, Simon Fraser University, University of British Columbia, and McGill University
| | - Susan Bryson
- Dalhousie University, IWK Health Centre, McMaster University, University of Ottawa, University of Toronto, Oregon Health and Sciences University, University of Alberta, Simon Fraser University, University of British Columbia, and McGill University Dalhousie University, IWK Health Centre, McMaster University, University of Ottawa, University of Toronto, Oregon Health and Sciences University, University of Alberta, Simon Fraser University, University of British Columbia, and McGill University
| | - Eric Fombonne
- Dalhousie University, IWK Health Centre, McMaster University, University of Ottawa, University of Toronto, Oregon Health and Sciences University, University of Alberta, Simon Fraser University, University of British Columbia, and McGill University
| | - Joanne Volden
- Dalhousie University, IWK Health Centre, McMaster University, University of Ottawa, University of Toronto, Oregon Health and Sciences University, University of Alberta, Simon Fraser University, University of British Columbia, and McGill University
| | - Charlotte Waddell
- Dalhousie University, IWK Health Centre, McMaster University, University of Ottawa, University of Toronto, Oregon Health and Sciences University, University of Alberta, Simon Fraser University, University of British Columbia, and McGill University
| | - Lonnie Zwaigenbaum
- Dalhousie University, IWK Health Centre, McMaster University, University of Ottawa, University of Toronto, Oregon Health and Sciences University, University of Alberta, Simon Fraser University, University of British Columbia, and McGill University
| | - Wendy Roberts
- Dalhousie University, IWK Health Centre, McMaster University, University of Ottawa, University of Toronto, Oregon Health and Sciences University, University of Alberta, Simon Fraser University, University of British Columbia, and McGill University
| | - Pat Mirenda
- Dalhousie University, IWK Health Centre, McMaster University, University of Ottawa, University of Toronto, Oregon Health and Sciences University, University of Alberta, Simon Fraser University, University of British Columbia, and McGill University
| | - Teresa Bennett
- Dalhousie University, IWK Health Centre, McMaster University, University of Ottawa, University of Toronto, Oregon Health and Sciences University, University of Alberta, Simon Fraser University, University of British Columbia, and McGill University
| | - Mayada Elsabbagh
- Dalhousie University, IWK Health Centre, McMaster University, University of Ottawa, University of Toronto, Oregon Health and Sciences University, University of Alberta, Simon Fraser University, University of British Columbia, and McGill University
| | - Stelios Georgiades
- Dalhousie University, IWK Health Centre, McMaster University, University of Ottawa, University of Toronto, Oregon Health and Sciences University, University of Alberta, Simon Fraser University, University of British Columbia, and McGill University
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Tordjman S, Davlantis KS, Georgieff N, Geoffray MM, Speranza M, Anderson GM, Xavier J, Botbol M, Oriol C, Bellissant E, Vernay-Leconte J, Fougerou C, Hespel A, Tavenard A, Cohen D, Kermarrec S, Coulon N, Bonnot O, Dawson G. Autism as a disorder of biological and behavioral rhythms: toward new therapeutic perspectives. Front Pediatr 2015; 3:1. [PMID: 25756039 PMCID: PMC4337381 DOI: 10.3389/fped.2015.00001] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2014] [Accepted: 01/05/2015] [Indexed: 12/13/2022] Open
Abstract
There is a growing interest in the role of biological and behavioral rhythms in typical and atypical development. Recent studies in cognitive and developmental psychology have highlighted the importance of rhythmicity and synchrony of motor, emotional, and interpersonal rhythms in early development of social communication. The synchronization of rhythms allows tuning and adaptation to the external environment. The role of melatonin in the ontogenetic establishment of circadian rhythms and the synchronization of the circadian clocks network suggests that this hormone might be also involved in the synchrony of motor, emotional, and interpersonal rhythms. Autism provides a challenging model of physiological and behavioral rhythm disturbances and their possible effects on the development of social communication impairments and repetitive behaviors and interests. This article situates autism as a disorder of biological and behavioral rhythms and reviews the recent literature on the role of rhythmicity and synchrony of rhythms in child development. Finally, the hypothesis is developed that an integrated approach focusing on biological, motor, emotional, and interpersonal rhythms may open interesting therapeutic perspectives for children with autism. More specifically, promising avenues are discussed for potential therapeutic benefits in autism spectrum disorder of melatonin combined with developmental behavioral interventions that emphasize synchrony, such as the Early Start Denver Model.
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Affiliation(s)
- Sylvie Tordjman
- Laboratoire Psychologie de la Perception, Université Paris Descartes, CNRS, UMR 8158 , Paris , France ; Pôle Hospitalo-Universitaire de Psychiatrie de l'Enfant et de l'Adolescent (PHUPEA), Centre Hospitalier Guillaume Régnier, Université de Rennes 1 , Rennes , France
| | - Katherine S Davlantis
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine , Durham, NC , USA
| | - Nicolas Georgieff
- Department of Child and Adolescent Psychiatry, Centre Hospitalier Le Vinatier , Lyon , France
| | - Marie-Maude Geoffray
- Department of Child and Adolescent Psychiatry, Centre Hospitalier Le Vinatier , Lyon , France
| | - Mario Speranza
- Department of Child and Adolescent Psychiatry, Centre Hospitalier de Versailles, Université de Versailles Saint-Quentin-en-Yvelines , Le Chensay , France
| | - George M Anderson
- Child Study Center, Yale University School of Medicine , New Haven, CT , USA
| | - Jean Xavier
- Department of Child and Adolescent Psychiatry, Assistance Publique - Hôpitaux de Paris, Groupe Hospitalier Pitié-Salpêtrière, CNRS FRE 2987, University Pierre and Marie Curie , Paris , France
| | - Michel Botbol
- Laboratoire Psychologie de la Perception, Université Paris Descartes, CNRS, UMR 8158 , Paris , France ; Service Hospitalo-Universitaire de Psychiatrie de l'Enfant et de l'Adolescent, CHU de Brest, Université de Bretagne Occidentale , Brest , France
| | - Cécile Oriol
- Pôle Hospitalo-Universitaire de Psychiatrie de l'Enfant et de l'Adolescent (PHUPEA), Centre Hospitalier Guillaume Régnier, Université de Rennes 1 , Rennes , France
| | - Eric Bellissant
- Clinical Investigation Center, INSERM CIC 0203, University Hospital, Rennes 1 University , Rennes , France ; Department of Clinical Pharmacology, University Hospital, Rennes 1 University , Rennes , France
| | - Julie Vernay-Leconte
- Pôle Hospitalo-Universitaire de Psychiatrie Adulte (PHUPA), Centre Hospitalier Guillaume Régnier, Université de Rennes 1 , Rennes , France
| | - Claire Fougerou
- Clinical Investigation Center, INSERM CIC 0203, University Hospital, Rennes 1 University , Rennes , France ; Department of Clinical Pharmacology, University Hospital, Rennes 1 University , Rennes , France
| | - Anne Hespel
- Clinical Investigation Center, INSERM CIC 0203, University Hospital, Rennes 1 University , Rennes , France ; Department of Clinical Pharmacology, University Hospital, Rennes 1 University , Rennes , France
| | - Aude Tavenard
- Clinical Investigation Center, INSERM CIC 0203, University Hospital, Rennes 1 University , Rennes , France ; Department of Clinical Pharmacology, University Hospital, Rennes 1 University , Rennes , France
| | - David Cohen
- Department of Child and Adolescent Psychiatry, Assistance Publique - Hôpitaux de Paris, Groupe Hospitalier Pitié-Salpêtrière, CNRS FRE 2987, University Pierre and Marie Curie , Paris , France
| | - Solenn Kermarrec
- Laboratoire Psychologie de la Perception, Université Paris Descartes, CNRS, UMR 8158 , Paris , France ; Pôle Hospitalo-Universitaire de Psychiatrie de l'Enfant et de l'Adolescent (PHUPEA), Centre Hospitalier Guillaume Régnier, Université de Rennes 1 , Rennes , France
| | - Nathalie Coulon
- Laboratoire Psychologie de la Perception, Université Paris Descartes, CNRS, UMR 8158 , Paris , France
| | - Olivier Bonnot
- Laboratoire Psychologie de la Perception, Université Paris Descartes, CNRS, UMR 8158 , Paris , France
| | - Geraldine Dawson
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine , Durham, NC , USA
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Picchioni D, Reith RM, Nadel JL, Smith CB. Sleep, plasticity and the pathophysiology of neurodevelopmental disorders: the potential roles of protein synthesis and other cellular processes. Brain Sci 2014; 4:150-201. [PMID: 24839550 PMCID: PMC4020186 DOI: 10.3390/brainsci4010150] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2013] [Revised: 02/26/2014] [Accepted: 03/07/2014] [Indexed: 12/28/2022] Open
Abstract
Sleep is important for neural plasticity, and plasticity underlies sleep-dependent memory consolidation. It is widely appreciated that protein synthesis plays an essential role in neural plasticity. Studies of sleep-dependent memory and sleep-dependent plasticity have begun to examine alterations in these functions in populations with neurological and psychiatric disorders. Such an approach acknowledges that disordered sleep may have functional consequences during wakefulness. Although neurodevelopmental disorders are not considered to be sleep disorders per se, recent data has revealed that sleep abnormalities are among the most prevalent and common symptoms and may contribute to the progression of these disorders. The main goal of this review is to highlight the role of disordered sleep in the pathology of neurodevelopmental disorders and to examine some potential mechanisms by which sleep-dependent plasticity may be altered. We will also briefly attempt to extend the same logic to the other end of the developmental spectrum and describe a potential role of disordered sleep in the pathology of neurodegenerative diseases. We conclude by discussing ongoing studies that might provide a more integrative approach to the study of sleep, plasticity, and neurodevelopmental disorders.
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Affiliation(s)
- Dante Picchioni
- Behavioral Biology Branch, Walter Reed Army Institute of Research, Silver Spring, MD 20910, USA; E-Mail:
- Advanced MRI Section, National Institute of Neurological Disorders and Stroke, Bethesda, MD 20892, USA
- Section on Neuroadaptation and Protein Metabolism, National Institute of Mental Health, Bethesda, MD 20892, USA; E-Mails: (R.M.R.); (J.L.N.)
| | - R. Michelle Reith
- Section on Neuroadaptation and Protein Metabolism, National Institute of Mental Health, Bethesda, MD 20892, USA; E-Mails: (R.M.R.); (J.L.N.)
| | - Jeffrey L. Nadel
- Section on Neuroadaptation and Protein Metabolism, National Institute of Mental Health, Bethesda, MD 20892, USA; E-Mails: (R.M.R.); (J.L.N.)
| | - Carolyn B. Smith
- Section on Neuroadaptation and Protein Metabolism, National Institute of Mental Health, Bethesda, MD 20892, USA; E-Mails: (R.M.R.); (J.L.N.)
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Humphreys JS, Gringras P, Blair PS, Scott N, Henderson J, Fleming PJ, Emond AM. Sleep patterns in children with autistic spectrum disorders: a prospective cohort study. Arch Dis Child 2014; 99:114-8. [PMID: 24061777 PMCID: PMC3913218 DOI: 10.1136/archdischild-2013-304083] [Citation(s) in RCA: 113] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2013] [Revised: 07/16/2013] [Accepted: 07/31/2013] [Indexed: 02/06/2023]
Abstract
OBJECTIVE To investigate longitudinal sleep patterns in children with autistic spectrum disorders (ASDs). STUDY DESIGN Prospective longitudinal study using Avon Longitudinal Study of Parents and Children, an English cohort born in 1991-1992. Parental reports of sleep duration were collected by questionnaires at 8 time points from 6 months to 11 years. Children with an ASD diagnosis at age 11 years (n=73) were identified from health and education records. RESULTS From aged 30 months to 11 years old, children with ASD slept for 17-43 min less each day than contemporary controls. No significant difference in total sleep duration was found in infancy, but from 30 months of age children with ASD slept less than their peers, a difference that remained significant after adjusting for sex, ethnicity, high parity and epilepsy. The reduction in total sleep was wholly due to changes in night rather than daytime sleep duration. Night-time sleep duration was shortened by later bedtimes and earlier waking times. Frequent waking (3 or more times a night) was also evident among the children with ASD from 30 months of age. Age-specific decreases of >1SD within individuals in sleep duration across adjacent time points was a predictor of ASD between 18 months and 30 months of age (p=0.04) and from 30 months to 42 months (p=0.02). CONCLUSIONS Sleep duration in children with ASD is reduced from 30 months of age and persists until adolescence.
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Moss AHB, Gordon JE, O’Connell A. Impact of Sleepwise: An Intervention for Youth with Developmental Disabilities and Sleep Disturbance. J Autism Dev Disord 2014; 44:1695-707. [DOI: 10.1007/s10803-014-2040-y] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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Relationship between children's sleep and mental health in mothers of children with and without autism. J Autism Dev Disord 2013; 43:956-63. [PMID: 22932769 DOI: 10.1007/s10803-012-1639-0] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
The study employed 90 children with autism spectrum disorders (ASDs) who were matched to 90 typically developing children on age, gender, and ethnicity. Using structural equation modeling, maternal sleep and maternal stress mediated the relationship between children's sleep and mothers' mental health for mothers of children with and without ASDs. Mothers of children with ASDs reported more problems related to children's sleep, their own sleep, greater stress, and poorer mental health; however, children's sleep and maternal sleep were more closely related to maternal stress for mothers of typically developing children. Implications of these findings and future directions for research are discussed.
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