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Peters SU, Shelton AR, Malow BA, Neul JL. A clinical-translational review of sleep problems in neurodevelopmental disabilities. J Neurodev Disord 2024; 16:41. [PMID: 39033100 PMCID: PMC11265033 DOI: 10.1186/s11689-024-09559-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Accepted: 07/05/2024] [Indexed: 07/23/2024] Open
Abstract
Sleep disorders are very common across neurodevelopmental disorders and place a large burden on affected children, adolescents, and their families. Sleep disturbances seem to involve a complex interplay of genetic, neurobiological, and medical/environmental factors in neurodevelopmental disorders. In this review, we discuss animal models of sleep problems and characterize their presence in two single gene disorders, Rett Syndrome, and Angelman Syndrome and two more commonly occurring neurodevelopmental disorders, Down Syndrome, and autism spectrum disorders. We then discuss strategies for novel methods of assessment using wearable sensors more broadly for neurodevelopmental disorders in general, including the importance of analytical validation. An increased understanding of the mechanistic contributions and potential biomarkers of disordered sleep may offer quantifiable targets for interventions that improve overall quality of life for affected individuals and their families.
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Affiliation(s)
- Sarika U Peters
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, USA.
- Vanderbilt Kennedy Center for Research on Human Development, One Magnolia Circle, Room 404B, Nashville, TN, 37203, USA.
| | - Althea Robinson Shelton
- Vanderbilt Kennedy Center for Research on Human Development, One Magnolia Circle, Room 404B, Nashville, TN, 37203, USA
- Department of Neurology, Vanderbilt University Medical Center, Nashville, USA
| | - Beth A Malow
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, USA
- Vanderbilt Kennedy Center for Research on Human Development, One Magnolia Circle, Room 404B, Nashville, TN, 37203, USA
- Department of Neurology, Vanderbilt University Medical Center, Nashville, USA
| | - Jeffrey L Neul
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, USA
- Vanderbilt Kennedy Center for Research on Human Development, One Magnolia Circle, Room 404B, Nashville, TN, 37203, USA
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Sadikova E, Soland J, Menezes M, Mazurek M. Impact of adverse childhood experiences and family resilience on sleep duration in autistic children. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2024:13623613241235880. [PMID: 38807297 DOI: 10.1177/13623613241235880] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2024]
Abstract
LAY ABSTRACT Autistic children are more likely to have sleep difficulties and to experience adverse childhood experiences. Adverse childhood experiences can include parental divorce, bullying, or witnessing violence. We also know that children in families who are resilient (e.g. families who are connected, work together, and help each other) are less impacted by adverse childhood experiences. Our study examined whether there was a relationship between adverse childhood experiences and sleep duration in autistic children. We also wanted to find out whether family resilience protects from the negative impact of adverse childhood experiences on sleep duration. We used data from 3247 parent surveys about their children that we got from the National Survey of Children's Health. We found that children with adverse childhood experiences are more likely to get less sleep. We also found that children with resilient families were more likely to get more sleep. Our results show that family resilience helps weaken the relationship between adverse childhood experiences and sleep, so it is important to help families build resilience.
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Gernert CC, Falter-Wagner CM, Noreika V, Jachs B, Jassim N, Gibbs K, Streicher J, Betts H, Bekinschtein TA. Stress in autism (STREAM): A study protocol on the role of circadian activity, sleep quality and sensory reactivity. PLoS One 2024; 19:e0303209. [PMID: 38768146 PMCID: PMC11104633 DOI: 10.1371/journal.pone.0303209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2023] [Accepted: 04/21/2024] [Indexed: 05/22/2024] Open
Abstract
Mental health issues are markedly increased in individuals with autism, making it the number one research priority by stakeholders. There is a crucial need to use personalized approaches to understand the underpinnings of mental illness in autism and consequently, to address individual needs. Based on the risk factors identified in typical mental research, we propose the following themes central to mental health issues in autism: sleep difficulties and stress. Indeed, the prevalence of manifold circadian disruptions and sleep difficulties in autism, alongside stress related to sensory overload, forms an integral part of autistic symptomatology. This proof-of-concept study protocol outlines an innovative, individualised approach towards investigating the interrelationships between stress indices, sleep and circadian activation patterns, and sensory sensitivity in autism. Embracing an individualized methodology, we aim to collect 14 days of data per participant from 20 individuals with autism diagnoses and 20 without. Participants' sleep will be monitored using wearable EEG headbands and a sleep diary. Diurnal tracking of heart rate and electrodermal activity through wearables will serve as proxies of stress. Those objective data will be synchronized with subjective experience traces collected throughout the day using the Temporal Experience Tracing (TET) method. TET facilitates the quantification of relevant aspects of individual experience states, such as stress or sensory sensitivities, by providing a continuous multidimensional description of subjective experiences. Capturing the dynamics of subjective experiences phase-locked to neural and physiological proxies both between and within individuals, this approach has the potential to contribute to our understanding of critical issues in autism, including sleep problems, sensory reactivity and stress. The planned strives to provide a pathway towards developing a more nuanced and individualized approach to addressing mental health in autism.
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Affiliation(s)
- Clara C. Gernert
- Department of Psychiatry and Psychotherapy, LMU University Hospital, LMU Munich, Munich, Germany
- Consciousness and Cognition Lab, Department of Psychology, University of Cambridge, Cambridge, United Kingdom
| | | | - Valdas Noreika
- Consciousness and Cognition Lab, Department of Psychology, University of Cambridge, Cambridge, United Kingdom
- Department of Psychology, School of Biological and Behavioural Sciences, Queen Mary University of London, London, United Kingdom
| | - Barbara Jachs
- Consciousness and Cognition Lab, Department of Psychology, University of Cambridge, Cambridge, United Kingdom
| | - Nazia Jassim
- Autism Research Centre, Department of Psychiatry, University of Cambridge, Cambridge, United Kingdom
- Prediction and Learning Lab, Department of Psychology, University of Cambridge, Cambridge, United Kingdom
| | | | - Joaquim Streicher
- Consciousness and Cognition Lab, Department of Psychology, University of Cambridge, Cambridge, United Kingdom
| | - Hannah Betts
- Consciousness and Cognition Lab, Department of Psychology, University of Cambridge, Cambridge, United Kingdom
| | - Tristan A. Bekinschtein
- Consciousness and Cognition Lab, Department of Psychology, University of Cambridge, Cambridge, United Kingdom
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Guner N, Hayton JA. Parental and Child Sleep: Children with Vision Impairment, Autistic Children, and Children with Comorbid Vision Impairment and Autism. Brain Sci 2024; 14:485. [PMID: 38790463 PMCID: PMC11119615 DOI: 10.3390/brainsci14050485] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2024] [Revised: 05/08/2024] [Accepted: 05/09/2024] [Indexed: 05/26/2024] Open
Abstract
BACKGROUND Parents report associations between children's sleep disturbances and behaviors. Children with neurodevelopmental conditions (e.g., Williams Syndrome and autism) are consistently reported to experience increased sleeping problems. Sleep in children with vision impairment and children with a dual diagnosis of vision impairment and autism remains understudied. METHODS Our exploratory study compared sleep profiles in 52 children (aged 4-12 years) and their parents (n = 37), across four groups: children with vision impairment (VI; n = 9), autism (n = 10), comorbid vision impairment + autism (n = 6), and typically developing children (n = 27). Childhood sleep was measured using the parental report Childhood Sleep Habits Questionnaire and sleep diaries. Children's cognitive functioning was measured using digit span, semantic, and phonemic verbal fluency measures. Parental sleep was measured via the Pittsburgh Sleep Quality Index and Epworth Sleepiness Scale. RESULTS Clinically disordered sleep was reported in all child groups (p ≤ 0.001), particularly children with VI + autism. Age, not sleep quality/quantity, predicted cognitive task performance in TD and autistic groups, but not in VI and VI + autism groups. The child's diagnosis affected parental sleep, particularly in children with a dual diagnosis of VI + autism. CONCLUSIONS All participants experienced problematic sleep to varying degrees. Those most affected were children and parents in the VI + autism group, suggesting that autism may be the main driver of sleep problems in our sample.
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Affiliation(s)
| | - Jessica Antonia Hayton
- Department of Psychology and Human Development, IOE, UCL’s Faculty of Education and Society, University College London, London WC1H 0AL, UK;
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Weissenkampen JD, Ghorai A, Fasolino M, Gehringer B, Rajan M, Dow HC, Sebro R, Rader DJ, Keenan BT, Almasy L, Brodkin ES, Bucan M. Sleep and Activity Patterns in Autism Spectrum Disorder. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2024:2024.05.02.592263. [PMID: 38766266 PMCID: PMC11100584 DOI: 10.1101/2024.05.02.592263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2024]
Abstract
Background Autism spectrum disorder (ASD) is a highly heritable and heterogeneous neurodevelopmental disorder characterized by impaired social interactions, repetitive behaviors, and a wide range of comorbidities. Between 44-83% of autistic individuals report sleep disturbances, which may share an underlying neurodevelopmental basis with ASD. Methods We recruited 382 ASD individuals and 223 of their family members to obtain quantitative ASD-related traits and wearable device-based accelerometer data spanning three consecutive weeks. An unbiased approach identifying traits associated with ASD was achieved by applying the elastic net machine learning algorithm with five-fold cross-validation on 6,878 days of data. The relationship between sleep and physical activity traits was examined through linear mixed-effects regressions using each night of data. Results This analysis yielded 59 out of 242 actimetry measures associated with ASD status in the training set, which were validated in a test set (AUC: 0.777). For several of these traits (e.g. total light physical activity), the day-to-day variability, in addition to the mean, was associated with ASD. Individuals with ASD were found to have a stronger correlation between physical activity and sleep, where less physical activity decreased their sleep more significantly than that of their non-ASD relatives. Conclusions The average duration of sleep/physical activity and the variation in the average duration of sleep/physical activity strongly predict ASD status. Physical activity measures were correlated with sleep quality, traits, and regularity, with ASD individuals having stronger correlations. Interventional studies are warranted to investigate whether improvements in both sleep and increased physical activity may improve the core symptoms of ASD.
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Kim H, Kim JH, Yi JH, Kim JY, Solmi M, Cortese S, Smith L, Koyanagi A, Shin JI, Cheon KA, Fusar-Poli P. Correlations between sleep problems, core symptoms, and behavioral problems in children and adolescents with autism spectrum disorder: a systematic review and meta-analysis. Eur Child Adolesc Psychiatry 2024; 33:1539-1549. [PMID: 37477722 PMCID: PMC11098879 DOI: 10.1007/s00787-023-02253-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Accepted: 06/21/2023] [Indexed: 07/22/2023]
Abstract
Children and adolescents with autism spectrum disorder (ASD) experience various sleep problems. Sleep problems co-occur in a bidirectional relationship with ASD core symptoms and behavioral problems. However, studies on how these three factors are intricately linked to each other are limited. This meta-analysis examined the differential relationship between specific sleep problems, core symptoms, and behavioral problems in this population. This study was registered in PROSPERO (CRD42022339695). We systematically searched the PubMed/MEDLINE, Web of Science, and Scopus databases from inception to April 27, 2022. Observational studies that reported correlations between measures of sleep problems, ASD core symptoms, or ASD behavioral problems were included, and participants aged 18 years or below were enrolled. The correlation coefficient (r) was assessed as the primary effect metric. Total 22 cross-sectional studies were included, which comprised 2655 participants (mean age = 6.60 years old; mean percentage of boys = 80.64%). We found correlations between total sleep problems and total core symptoms (r 0.293 [95% confidence interval - 0.095 to 0.604]), total sleep problems and total behavioral problems (r 0.429 [0.299-0.544]), and total core symptoms and total behavioral problems (r - 0.050 [- 0.177 to 0.079]) and identified statistically significant correlations between specific components of sleep problems, ASD core symptoms, and ASD behavioral problems. Each specific sleep problem showed a unique association with core symptoms and behavioral problems. Sleep problems in ASD should be explored in detail, and the closely linked core symptoms and behavioral problems should be common therapeutic targets.
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Affiliation(s)
- Heeyeon Kim
- Department of Psychiatry, Yongin Severance Hospital, Yonsei University College of Medicine, Yongin, Republic of Korea
- Institute of Behavioral Science in Medicine, Yonsei University College of Medicine, Yonsei University Health System, Seoul, Republic of Korea
| | - Jae Han Kim
- Yonsei University College of Medicine, Severance Hospital, Yonsei University Health System, Seoul, Republic of Korea
| | - Ju Hyeon Yi
- Yonsei University College of Medicine, Severance Hospital, Yonsei University Health System, Seoul, Republic of Korea
| | - Jong Yeob Kim
- Yonsei University College of Medicine, Severance Hospital, Yonsei University Health System, Seoul, Republic of Korea
| | - Marco Solmi
- Department of Psychiatry, University of Ottawa, Ottawa, ON, Canada
- Department of Mental Health, The Ottawa Hospital, Ottawa, ON, Canada
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON, Canada
- Department of Child and Adolescent Psychiatry, Charité Universitätsmedizin, Berlin, Germany
| | - Samuele Cortese
- Centre for Innovation in Mental Health, School of Psychology, Faculty of Environmental and Life Sciences, University of Southampton, Southampton, UK
- Clinical and Experimental Sciences (CNS and Psychiatry), Faculty of Medicine, University of Southampton, Southampton, UK
- Solent NHS Trust, Southampton, UK
- Hassenfeld Children's Hospital at NYU Langone, New York University Child Study Center, NY, New York City, USA
| | - Lee Smith
- Centre for Health, Performance, and Wellbeing, Anglia Ruskin University, Cambridge, CB1 1PT, UK
| | - Ai Koyanagi
- Parc Sanitari Sant Joan de Déu/CIBERSAM/ISCIII, Sant Boi de Llobregat, Barcelona, Spain
- ICREA, Pg. Lluis Companys 23, Barcelona, Spain
| | - Jae Il Shin
- Department of Pediatrics, Yonsei University College of Medicine, Yonsei-ro 50, Seodaemun-gu, C.P.O. Box 8044, Seoul, 03722, Republic of Korea.
- Severance Children's Hospital, Yonsei University Health System, Seoul, Republic of Korea.
- Severance Underwood Meta-research Center, Institute of Convergence Science, Yonsei University, Seoul, Republic of Korea.
| | - Keun-Ah Cheon
- Institute of Behavioral Science in Medicine, Yonsei University College of Medicine, Yonsei University Health System, Seoul, Republic of Korea.
- Department of Child and Adolescent Psychiatry, Yonsei University College of Medicine, Severance Hospital, Yonsei-ro 50, Seodaemun-gu, Seoul, 03722, Republic of Korea.
| | - Paolo Fusar-Poli
- Department of Psychosis Studies, Early Psychosis: Interventions and Clinical-Detection (EPIC) Lab, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
- OASIS Service, South London and Maudsley NHS Foundation Trust, London, UK
- National Institute for Health Research, Maudsley Biomedical Research Centre, London, UK
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Sidhu N, Wong Z, Bennett AE, Souders MC. Sleep Problems in Autism Spectrum Disorder. Pediatr Clin North Am 2024; 71:253-268. [PMID: 38423719 DOI: 10.1016/j.pcl.2024.01.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/02/2024]
Abstract
Sleep problems are common in children with autism spectrum disorder (ASD), with 40% to 80% prevalence. Common disorders include insomnia, parasomnias, and circadian rhythm sleep-wake disorders. These problems have a multifactorial etiology and can both exacerbate and be exacerbated by core ASD symptoms. Sleep problems also impact the health and quality of life of both patients and their caregivers. All children with autism should be regularly screened for sleep problems and evaluated for co-occurring medical contributors. Behavioral interventions with caregiver training remain first-line treatment for sleep disorders in both neurotypical and neurodiverse youth.
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Affiliation(s)
- Navjot Sidhu
- Division of Developmental and Behavioral Pediatrics, The Children's Hospital of Philadelphia, 3550 Market Street, 3rd Floor, Philadelphia, PA 19104, USA
| | - Zoe Wong
- The Children's Hospital of Philadelphia, Center for Autism Research, Sidney Kimmel Medical College, Thomas Jefferson University
| | - Amanda E Bennett
- Division of Developmental and Behavioral Pediatrics, The Children's Hospital of Philadelphia, 3550 Market Street, 3rd Floor, Philadelphia, PA 19104, USA; The Children's Hospital of Philadelphia, Center for Autism Research, Sidney Kimmel Medical College, Thomas Jefferson University; Department of Pediatrics, The University of Pennsylvania Perelman School of Medicine; Autism Integrated Care Program, Division of Developmental and Behavioral Pediatrics, The Children's Hospital of Philadelphia, 3550 Market Street, 3rd Floor, Philadelphia, PA 19104, USA.
| | - Margaret C Souders
- The University of Pennsylvania School of Nursing, The Children's Hospital of Philadelphia
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Liang X, Haegele JA, Tse ACY, Li M, Zhang H, Zhao S, Li SX. The impact of the physical activity intervention on sleep in children and adolescents with autism spectrum disorder: A systematic review and meta-analysis. Sleep Med Rev 2024; 74:101913. [PMID: 38442500 DOI: 10.1016/j.smrv.2024.101913] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Revised: 02/14/2024] [Accepted: 02/16/2024] [Indexed: 03/07/2024]
Abstract
Pharmacological treatments (i.e., melatonin) and non-pharmacological therapies (e.g., parent-based sleep education programs and behavioural interventions) have been found to result in improved sleep in children and adolescents with autism spectrum disorder (ASD). However, there are several limitations to these treatment approaches, including concerns about the possible side-effects and safety, high-cost and uncertainties of long-term effects. Physical activity (PA) intervention is a promising behavioural intervention that has received increasing attention. However, the effects of PA intervention on sleep are still unclear in this clinical group. This study aimed to synthesize available empirical studies concerning the effects of PA interventions on sleep in children and adolescents with ASD. Following PRISMA guidelines, seven electronic databases: APA PsychInfo, CINAHL Ultimate, ERIC, MEDLINE, PubMed, SPORTDiscus, and Web of Science, were searched from inception to March 2023. Randomized controlled trials/quasi-experimental designs with comparison groups were included. Initially, 444 articles were identified, 13 articles underwent systematic review, and 8 studies with control groups and sufficient statistical data were selected for meta-analysis. Compared to no-treatment control groups, PA interventions had a large positive effect on parent-reported general sleep problems, night awakenings, sleep resistance, sleep duration and actigraphy-assessed sleep efficiency in children and adolescents with ASD.
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Affiliation(s)
- Xiao Liang
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong SAR, China.
| | - Justin A Haegele
- Department of Human Movement Sciences, Old Dominion University, Norfolk, USA
| | - Andy Choi-Yeung Tse
- Department of Health and Physical Education, The Education University of Hong Kong, Hong Kong SAR, China
| | - Minghui Li
- Faculty of Sports Science, Ningbo University, Ningbo, China
| | - Hui Zhang
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong SAR, China; Research Institute for Intelligent Wearable Systems, The Hong Kong Polytechnic University, Hong Kong SAR, China
| | - Shi Zhao
- School of Public Health, Tianjin Medical University, Tianjin, China; Tianjin Key Laboratory of Environment, Nutrition and Public Health, Tianjin Medical University, Tianjin, China; Key Laboratory of Prevention and Control of Major Diseases in the Population (MoE), Tianjin Medical University, Tianjin, China
| | - Shirley Xin Li
- Department of Psychology, University of Hong Kong, Hong Kong SAR, China; State Key Laboratory of Brain and Cognitive Sciences, University of Hong Kong, Hong Kong SAR, China
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Voci A, Mazzone L, De Stefano D, Valeriani M, Bruni O, Moavero R. Restless sleep disorder in a sample of children and adolescents with autism spectrum disorder: preliminary results from a case series. J Clin Sleep Med 2024; 20:427-432. [PMID: 37909101 PMCID: PMC11019215 DOI: 10.5664/jcsm.10902] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Revised: 10/27/2023] [Accepted: 10/27/2023] [Indexed: 11/02/2023]
Abstract
STUDY OBJECTIVES Sleep disorders are a frequent comorbidity among children with autism spectrum disorder (ASD). Among sleep-related issues of ASD, restless sleep is a common complaint. In recent years, restless sleep disorder (RSD) has been proposed as a new clinical entity, characterized by agitated sleep as its predominant manifestation. Despite the high prevalence of sleep disorders and data reporting restless sleep among ASD patients, to date no study has yet characterized RSD within patients with ASD. Therefore, the aim of our study was to assess the occurrence of RSD in a sample of children and adolescents with ASD through clinical and polysomnographic assessment. METHODS Children and adolescents with ASD ages 6-18 years were recruited for the study. Through parental interviews, patients with a suspected RSD were selected and offered diagnostic investigation by video-polysomnography and blood tests to assess martial balance. RESULTS Among the 129 participants included, 16 patients (12.4%) were found to have a suspected RSD. Only 6 (4.7%) underwent video-polysomnography due to lack of compliance or family refusal. In 6/6 participants examined, the disorder was confirmed by video-polysomnography movement analysis (total movement index ≥ 5 events/h) and ferritin values were found in the normal range. CONCLUSIONS RSD does not appear to be particularly frequent among patients with ASD and that of iron metabolism may not be the main factor implicated in the pathogenesis of RSD within this population. Additional evaluation is needed to confirm the result and further investigate the etiological mechanisms underlying the disorder. CITATION Voci A, Mazzone L, De Stefano D, Valeriani M, Bruni O, Moavero R. Restless sleep disorder in a sample of children and adolescents with autism spectrum disorder: preliminary results from a case series. J Clin Sleep Med. 2024;20(3):427-432.
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Affiliation(s)
- Alessandra Voci
- Child Neurology and Psychiatry Unit, Tor Vergata University of Rome, Italy
- Developmental Neurology Unit, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
| | - Luigi Mazzone
- Child Neurology and Psychiatry Unit, Tor Vergata University of Rome, Italy
| | - Donata De Stefano
- Developmental Neurology Unit, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
| | - Massimiliano Valeriani
- Developmental Neurology Unit, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
- Center for Sensory Motor Interaction, Aalborg University, Aalborg, Denmark
| | - Oliviero Bruni
- Department of Developmental and Social Psychology, Sapienza University, Rome, Italy
| | - Romina Moavero
- Child Neurology and Psychiatry Unit, Tor Vergata University of Rome, Italy
- Developmental Neurology Unit, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
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Avci D. Mental Health Problems Among Adolescents With Mild Intellectual Disability and Relation to Sleep Quality and Perceived Social Support: A Comparative Study. J Psychosoc Nurs Ment Health Serv 2024; 62:39-50. [PMID: 37646605 DOI: 10.3928/02793695-20230821-04] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/01/2023]
Abstract
The current cross-sectional study sought to determine the mental health problems of adolescents with mild intellectual disability (ID) and influencing factors. This study, which used a comparison group, was performed with 188 adolescents (91 with mild ID and 97 without ID) between January 2019 and June 2019 in Turkey. Data were collected using a Personal Information Form, the Strengths and Difficulties Questionnaire, Pittsburgh Sleep Quality Index, and Perceived Social Support Scale. Adolescents with mild ID were at higher risk for mental health problems compared to those without ID. According to linear regression analysis, sex, age, birth order, maternal age, parents' educational level, sleep quality, and perceived social support were statistically significant predictive factors of mental health problems in adolescents with mild ID. Results of this study indicate that adolescents with mild ID are at greater risk for mental health problems and that effective prevention/intervention strategies are needed. [Journal of Psychosocial Nursing and Mental Health Services, 62(3), 39-50.].
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11
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Garcia JM, Murray M, Brazendale K, Rice DJ, Fukuda D. Effects of a family judo program on sleep quality in youth with Autism Spectrum Disorder. Sleep Med 2024; 115:152-154. [PMID: 38367356 DOI: 10.1016/j.sleep.2023.11.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Accepted: 11/20/2023] [Indexed: 02/19/2024]
Abstract
OBJECTIVE The purpose of this study was to examine the effects of a family-based judo program on sleep quality in youth diagnosed with Autism Spectrum Disorder (ASD). METHODS Eighteen youth (13.17 years ± 3.76, 78% male) diagnosed with ASD participated in a 14-week family judo program. Sleep quality was assessed using the Actigraph GT9X accelerometer pre- and post-judo intervention. Non-parametric paired t-tests were conducted to examine changes in sleep quality variables. RESULTS There was a significant increase in sleep efficiency (p = .05), and a significant decrease in both sleep latency (p = .001) and wake after sleep onset (p = .02) following participation in the judo program. There were no changes in sleep duration observed in this sample (p = .83). CONCLUSION Participation in a family judo program may improve sleep quality in youth with ASD. More research is necessary to understand the mechanisms by which judo may improve sleep quality in youth with ASD.
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Affiliation(s)
- Jeanette M Garcia
- School of Sport Sciences, College of Applied Human Sciences, West Virginia University, Morgantown, WV, USA.
| | - Michelle Murray
- Department of Health Sciences, College of Health Professions and Sciences, University of Central Florida, Orlando, FL, USA
| | - Keith Brazendale
- Department of Health Sciences, College of Health Professions and Sciences, University of Central Florida, Orlando, FL, USA
| | - David J Rice
- School of Sport Sciences, College of Applied Human Sciences, West Virginia University, Morgantown, WV, USA
| | - David Fukuda
- School of Kinesiology and Physical Therapy, College of Health Professions and Sciences, University of Central Florida, Orlando, FL, USA
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12
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Tse ACY, Lee PH, Sit CHP, Poon ETC, Sun F, Pang CL, Cheng JCH. Comparing the Effectiveness of Physical Exercise Intervention and Melatonin Supplement in Improving Sleep Quality in Children with ASD. J Autism Dev Disord 2023:10.1007/s10803-023-06172-7. [PMID: 37950776 DOI: 10.1007/s10803-023-06172-7] [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: 10/26/2023] [Indexed: 11/13/2023]
Abstract
PURPOSE Previous studies have demonstrated that physical exercise can modulate the endogenous melatonin level in children with autism spectrum disorder (ASD) and improve their sleep quality. However, it remains unclear whether physical exercise or melatonin supplement, or a combination of both, is more effective in improving sleep quality in this population. The purpose of this study is to answer this research question by comparing the effectiveness of three types of interventions (physical exercise vs. melatonin supplement or a combination of both) in improving sleep quality in children with ASD. METHODS Sixty-two (62) children diagnosed with ASD were randomly assigned to one of four groups: cycling (n = 18), melatonin supplement (n = 14), a combination of both (n = 12), and placebo control group (n = 18). Four (4) sleep parameters (sleep efficiency, sleep onset latency, sleep duration, and wake after sleep onset) were assessed. RESULTS The results revealed a significant improvement in sleep efficiency, sleep onset latency, and sleep duration in all of the interventions, but not in the placebo control group. However, no significant group differences were found among the interventions (ps > .05). CONCLUSION Our findings suggest similar effectiveness of physical exercise and melatonin supplementation in improving sleep quality in children with ASD.
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Affiliation(s)
- Andy C Y Tse
- Department of Health and Physical Education, The Education University of Hong Kong, Rm D4-2/F-02, Block D4, 10 Lo Ping Road, Tai Po, N.T, Hong Kong, China.
| | - Paul H Lee
- Clinical Trial Unit, University of Southampton, Southampton, UK
| | - Cindy H P Sit
- Department of Sports Science and Physical Education, Chinese University of Hong Kong, Hong Kong, China
| | - Eric Tsz-Chun Poon
- Department of Sports Science and Physical Education, Chinese University of Hong Kong, Hong Kong, China
| | - F Sun
- Department of Health and Physical Education, The Education University of Hong Kong, Rm D4-2/F-02, Block D4, 10 Lo Ping Road, Tai Po, N.T, Hong Kong, China
| | - Chi-Ling Pang
- School of Education, John Hopkins University, Baltimore, USA
| | - James C H Cheng
- Department of Paediatrics and Adolescent Health, United Christian Hospital, Hong Kong, China
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13
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López-Zamora M, Cano-Villagrasa A, Cortés-Ramos A, Porcar-Gozalbo N. The Influence of Sleep Disorders on Neurobiological Structures and Cognitive Processes in Pediatric Population with ASD and Epilepsy: A Systematic Review. Eur J Investig Health Psychol Educ 2023; 13:2358-2372. [PMID: 37998056 PMCID: PMC10670909 DOI: 10.3390/ejihpe13110166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Revised: 10/18/2023] [Accepted: 10/23/2023] [Indexed: 11/25/2023] Open
Abstract
Autism Spectrum Disorder (ASD) and epilepsy are increasingly prevalent comorbidities in our society. These two disorders are often accompanied by other comorbidities, such as sleep disorders, significantly impacting the quality of life of individuals with ASD and epilepsy. To date, clinical approaches have primarily been descriptive in nature. Therefore, this study aimed to analyze the relationship between ASD, epilepsy, and sleep disorders, exploring neurobiological dysfunctions and cognitive alterations. A total of 22 scientific articles were selected using a systematic literature review following the criteria established using the PRISMA model. The selected articles were gathered from major databases: Medline, PubMed, PsycINFO, Google Scholar, and Web of Science. Inclusion criteria specified that study participants had an official diagnosis of ASD, the article precisely described the evaluation parameters used in the study participants, and individual characteristics of the sleep disorders of the study participants were specified. The results indicate, firstly, that the primary cause of sleep disorders in this population is directly linked to abnormal serotonin behaviors. Secondly, significant alterations in memory, attention, and hyperactivity were observed. In conclusion, sleep disorders negatively impact the quality of life and neurocognitive development of the pediatric population with ASD and epilepsy.
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Affiliation(s)
- Miguel López-Zamora
- Department of Developmental and Educational Psychology, University of Malaga, 29010 Malaga, Spain;
| | - Alejandro Cano-Villagrasa
- Faculty of Health Sciences, Universidad Internacional de Valencia, 46002 Valencia, Spain;
- Health Sciences PhD Program, Universidad Católica de Murcia UCAM, Campus de los Jerónimos n°135, Guadalupe, 30107 Murcia, Spain
| | - Antonio Cortés-Ramos
- Department of Developmental and Educational Psychology, Faculty of Educational and Sports Sciences of Melilla, University of Granada, 18071 Granada, Spain;
| | - Nadia Porcar-Gozalbo
- Faculty of Health Sciences, Universidad Internacional de Valencia, 46002 Valencia, Spain;
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14
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Liang X, Haegele JA, Healy S, Tse ACY, Qiu H, Zhao S, Li C. Age-Related Differences in Accelerometer-Assessed Physical Activity and Sleep Parameters Among Children and Adolescents With and Without Autism Spectrum Disorder: A Meta-Analysis. JAMA Netw Open 2023; 6:e2336129. [PMID: 37801316 PMCID: PMC10559179 DOI: 10.1001/jamanetworkopen.2023.36129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Accepted: 08/22/2023] [Indexed: 10/07/2023] Open
Abstract
Importance Physical inactivity and sleep disorders are health-related concerns of youth with autism spectrum disorder (ASD) that can persist from childhood and exacerbate core symptoms. However, evidence on group differences in accelerometer-assessed physical activity and sleep parameters among youth with and without ASD is inconclusive and age-specific effects remain unclear. Objective To synthesize evidence on group differences in accelerometer-assessed physical activity and sleep parameters and examine the moderating effects of age between children and adolescents with and without ASD. Data Sources American Psychological Association PsychInfo, CINAHL Ultimate, ERIC, MEDLINE, SPORTDiscus with Full Text, and Web of Science from inception to February 2023. Study Selection Two independent reviewers screened articles for observational research comparing accelerometer-assessed physical activity levels and sleep parameters in children and adolescents with and without ASD. Data Extraction and Synthesis After developing a standardized form, relevant data were extracted. Quality was assessed using the McMaster Critical Review Form and rated based on sample, measurement, and analyses. The Preferring Reporting Items for Systematic Reviews and Meta-Analyses guideline was followed. Main Outcomes and Measures The primary outcomes were actigraphy-measured MVPA, sleep latency, sleep efficiency, total sleep time, and wake after sleep onset. Data were pooled using a random-effects model. Hedges g was used to express the effect size index. Meta-regression on age was also performed to investigate the potential moderating effects. Results Collectively, 1757 studies were initially identified. Among 104 articles that were assessed, 28 were included, comprising moderate-to-vigorous physical activity (MVPA), 4 sleep parameters, and 73 independent effect sizes. A total of 28 studies were included in analysis, comprising 805 children and adolescents with ASD and 1573 without ASD (age range, 5.1-16.9 years). Compared with peers without ASD, children and adolescents with ASD had a small-to-moderate difference in MVPA (g = -0.450; 95% CI, -0.622 to -0.277), total sleep time (g = -0.332; 95% CI, -0.574 to -0.090), sleep efficiency (g = -0.424; 95% CI, -0.645 to -0.203), and a moderate difference in sleep latency (g = 0.514; 95% CI, 0.351 to 0.677) measured by actigraphy. Children and adolescents with ASD experienced an age-related decline in moderate-to-vigorous physical activity (β = -0.049 [95% CI, -0.097 to -0.001]; P = .045), indicating that younger children with ASD showed a smaller difference in MVPA compared with their peers without ASD. Moderating effects of age on sleep parameters were not significant. Conclusions and Relevance The findings of this meta-analysis suggested that children and adolescents with ASD had lower MVPA and worse sleep than peers without ASD, and the difference in MVPA varied with age. These findings reinforce the need for public health initiatives aimed at reducing these group disparities.
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Affiliation(s)
- Xiao Liang
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong
| | - Justin A. Haegele
- Department of Human Movement Sciences, Old Dominion University, Norfolk, Virginia
- Center for Movement, Health, & Disability, Old Dominion University, Norfolk, Virginia
| | - Sean Healy
- Department of Physical Education and Sports Science, University of Limerick, Limerick, Ireland
| | - Andy Choi-Yeung Tse
- Department of Health and Physical Education, The Education University of Hong Kong, Hong Kong
| | - Hui Qiu
- Department of Educational Administration and Policy, The Chinese University of Hong Kong, Hong Kong
| | - Shi Zhao
- JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong
| | - Chunxiao Li
- School of Physical Education & Sports Science, South China Normal University, Guangzhou, China
- Adapted Physical Activity Laboratory, South China Normal University, Guangzhou, China
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15
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Shui AM, Lampinen LA, Richdale A, Katz T. Predicting future sleep problems in young autistic children. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2023; 27:2063-2085. [PMID: 36755236 DOI: 10.1177/13623613231152963] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/10/2023]
Abstract
LAY ABSTRACT Sleep problems are common in autistic children and negatively impact daytime functioning. A method for predicting sleep problems could help with treatment and prevention of such problems. This study aimed to determine predictors of sleep problems among young autistic children. Study participants consisted of autistic children aged 2-5 years who did not have sleep problems at a first visit (Autism Treatment Network Registry) and had sleep data available at a subsequent visit (Registry Call-Back Assessment study). Sleep problems for five study cohorts of children were defined by different methods, including parent questionnaires and parent- or clinician-report of sleep problems. We found that self-injurious behavior, sensory issues, dental problems, and lower primary caregiver education level were significant risk factors of future sleep problems. These predictors may help clinicians provide prevention or earlier treatment for children who are at risk of developing sleep problems.
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Affiliation(s)
- Amy M Shui
- Massachusetts General Hospital, USA
- University of California, San Francisco, USA
| | | | | | - Terry Katz
- University of Colorado School of Medicine, USA
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16
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Harper L, McAnelly S, Walshe I, Ooms A, Tuffrey-Wijne IM. Behavioural sleep problems in children and adults with intellectual disabilities: An integrative literature review. JOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES 2023; 36:916-928. [PMID: 37177858 DOI: 10.1111/jar.13116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2022] [Revised: 04/27/2023] [Accepted: 05/02/2023] [Indexed: 05/15/2023]
Abstract
BACKGROUND People with intellectual disabilities are more likely to experience sleep problems, which can affect quality of life, physical health, mental health and well-being. METHODS An integrative literature review was conducted to investigate what is known about behavioural sleep disturbances in people with an intellectual disability. The search used the following databases: Scopus, PsycInfo and Cinahl, to find papers published since 2015. RESULTS Within intellectual disability research, sleep appears as a common issue due to its high prevalence, negative relationships with an individual's physical and mental health, their quality of life, and impact of sleep problems on family or carers. The growing evidence base appears to support the use of behavioural, lifestyle and pharmacological interventions to improve sleep in people with an intellectual disability. CONCLUSION A wide array of literature provides evidence that people with intellectual disabilities are affected by and need support with their sleep.
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Affiliation(s)
- Lynette Harper
- Health and Life Sciences, Northumbria University, London, UK
| | - Su McAnelly
- Health and Life Sciences, Northumbria University, London, UK
| | - Ian Walshe
- Health and Life Sciences, Northumbria University, London, UK
| | - Ann Ooms
- Faculty of Health, Science, Social Care and Education, Kingston University, London, UK
| | - Irene M Tuffrey-Wijne
- Faculty of Health, Science, Social Care and Education, Kingston University, London, UK
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17
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Raman N, Ringold SM, Jayashankar A, Butera CD, Kilroy E, Harrison L, Cermak SA, Aziz-Zadeh L. Relationships between Affect Recognition, Empathy, Alexithymia, and Co-Occurring Conditions in Autism. Brain Sci 2023; 13:1161. [PMID: 37626517 PMCID: PMC10452701 DOI: 10.3390/brainsci13081161] [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] [Received: 07/22/2023] [Revised: 07/31/2023] [Accepted: 08/01/2023] [Indexed: 08/27/2023] Open
Abstract
Prior studies show differences in empathy and affect-recognition ability between those with autism spectrum disorder (ASD) and typically developing (TD) individuals. Autistic individuals also exhibit increased behavioral, gastrointestinal, and sleep issues. In the current study, we explored the differences in empathy and affect recognition between the ASD and TD groups; and we investigated their associations with conditions co-occurring in ASD. A total of 54 TD and 56 ASD children (8-17 years) were included. As compared to the TD group, the ASD group showed lower scores for affect recognition and perspective taking (PT) and higher scores for personal distress (PD). Interestingly, results from hierarchical linear regressions suggested that disparities in the PD and PT between the groups were primarily attributable to attenuated levels of alexithymia, rather than being mediated by the presence of an autism diagnosis. Differences in affect-recognition ability, however, were mediated by both an autism diagnosis and alexithymia. We also found significant correlations between empathy and affect recognition and measures of related conditions common in ASD. Alexithymia, hence, contributes to difficulties in empathy while both alexithymia and autism are associated with affect-recognition ability in ASD. Additionally, the association between affect recognition and empathic ability with co-occurring conditions in ASD needs to be considered during assessments and interventions.
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Affiliation(s)
- Nandita Raman
- Division of Occupational Science and Occupational Therapy, University of Southern California, Los Angeles, CA 90089, USA; (N.R.); (S.M.R.); (A.J.); (C.D.B.); (E.K.); (L.H.); (S.A.C.)
- Brain and Creativity Institute, Dornsife College of Letters, Arts and Sciences, University of Southern California, Los Angeles, CA 90089, USA
| | - Sofronia M. Ringold
- Division of Occupational Science and Occupational Therapy, University of Southern California, Los Angeles, CA 90089, USA; (N.R.); (S.M.R.); (A.J.); (C.D.B.); (E.K.); (L.H.); (S.A.C.)
- Brain and Creativity Institute, Dornsife College of Letters, Arts and Sciences, University of Southern California, Los Angeles, CA 90089, USA
| | - Aditya Jayashankar
- Division of Occupational Science and Occupational Therapy, University of Southern California, Los Angeles, CA 90089, USA; (N.R.); (S.M.R.); (A.J.); (C.D.B.); (E.K.); (L.H.); (S.A.C.)
- Brain and Creativity Institute, Dornsife College of Letters, Arts and Sciences, University of Southern California, Los Angeles, CA 90089, USA
| | - Christiana D. Butera
- Division of Occupational Science and Occupational Therapy, University of Southern California, Los Angeles, CA 90089, USA; (N.R.); (S.M.R.); (A.J.); (C.D.B.); (E.K.); (L.H.); (S.A.C.)
- Brain and Creativity Institute, Dornsife College of Letters, Arts and Sciences, University of Southern California, Los Angeles, CA 90089, USA
| | - Emily Kilroy
- Division of Occupational Science and Occupational Therapy, University of Southern California, Los Angeles, CA 90089, USA; (N.R.); (S.M.R.); (A.J.); (C.D.B.); (E.K.); (L.H.); (S.A.C.)
- Brain and Creativity Institute, Dornsife College of Letters, Arts and Sciences, University of Southern California, Los Angeles, CA 90089, USA
| | - Laura Harrison
- Division of Occupational Science and Occupational Therapy, University of Southern California, Los Angeles, CA 90089, USA; (N.R.); (S.M.R.); (A.J.); (C.D.B.); (E.K.); (L.H.); (S.A.C.)
- Brain and Creativity Institute, Dornsife College of Letters, Arts and Sciences, University of Southern California, Los Angeles, CA 90089, USA
| | - Sharon A. Cermak
- Division of Occupational Science and Occupational Therapy, University of Southern California, Los Angeles, CA 90089, USA; (N.R.); (S.M.R.); (A.J.); (C.D.B.); (E.K.); (L.H.); (S.A.C.)
- Department of Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles, CA 90033, USA
| | - Lisa Aziz-Zadeh
- Division of Occupational Science and Occupational Therapy, University of Southern California, Los Angeles, CA 90089, USA; (N.R.); (S.M.R.); (A.J.); (C.D.B.); (E.K.); (L.H.); (S.A.C.)
- Brain and Creativity Institute, Dornsife College of Letters, Arts and Sciences, University of Southern California, Los Angeles, CA 90089, USA
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18
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Carson M, Moore M, Cicalese O, Dunnewald M, Varker A, Mindell JA, Williamson AA. Variation in Twitter posts referencing pediatric sleep aids. Sleep Health 2023; 9:451-459. [PMID: 37330322 PMCID: PMC10524848 DOI: 10.1016/j.sleh.2023.04.009] [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] [Received: 07/26/2022] [Revised: 04/25/2023] [Accepted: 04/28/2023] [Indexed: 06/19/2023]
Abstract
OBJECTIVES Over 50% of parents who use social media seek parenting advice, however little is known about social media discussions surrounding child sleep aid use. The current study investigated Twitter posts about the use of pediatric sleep aids (melatonin, cannabidiol, weighted blankets, and essential oils), including post frequency, user characteristics, and content. In addition, variation in tweets before and after the onset of the COVID-19 pandemic was examined. METHODS Twitter was searched over a 25-month period using TweetDeck. Tweets were coded for user characteristics (eg, affiliations, gender) and content (eg, tone, states sleep or health outcomes, reference to a neurodevelopmental condition). RESULTS Of the 2754 tweets analyzed, melatonin was referenced most often (60%), followed by essential oils (23%), weighted blankets (14%), and cannabidiol (3%). Most were published by individual users (77%) and were positive (51%) in tone. About 1-third of tweets noted positive sleep or health effects of the sleep aid and only 7% referenced a neurodevelopmental condition. Tweets about pediatric sleep aids increased during the pandemic, primarily those posts about melatonin. CONCLUSIONS Melatonin is the most commonly discussed sleep aid on Twitter, followed by essential oils. Tweets are primarily positive. The number of tweets about sleep aids, specifically melatonin, has increased with time, with significantly more tweets after the start of the pandemic. Clinicians should consider using this outlet to provide empirically-based information regarding the efficacy and benefits or risks of sleep aid use in children.
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Affiliation(s)
| | - Melisa Moore
- Children's Hospital of Philadelphia, Philadelphia, PA, USA; Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | | | - Maja Dunnewald
- Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Abigail Varker
- Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Jodi A Mindell
- Saint Joseph's University, Philadelphia, PA, USA; Children's Hospital of Philadelphia, Philadelphia, PA, USA; Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Ariel A Williamson
- Children's Hospital of Philadelphia, Philadelphia, PA, USA; Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
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19
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Kim H, Kim JH, Kim J, Kim JY, Cortese S, Smith L, Koyanagi A, Radua J, Fusar-Poli P, Carvalho AF, Salazar de Pablo G, Shin JI, Cheon KA, Solmi M. Subjective and objective sleep alterations in medication-naïve children and adolescents with autism spectrum disorder: a systematic review and meta-analysis. Epidemiol Psychiatr Sci 2023; 32:e48. [PMID: 37469173 PMCID: PMC10387490 DOI: 10.1017/s2045796023000574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/21/2023] Open
Abstract
AIMS This study aimed to summarize the evidence on sleep alterations in medication-naïve children and adolescents with autism spectrum disorder (ASD). METHODS We systematically searched PubMed/Medline, Embase and Web of Science databases from inception through March 22, 2021. This study was registered with PROSPERO (CRD42021243881). Any observational study was included that enrolled medication-naïve children and adolescents with ASD and compared objective (actigraphy and polysomnography) or subjective sleep parameters with typically developing (TD) counterparts. We extracted relevant data such as the study design and outcome measures. The methodological quality was assessed through the Newcastle-Ottawa Scale (NOS). A meta-analysis was carried out using the random-effects model by pooling effect sizes as Hedges' g. To assess publication bias, Egger's test and p-curve analysis were done. A priori planned meta-regression and subgroup analysis were also performed to identify potential moderators. RESULTS Out of 4277 retrieved references, 16 studies were eligible with 981 ASD patients and 1220 TD individuals. The analysis of objective measures showed that medication-naïve ASD patients had significantly longer sleep latency (Hedges' g 0.59; 95% confidence interval [95% CI] 0.26 to 0.92), reduced sleep efficiency (Hedges' g -0.58; 95% CI -0.87 to -0.28), time in bed (Hedges' g -0.64; 95% CI -1.02 to -0.26) and total sleep time (Hedges' g -0.64; 95% CI -1.01 to -0.27). The analysis of subjective measures showed that they had more problems in daytime sleepiness (Hedges' g 0.48; 95% CI 0.26 to 0.71), sleep latency (Hedges' g 1.15; 95% CI 0.72 to 1.58), initiating and maintaining sleep (Hedges' g 0.86; 95% CI 0.39 to 1.33) and sleep hyperhidrosis (Hedges' g 0.48; 95% CI 0.29 to 0.66). Potential publication bias was detected for sleep latency, sleep period time and total sleep time measured by polysomnography. Some sleep alterations were moderated by age, sex and concurrent intellectual disability. The median NOS score was 8 (interquartile range 7.25-8.75). CONCLUSION We found that medication-naïve children and adolescents with ASD presented significantly more subjective and objective sleep alterations compared to TD and identified possible moderators of these differences. Future research requires an analysis of how these sleep alterations are linked to core symptom severity and comorbid behavioural problems, which would provide an integrated therapeutic intervention for ASD. However, our results should be interpreted in light of the potential publication bias.
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Affiliation(s)
- Heeyeon Kim
- Department of Psychiatry, Yongin Severance Hospital, Yonsei University College of Medicine, Yongin, Republic of Korea
- Institute of Behavioral Science in Medicine, Yonsei University College of Medicine, Yonsei University Health System, Seoul, Republic of Korea
| | - Jae Han Kim
- Yonsei University College of Medicine, Severance Hospital, Yonsei University Health System, Seoul, Republic of Korea
| | - Junghwan Kim
- Yonsei University College of Medicine, Severance Hospital, Yonsei University Health System, Seoul, Republic of Korea
| | - Jong Yeob Kim
- Yonsei University College of Medicine, Severance Hospital, Yonsei University Health System, Seoul, Republic of Korea
| | - Samuele Cortese
- Centre for Innovation in Mental Health, Academic Unit of Psychology, University of Southampton, Southampton, UK
- Clinical and Experimental Sciences (CNS and Psychiatry), Faculty of Medicine, University of Southampton, Southampton, UK
- Solent NHS Trust, Southampton, UK
- Hassenfeld Children's Hospital at NYU Langone, New York University Child Study Center, New York, NY, USA
| | - Lee Smith
- Centre for Health, Performance, and Wellbeing, Anglia Ruskin University, Cambridge, UK
| | - Ai Koyanagi
- Parc Sanitari Sant Joan de Déu/CIBERSAM, Universitat de Barcelona, Fundació Sant Joan de Déu, Sant Boi de Llobregat, Barcelona, Spain
| | - Joaquim Radua
- Imaging Mood- and Anxiety-Related Disorders (IMARD) Group, Institut d'Investigacions Biomèdiques August Pi i Sunyer(IDIBAPS), Mental Health Research Networking Center(CIBERSAM), University of Barcelona, Barcelona, Spain
| | - Paolo Fusar-Poli
- Department of Psychosis Studies, Early Psychosis: Interventions and Clinical-detection (EPIC) Lab, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
- OASIS Service, South London and Maudsley NHS Foundation Trust, London, UK
- National Institute for Health Research, Maudsley Biomedical Research Centre, London, UK
| | - Andre F Carvalho
- IMPACT Strategic Research Centre, Barwon Health, Deakin University School of Medicine, Geelong, VIC, Australia
| | - Gonzalo Salazar de Pablo
- Department of Psychosis Studies, Early Psychosis: Interventions and Clinical-detection (EPIC) Lab, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry and Mental Health, Hospital General Universitario Gregorio Marañón School of Medicine, Universidad Complutense, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), CIBERSAM, Madrid, Spain
- Child and Adolescent Mental Health Services, South London and Maudsley NHS Foundation Trust, London, UK
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Jae Il Shin
- Department of Pediatrics, Yonsei University College of Medicine, Severance Hospital, Yonsei University Health System, Seoul, Republic of Korea
- Severance Children's Hospital, Yonsei University Health System, Seoul, Republic of Korea
- Severance Underwood Meta-research Center, Institute of Convergence Science, Yonsei University, Seoul, Republic of Korea
| | - Keun-Ah Cheon
- Institute of Behavioral Science in Medicine, Yonsei University College of Medicine, Yonsei University Health System, Seoul, Republic of Korea
- Department of Child and Adolescent Psychiatry, Yonsei University College of Medicine, Severance Hospital, Seoul, Republic of Korea
| | - Marco Solmi
- Department of Psychosis Studies, Early Psychosis: Interventions and Clinical-detection (EPIC) Lab, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
- Department of Psychiatry, University of Ottawa, Ottawa, ON, Canada
- Department of Mental Health, The Ottawa Hospital, Ottawa, ON, Canada
- Ottawa Hospital Research Institute (OHRI) Clinical Epidemiology Program, University of Ottawa, Ottawa, ON, Canada
- Department of Child and Adolescent Psychiatry, Charité Universitätsmedizin, Berlin, Germany
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20
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Yamada T, Watanabe T, Sasaki Y. Are sleep disturbances a cause or consequence of autism spectrum disorder? Psychiatry Clin Neurosci 2023; 77:377-385. [PMID: 36949621 PMCID: PMC10871071 DOI: 10.1111/pcn.13550] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Revised: 03/10/2023] [Accepted: 03/17/2023] [Indexed: 03/24/2023]
Abstract
Autism spectrum disorder (ASD) is a neurodevelopmental disorder characterized by core symptoms such as atypical social communication, stereotyped behaviors, and restricted interests. One of the comorbid symptoms of individuals with ASD is sleep disturbance. There are two major hypotheses regarding the neural mechanism underlying ASD, i.e., the excitation/inhibition (E/I) imbalance and the altered neuroplasticity hypotheses. However, the pathology of ASD remains unclear due to inconsistent research results. This paper argues that sleep is a confounding factor, thus, must be considered when examining the pathology of ASD because sleep plays an important role in modulating the E/I balance and neuroplasticity in the human brain. Investigation of the E/I balance and neuroplasticity during sleep might enhance our understanding of the neural mechanisms of ASD. It may also lead to the development of neurobiologically informed interventions to supplement existing psychosocial therapies.
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Affiliation(s)
- Takashi Yamada
- Department of Cognitive, Linguistic, and Psychological Sciences, Brown University, Providence, 02912, USA
| | - Takeo Watanabe
- Department of Cognitive, Linguistic, and Psychological Sciences, Brown University, Providence, 02912, USA
| | - Yuka Sasaki
- Department of Cognitive, Linguistic, and Psychological Sciences, Brown University, Providence, 02912, USA
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21
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Hartman AG, McKendry S, Akcakaya M, Soehner A, Bodison SC, DeAlmeida D, Bendixen R. Characterizing rest-activity rhythms and sleep for children with and without tactile sensitivities: An observational study. Sleep Med 2023; 106:8-16. [PMID: 37030035 PMCID: PMC10159915 DOI: 10.1016/j.sleep.2023.03.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Revised: 03/01/2023] [Accepted: 03/23/2023] [Indexed: 03/30/2023]
Abstract
STUDY OBJECTIVES This cross-sectional, observational study aimed to characterize and compare movement-based rest-activity rhythms (RARs) and sleep period variables of children with tactile hypersensitivities (SS) and non-sensitive peers (NSS) to expand the understanding of experienced differences in sleep. METHODS Children (ages 6-10) wore Actigraph GT9X watches for 2 weeks and caregivers completed daily sleep diaries. RARs and sleep period variables (e.g., sleep efficiency, duration, wake after sleep onset) were analyzed and localized means were plotted to visualize average rhythms for each group. Groups were compared using Student's t tests, or non-parametric alternatives, and Hedge's g effect sizes. RESULTS Fifty-three children and their families participated in this study (nSS = 21 nNSS = 32). The groups had similar RARs and sleep period variables. In both groups, sleep efficiency was low (SESS = 78%, SENSS = 77%) and total sleep time was short (TSTSS = 7 hrs 26 mins, TSTNSS- 7 h, 33 min) compared to national recommendations. Despite these similarities, children with SS took noticeably longer to settle down and fall asleep (53 min) than children with NSS (26 min, p = .075, g = 0.95). CONCLUSION This study provides preliminary data describing RAR and sleep period variables in children with and without tactile hypersensitivities. While overall RAR and sleep variables were similar between groups, there is evidence that children with SS spend a longer time transitioning to sleep. Evidence is provided that wrist-worn actigraphy is tolerable and acceptable for children with tactile sensitivities. Actigraphy provides important, movement-based data that should be used in tandem with other measures of sleep health for future studies.
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Affiliation(s)
- Amy G Hartman
- University of Pittsburgh, Department of Psychiatry, United States.
| | - Sarah McKendry
- University of Pittsburgh, Department of Occupational Therapy, United States
| | - Murat Akcakaya
- University of Pittsburgh, Department of Engineering, United States
| | - Adriane Soehner
- University of Pittsburgh, Department of Psychiatry, United States
| | - Stefanie C Bodison
- University of Florida, Department of Occupational Therapy, United States
| | - Dilhari DeAlmeida
- University of Pittsburgh, Department of Health Information Management, United States
| | - Roxanna Bendixen
- Medical University of South Carolina, Division of Occupational Therapy, United States
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22
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Lewis S, Papadopoulos N, Mantilla A, Hiscock H, Whelan M, McGillivray J, Rinehart N. The impact of COVID-19 on sleep for autistic children: A systematic review. RESEARCH IN AUTISM SPECTRUM DISORDERS 2023; 102:102110. [PMID: 36713069 PMCID: PMC9868385 DOI: 10.1016/j.rasd.2023.102110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Revised: 12/21/2022] [Accepted: 01/18/2023] [Indexed: 06/18/2023]
Abstract
BACKGROUND Up to 80% of children with autism experience behavioural sleep problems, predominantly relating to bedtime resistance, sleep anxiety, sleep dysregulation, and shorter duration, which are associated with increased autistic symptom expression and emotional and behavioural difficulties. Researchers predicted the COVID-19 pandemic would worsen sleep and behavioural difficulties for autistic children, due to their need for routine and certainty. This systematic review is the first to focus on delineating the role of sleep disturbance in exacerbating autistic symptoms and internalising and externalising behaviours during the pandemic. METHOD In this PROSPERO registered systematic review, we aggregated and synthesised findings from empirical studies from 2020 onwards that included children with autism and examined sleep outcomes, using narrative and framework synthesis due to the variety of methods and designs employed. We identified additional relevant themes through inductive thematic analysis. RESULTS Seventy-one studies met the search criteria, and we selected seventeen for review following screening and quality assessment. These studies reported mixed findings; with strongest support for worsening of sleep problems typically experienced by autistic children, including difficulties with sleep regulation and shorter sleep duration. Further, sleep problems were associated with increased expression of autistic characteristics. CONCLUSIONS Preliminary findings of worsening sleep and increased autistic characteristics for autistic children throughout the COVID-19 pandemic highlight the need for ongoing, accessible and flexible service provision during exposure to environmental stressors. We propose that behavioural sleep interventions are well suited to telehealth adaptation and play an important role in supporting families when in-person treatment for sleep problems is not possible.
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Affiliation(s)
- Samantha Lewis
- Krongold Clinic, School of Educational Psychology and Counselling, Faculty of Education, Monash University, 19 Ancora-Imparo Way, Clayton, Victoria 3800, Australia
| | - Nicole Papadopoulos
- Krongold Clinic, School of Educational Psychology and Counselling, Faculty of Education, Monash University, 19 Ancora-Imparo Way, Clayton, Victoria 3800, Australia
| | - Ana Mantilla
- Krongold Clinic, School of Educational Psychology and Counselling, Faculty of Education, Monash University, 19 Ancora-Imparo Way, Clayton, Victoria 3800, Australia
| | - Harriet Hiscock
- Murdoch Children's Research Institute, Royal Children's Hospital, Flemington Road, Parkville, Victoria 3052, Australia
| | - Moira Whelan
- Krongold Clinic, School of Educational Psychology and Counselling, Faculty of Education, Monash University, 19 Ancora-Imparo Way, Clayton, Victoria 3800, Australia
| | - Jane McGillivray
- School of Psychology, Faculty of Health, Deakin University, 1 Gheringhap Street, Geelong, Victoria 3220, Australia
| | - Nicole Rinehart
- Krongold Clinic, School of Educational Psychology and Counselling, Faculty of Education, Monash University, 19 Ancora-Imparo Way, Clayton, Victoria 3800, Australia
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23
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Henderson LM, St Clair M, Knowland V, van Rijn E, Walker S, Gaskell MG. Stronger Associations Between Sleep and Mental Health in Adults with Autism: A UK Biobank Study. J Autism Dev Disord 2023; 53:1543-1559. [PMID: 34860312 PMCID: PMC10066094 DOI: 10.1007/s10803-021-05382-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/22/2021] [Indexed: 12/26/2022]
Abstract
This study examined sleep and its cognitive and affective correlates in adults with and without autism spectrum disorder (ASD), utilizing UK Biobank data. There were no group differences in subjective sleep duration [n = 220 ASD; n = 2200 general population (GP)]. Accelerometer measures of sleep duration or nighttime activity did not differ by group, but sleep efficiency was marginally lower in ASD (n = 83 ASD; n = 824 GP). Sleep efficiency was associated with wellbeing and mental health, and pathways between accelerometer sleep measures and wellbeing and mental health were significantly stronger for adults with ASD (who also reported substantially poorer wellbeing and > 5 × likelihood of experiencing mental distress). These findings highlight the need to monitor sleep to maintain good mental health in adult ASD.
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Affiliation(s)
- Lisa M Henderson
- Department of Psychology, University of York, York, YO10 5DD, UK.
| | - M St Clair
- Department of Psychology, University of Bath, Bath, UK
| | - V Knowland
- Department of Speech and Language Sciences, University of Newcastle, Newcastle, Australia
| | - E van Rijn
- Department of Psychology, University of York, York, YO10 5DD, UK
| | - S Walker
- Department of Psychology, University of York, York, YO10 5DD, UK
| | - M G Gaskell
- Department of Psychology, University of York, York, YO10 5DD, UK
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24
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Jeon M, Neoh MJY, Esposito G, Halstead E, Haghighatfard A, Dimitriou D. Cross-country comparison of parental reports and objective measures of sleep patterns of typically developing children and autistic children between the UK and South Korea. Sleep Med 2023; 101:162-177. [PMID: 36395721 DOI: 10.1016/j.sleep.2022.10.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Revised: 10/06/2022] [Accepted: 10/22/2022] [Indexed: 11/06/2022]
Abstract
Sleep duration and disturbances in typically developing (TD) children have been found to vary across countries. Given the impact of culture on sleep patterns in TD children, it is also necessary to examine the impact of culture on sleep patterns in children with atypical development. However, previous studies have often relied only on parent reports of children's sleep. Hence, the present study conducted a cross-cultural comparison of sleep duration and disturbances of school-aged TD children and autistic children in the UK and South Korea (hereafter Korea) using both subjective and objective sleep measurements. Cultural differences were observed in both actigraphy measures and parent reports of children's sleep duration and disturbances. Both TD children and autistic children in Korea had a later bedtime, later getting up time and shorter nocturnal sleep duration than their peers in the UK (p < .05). Furthermore, greater parent-reported sleep disturbances were reported in TD children in Korea compared to TD children in the UK and in autistic children in the UK compared to autistic children in Korea. Correlational analyses indicated that most parent-reported measures of children's sleep did not significantly correlate with objective measures and child reports, suggesting that studies on children's sleep can benefit by collecting data from multiple sources. Taken together, these findings suggest a cultural influence on sleep duration and disturbances of both TD children and autistic children. This study raises questions for further research to identify factors underlying cultural differences in children's sleep duration and disturbances.
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Affiliation(s)
- Mina Jeon
- Sleep Education and Research Laboratory, UCL Institute of Education, London, UK.
| | - Michelle Jin Yee Neoh
- Psychology Program, School of Social Sciences, Nanyang Technological University, Singapore
| | - Gianluca Esposito
- Department of Psychology and Cognitive Science, University of Trento, Rovereto, Italy
| | - Elizabeth Halstead
- Sleep Education and Research Laboratory, UCL Institute of Education, London, UK
| | - Arvin Haghighatfard
- Sleep Education and Research Laboratory, UCL Institute of Education, London, UK
| | - Dagmara Dimitriou
- Sleep Education and Research Laboratory, UCL Institute of Education, London, UK
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25
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Pattison E, Mantilla A, Fuller-Tyszkiewicz M, Marks D, Sciberras E, McGillivray J, Papadopoulos N, Rinehart N. Acceptability of a behavioural sleep intervention for autistic children: A qualitative evaluation of Sleeping Sound. Sleep Med 2022; 100:378-389. [PMID: 36201889 DOI: 10.1016/j.sleep.2022.09.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Revised: 09/07/2022] [Accepted: 09/13/2022] [Indexed: 01/12/2023]
Abstract
OBJECTIVE The aim of the current study was to evaluate parental perceptions of the acceptability of a brief behavioural sleep intervention for autistic children (aged 5-13 years) using the Theoretical Framework of Acceptability (TFA). METHODS Qualitative data were collected during a large randomised controlled trial evaluating the efficacy of the Sleeping Sound intervention: 123 families were randomised to the intervention group, of which 115 (93%) completed at least one intervention session and 82 (67%) provided qualitative evaluation data in the 3-month follow-up survey. Consultation records from intervention sessions and parent surveys were qualitatively analysed post hoc using a hybrid approach to thematic analysis. RESULTS Findings were categorised under the seven themes of the TFA (affective attitude, burden, ethicality, intervention coherence, opportunity costs, perceived effectiveness, self-efficacy) in addition to three themes that were defined following inductive and deductive coding (barriers to implementation, facilitators to implementation, suggestions for improvement). Participants spoke positively about their experience participating in the intervention and perceived the intervention to be appropriate and effective. Most parents (95.5%) reported that they would recommend the Sleeping Sound intervention to other families of autistic children. Barriers to implementation included child and parent anxiety, child health problems, parental preferences, family circumstances, and other (e.g., school holidays). Facilitators to implementation included family support and consistency with strategies. CONCLUSIONS The Sleeping Sound intervention was considered acceptable to parents of autistic children as evidenced by largely positive feedback regarding their experience. The results highlighted areas for improvement which can be used to inform future iterations of the intervention.
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Affiliation(s)
- Emily Pattison
- School of Psychology, Faculty of Health, Deakin University, 1 Gheringhap Street, Geelong, Victoria, 3220, Australia
| | - Ana Mantilla
- Krongold Clinic, School of Educational Psychology and Counselling, Faculty of Education, Monash University, 19 Ancora Imparo Way, Clayton, Victoria, 3800, Australia
| | - Matthew Fuller-Tyszkiewicz
- School of Psychology, Faculty of Health, Deakin University, 1 Gheringhap Street, Geelong, Victoria, 3220, Australia.
| | - Deborah Marks
- Royal Children's Hospital, 50 Flemington Road, Parkville, Victoria, 3052, Australia
| | - Emma Sciberras
- School of Psychology, Faculty of Health, Deakin University, 1 Gheringhap Street, Geelong, Victoria, 3220, Australia; Murdoch Children's Research Institute, 50 Flemington Road, Parkville, Victoria, 3052, Australia; Department of Paediatrics, University of Melbourne, Grattan Street, Parkville, Victoria, 3010, Australia
| | - Jane McGillivray
- School of Psychology, Faculty of Health, Deakin University, 1 Gheringhap Street, Geelong, Victoria, 3220, Australia
| | - Nicole Papadopoulos
- Krongold Clinic, School of Educational Psychology and Counselling, Faculty of Education, Monash University, 19 Ancora Imparo Way, Clayton, Victoria, 3800, Australia
| | - Nicole Rinehart
- Krongold Clinic, School of Educational Psychology and Counselling, Faculty of Education, Monash University, 19 Ancora Imparo Way, Clayton, Victoria, 3800, Australia
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26
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Kim Y, Kadlaskar G, Keehn RM, Keehn B. Measures of tonic and phasic activity of the locus coeruleus-norepinephrine system in children with autism spectrum disorder: An event-related potential and pupillometry study. Autism Res 2022; 15:2250-2264. [PMID: 36164264 PMCID: PMC9722557 DOI: 10.1002/aur.2820] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Accepted: 09/07/2022] [Indexed: 12/15/2022]
Abstract
A growing body of research suggests that locus coeruleus-norepinephrine (LC-NE) system may function differently in individuals with autism spectrum disorder (ASD). Understanding the dynamics of both tonic (resting pupil diameter) and phasic (pupil dilation response [PDR] and event-related potential [ERP]) indices may provide meaningful insights about the nature of LC-NE function in ASD. Twenty-four children with ASD and 27 age- and nonverbal-IQ matched typically developing (TD) children completed two experiments: (1) a resting eye-tracking task to measure tonic pupil diameter, and (2) a three-stimulus oddball paradigm to measure phasic responsivity using PDR and ERP. Consistent with prior reports, our results indicate that children with ASD exhibit increased tonic (resting pupil diameter) and reduced phasic (PDR and ERP) activity of the LC-NE system compared to their TD peers. For both groups, decreased phasic responsivity was associated with increased resting pupil diameter. Lastly, tonic and phasic LC-NE indices were primarily related to measures of attention-deficit/hyperactivity disorder (ADHD), and not ASD, symptomatology. These findings expand our understanding of neurophysiological differences present in ASD and demonstrate that aberrant LC-NE activation may be associated with atypical arousal and decreased responsivity to behaviorally-relevant information in ASD.
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Affiliation(s)
- Yesol Kim
- Department of Speech, Language, and Hearing Sciences,
Purdue University, West Lafayette, IN
| | - Girija Kadlaskar
- Department of Speech, Language, and Hearing Sciences,
Purdue University, West Lafayette, IN
| | | | - Brandon Keehn
- Department of Speech, Language, and Hearing Sciences,
Purdue University, West Lafayette, IN,Department of Psychological Sciences, Purdue University,
West Lafayette, IN
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27
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Schiltz HK, Fenning RM, Erath SA, Baker JK. Parasympathetic functioning and sleep problems in children with autism spectrum disorder. Autism Res 2022; 15:2138-2148. [PMID: 36114684 PMCID: PMC9825964 DOI: 10.1002/aur.2816] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2022] [Accepted: 09/01/2022] [Indexed: 01/12/2023]
Abstract
Respiratory sinus arrhythmia (RSA), an index of parasympathetic nervous system activity, has been linked with sleep quality among children with neurotypical development. The current study extended examination of these processes to children with autism spectrum disorder (ASD), a group at considerable risk for sleep problems. Participants included 54 children with ASD (aged 6-10 years, 43% Hispanic). RSA data were collected via a wired MindWare system during a 3-min baseline and a 3-min challenge task. Parents reported on their children's sleep problems and sleep duration using the Children's Sleep Habits Questionnaire, Abbreviated. Although no significant correlations emerged between RSA indices and parent-reported child sleep, baseline RSA and RSA reactivity interacted in the prediction of sleep problems. For children with higher RSA reactivity, higher baseline RSA was associated with fewer sleep problems, but for children with lower RSA reactivity, baseline RSA was not predictive. No main effects or interactions of RSA predicted sleep duration. Findings suggest resilience against sleep problems for children with ASD presenting with higher baseline RSA and higher RSA reactivity. Implications of these results center upon directly targeting psychophysiology (i.e., parasympathetic nervous system regulation) as a possible mechanism to improve sleep in children with ASD, and developing personalized interventions based on physiological markers of risk and resilience.
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Affiliation(s)
- Hillary K. Schiltz
- Department of PsychologyMarquette UniversityMilwaukeeWisconsinUSA
- Department of Child and Adolescent Studies, Center for AutismCalifornia State UniversityFullertonCaliforniaUSA
- Semel Institute for Neuroscience and Human BehaviorUniversity of CaliforniaLos AngelesCaliforniaUSA
| | - Rachel M. Fenning
- Department of Child and Adolescent Studies, Center for AutismCalifornia State UniversityFullertonCaliforniaUSA
- Department of Psychological Science and The Claremont Autism CenterClaremont McKenna CollegeClaremontCaliforniaUSA
| | | | - Jason K. Baker
- Department of Child and Adolescent Studies, Center for AutismCalifornia State UniversityFullertonCaliforniaUSA
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28
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Dal Pai J, Wolff CG, Aranchipe CS, Kepler CK, dos Santos GA, Canton LAL, de Carvalho AB, Richter SA, Nunes ML. COVID-19 Pandemic and Autism Spectrum Disorder, Consequences to Children and Adolescents - a Systematic Review. REVIEW JOURNAL OF AUTISM AND DEVELOPMENTAL DISORDERS 2022:1-26. [PMID: 36189101 PMCID: PMC9510314 DOI: 10.1007/s40489-022-00344-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2022] [Accepted: 08/27/2022] [Indexed: 11/13/2022]
Abstract
In this systematic review, we aimed to identify the impact of the COVID-19 pandemic on children/adolescents with a diagnosis of autism spectrum disorder (ASD). The protocol was registered on PROSPERO CRD42021255848. Articles were selected from PubMed, Embase, and LILACS according to these characteristics: patients from zero to 18 years old, exposed to the COVID-19 pandemic, impact on social communication/interaction and restricted/repetitive behavior domains. The Newcastle-Ottawa Scale was used to assess methodological quality and the risk of bias. Of the 351 articles initially identified, 26 were finally included with information on 8,610 patients. Although the studies were heterogeneous, they indicated that the pandemic-related issues experienced by patients with ASD were mostly manifested in their behavior and sleep patterns. Supplementary Information The online version contains supplementary material available at 10.1007/s40489-022-00344-4.
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Affiliation(s)
- Janise Dal Pai
- Brain Institute of Rio Grande Do Sul, Pontifical Catholic University of Rio Grande do Sul (InsCer/PUCRS), Porto Alegre, Brazil
| | - Cecília Gatti Wolff
- Extension and Management of Continuing Education Activities Program, Pontifical Catholic University of Rio Grande do Sul (PEGA/PUCRS), Porto Alegre, Brazil
| | - Carolina Siciliani Aranchipe
- Extension and Management of Continuing Education Activities Program, Pontifical Catholic University of Rio Grande do Sul (PEGA/PUCRS), Porto Alegre, Brazil
| | - Carolina Knorst Kepler
- Extension and Management of Continuing Education Activities Program, Pontifical Catholic University of Rio Grande do Sul (PEGA/PUCRS), Porto Alegre, Brazil
| | - Gabriele Alves dos Santos
- Extension and Management of Continuing Education Activities Program, Pontifical Catholic University of Rio Grande do Sul (PEGA/PUCRS), Porto Alegre, Brazil
| | - Luiz Augusto Leal Canton
- Extension and Management of Continuing Education Activities Program, Pontifical Catholic University of Rio Grande do Sul (PEGA/PUCRS), Porto Alegre, Brazil
| | - Antonella Brun de Carvalho
- Extension and Management of Continuing Education Activities Program, Pontifical Catholic University of Rio Grande do Sul (PEGA/PUCRS), Porto Alegre, Brazil
| | - Samanta Andresa Richter
- Brain Institute of Rio Grande Do Sul, Pontifical Catholic University of Rio Grande do Sul (InsCer/PUCRS), Porto Alegre, Brazil
| | - Magda Lahorgue Nunes
- School of Medicine, Pontifical Catholic University of Rio Grande do Sul (InsCer/PUCRS), Av Ipiranga 6690, building 63, 2nd floor, 90610-000 Porto Alegre, Brazil
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29
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Patti MA, Kelsey KT, MacFarlane AJ, Papandonatos GD, Arbuckle TE, Ashley-Martin J, Fisher M, Fraser WD, Lanphear BP, Muckle G, Braun JM. Maternal Folate Status and the Relation between Gestational Arsenic Exposure and Child Health Outcomes. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:11332. [PMID: 36141604 PMCID: PMC9517145 DOI: 10.3390/ijerph191811332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Revised: 09/02/2022] [Accepted: 09/03/2022] [Indexed: 06/16/2023]
Abstract
Gestational arsenic exposure adversely impacts child health. Folate-mediated 1-carbon metabolism facilitates urinary excretion of arsenic and may prevent arsenic-related adverse health outcomes. We investigated the potential for maternal folate status to modify associations between gestational arsenic exposure and child health. We used data from 364 mother-child pairs in the MIREC study, a prospective pan-Canadian cohort. During pregnancy, we measured first trimester urinary arsenic concentrations, plasma folate biomarkers, and folic acid supplementation intake. At age 3 years, we evaluated twelve neurodevelopmental and anthropometric features. Using latent profile analysis and multinomial regression, we developed phenotypic profiles of child health, estimated covariate-adjusted associations between arsenic and these phenotypic profiles, and evaluated whether folate status modified these associations. We identified three phenotypic profiles of neurodevelopment and three of anthropometry, ranging from less to more optimal child health. Gestational arsenic was associated with decreased odds of optimal neurodevelopment. Maternal folate status did not modify associations of arsenic with neurodevelopmental phenotypic profiles, but gestational arsenic was associated with increased odds of excess adiposity among those who exceed recommendations for folic acid (>1000 μg/day). However, arsenic exposure was low and folate status was high. Gestational arsenic exposure may adversely impact child neurodevelopment and anthropometry, and maternal folate status may not modify these associations; however, future work should examine these associations in more arsenic-exposed or lower folate-status populations.
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Affiliation(s)
- Marisa A. Patti
- Department of Epidemiology, Brown University, 121 S Main St., Providence, RI 02903, USA
| | - Karl T. Kelsey
- Department of Epidemiology, Brown University, 121 S Main St., Providence, RI 02903, USA
| | - Amanda J. MacFarlane
- Nutrition Research Division, Health Canada, 251 Sir Frederick Banting Driveway, Ottawa, ON K1A 0K9, Canada
- Department of Biology, Carleton University, 1125 Colonel By Dr., Ottawa, ON K1S 5B6, Canada
| | - George D. Papandonatos
- Department of Biostatistics, Brown University, 121 S Main St., Providence, RI 02903, USA
| | - Tye E. Arbuckle
- Environmental Health Science and Research Bureau, Healthy Environments and Consumer Branch, Health Canada, 50 Colombine Driveway, Ottawa, ON K1A 0K9, Canada
| | - Jillian Ashley-Martin
- Environmental Health Science and Research Bureau, Healthy Environments and Consumer Branch, Health Canada, 50 Colombine Driveway, Ottawa, ON K1A 0K9, Canada
| | - Mandy Fisher
- Environmental Health Science and Research Bureau, Healthy Environments and Consumer Branch, Health Canada, 50 Colombine Driveway, Ottawa, ON K1A 0K9, Canada
| | - William D. Fraser
- Department D’obstétrique et Gynécologie, Université de Sherbrooke, 2500 Bd de L’Université, Sherbrooke, QC J1K 2R1, Canada
| | - Bruce P. Lanphear
- Department of Health Sciences, Simon Fraser University, 515 W Haastings St., Vancouver, BC V5A 1S6, Canada
| | - Gina Muckle
- School of Psychology, Université Laval, Ville de Québec, 2325 Rue de L’Université, Québec, QC G1V 0B4, Canada
| | - Joseph M. Braun
- Department of Epidemiology, Brown University, 121 S Main St., Providence, RI 02903, USA
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30
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Bin Eid W, Lim M, Halstead E, Esposito G, Dimitriou D. A cross-cultural comparison of sleep patterns between typically developing children and children with ASD living in Saudi Arabia and the United Kingdom. RESEARCH IN DEVELOPMENTAL DISABILITIES 2022; 128:104290. [PMID: 35810543 DOI: 10.1016/j.ridd.2022.104290] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Revised: 06/10/2022] [Accepted: 06/19/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Sleep is crucial for child development, especially for children with ASD. While it is known that children with ASD experience more severe sleep problems and that these problems tend to persist compared to their typically developing counterparts, these findings tend to come from only Western countries. A cross-cultural study is important to understand if the prevailing understanding of sleep in children with ASD can be extended to different cultural backgrounds. AIM A cross-cultural study is conducted, involving typically developing children and children with ASD aged 5-12 across two countries: Saudi Arabia and the United Kingdom. METHODS AND PROCEDURES Using a combination of questionnaires measuring ASD severity (CARS-2), sleep quality (CSHQ), sociodemographic and lifestyle variables and sleep diaries, 244 children were sampled using a mixture of snowball and convenience sampling methods. OUTCOMES AND RESULTS Children with ASD experience more sleep problems compared to typically developing children in Saudi Arabia, and these problems similarly persist across time. Specifically, it was found that children with ASD in Saudi Arabia experience greater sleep onset latency and a greater number of night awakenings. Additionally, across the ASD groups, it was found that children from Saudi Arabia generally experienced poorer sleep than children in the United Kingdom in terms of shorter sleep duration, although children in the United Kingdom tended to report more instances of sleep anxiety and parasomnias. CONCLUSIONS AND IMPLICATIONS Several reasons such as parental education about sleep hygiene, cultural influences and social hours were put forward as potential explanations for cross-cultural differences. Findings served to emphasise the importance of culturally-appropriate interventions and public education regarding child sleep.
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Affiliation(s)
- W Bin Eid
- Sleep Education and Research Laboratory, UCL Institute of Education, 25 Woburn Square, WC1H 0AA London, UK
| | - M Lim
- Psychology Program, School of Social Sciences, Nanyang Technological University, Singapore
| | - E Halstead
- Sleep Education and Research Laboratory, UCL Institute of Education, 25 Woburn Square, WC1H 0AA London, UK
| | - G Esposito
- Affiliative Behaviour and Physiology Lab, Department of Psychology and Cognitive Science, University of Trento, Corso Bettini, 31, I-38068 Rovereto, Italy.
| | - D Dimitriou
- Sleep Education and Research Laboratory, UCL Institute of Education, 25 Woburn Square, WC1H 0AA London, UK.
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31
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Micsinszki SK, Ballantyne M, Cleverley K, Green P, Brennenstuhl S, Stremler R. Examining factors associated with sleep quality in parents of children 4-10 years with autism spectrum disorder. Disabil Rehabil 2022:1-13. [PMID: 35979804 DOI: 10.1080/09638288.2022.2103594] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
PURPOSE Parents of children with autism spectrum disorder often report poorer sleep compared to parents of typically developing children. When parents do not obtain enough quality sleep, functioning may be compromised placing the onus of care on already stressed parents. However, improving sleep duration may not improve sleep quality and is not always feasible. This study aimed to measure sleep quality in parents of children with autism spectrum disorder, determine if stress and children's sleep are associated with sleep quality and whether resources, appraisals, and coping moderate these relationships. MATERIALS AND METHODS Multivariable regression was used to determine the effects of stress and children's sleep problems on sleep quality and test modifying effects. RESULTS Mean (SD) Pittsburgh Sleep Quality Index scores was 8.81 (3.76), with 77.6% of parents scoring above the clinical cut-off. Mean (SD) Children's Sleep Habits Questionnaire scores was 54.03 (8.32), with 96.3% of parents rating their child's sleep above the clinical cut-off. Children's sleep was the only significant predictor and none of the expected effect modifiers were significant. CONCLUSION Children's sleep may be an important target to improve parent sleep quality but requires systematic assessment with interventional research. Implications for rehabilitationBoth parents and their 4-10-year-old children with ASD experience high levels of sleep disturbances.Clinicians can start the conversation early with parents about their children's sleep by providing them with information to increase awareness and recognize healthy sleep habits in their children.Clinicians are important in the assessment, management, and evaluation of pediatric sleep problems, which may have significant spillover effects on parents of children with ASD.There is a need for more resources and training to be available to clinicians to assess children and their parents for sleep problems, which could extend beyond the assessment of sleep and consider parent's daytime functioning and mental health.
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Affiliation(s)
| | - Marilyn Ballantyne
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Canada.,Holland Bloorview Kids Rehabilitation Hospital, Toronto, Canada
| | - Kristin Cleverley
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Canada.,Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada.,Centre for Addiction and Mental Health, Toronto, Canada
| | - Pamela Green
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Canada.,Holland Bloorview Kids Rehabilitation Hospital, Toronto, Canada
| | - Sarah Brennenstuhl
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Canada
| | - Robyn Stremler
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Canada.,The Hospital for Sick Children (SickKids), Toronto, Canada
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32
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Study protocol for a randomized controlled trial comparing the effectiveness of physical exercise and melatonin supplement on treating sleep disturbance in children with autism spectrum disorders. PLoS One 2022; 17:e0270428. [PMID: 35793342 PMCID: PMC9258841 DOI: 10.1371/journal.pone.0270428] [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: 01/27/2022] [Accepted: 06/07/2022] [Indexed: 11/25/2022] Open
Abstract
Background Previous study showed that both melatonin supplement and physical exercise intervention could improve sleep quality in children with autism spectrum disorders (ASD) with the increase in endogenous melatonin level. However, none of the studies have directly compared the effectiveness between the two interventions on treating sleep disturbance in children with ASD. Without direct comparison, we do not know which intervention is better. Thus, we designed a study to compare which intervention is more effective to treat sleep disturbance in children with ASD and to examine whether the combination of the two could be the most efficacious. We present a protocol for conducting a randomized controlled trial to compare the effectiveness of physical exercise and melatonin supplement on treating sleep disturbance in children with ASD. Study design The proposed study will be a four-group randomised control trial (RCT) design, with equal allocation of participants to the three intervention groups and one control group. Methods All eligible participants will be randomly allocated to a morning jogging group, a melatonin supplement group, a combination group and a control group. Changes in sleep quality will be monitored through actigraphic assessment and parental sleep logs. Melatonin levels represented by 6-sulfoxymelatonin will be measured from the participants’ 24-h and the first morning void urinary samples. All the assessments will be carried out before the intervention (T1), in the mid of the study (5 weeks after the commencement of the study) (T2) and after the 10-week intervention (T3). Level of statistical significance will be set at 5% (i.e. p < .05). The results of this trial will be submitted for publication in peer-reviewed journal. Findings The findings will provide evidence to determine whether physical exercise or melatonin supplement or the combination of interventions is the most effective to treat sleep disturbance in children with ASD.
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Approches thérapeutiques des troubles du sommeil et des rythmes chez l’enfant avec TSA. Encephale 2022; 48:294-303. [DOI: 10.1016/j.encep.2021.08.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Revised: 07/12/2021] [Accepted: 08/20/2021] [Indexed: 12/27/2022]
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Gao Y, Aljazi MB, He J. Neural Hyperactivity Is a Core Pathophysiological Change Induced by Deletion of a High Autism Risk Gene Ash1L in the Mouse Brain. Front Behav Neurosci 2022; 16:873466. [PMID: 35449559 PMCID: PMC9016273 DOI: 10.3389/fnbeh.2022.873466] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Accepted: 03/11/2022] [Indexed: 11/13/2022] Open
Abstract
ASH1L is one of the highest risk genes associated with autism spectrum disorder (ASD) and intellectual disability (ID). Our recent studies demonstrate that loss of Ash1l in the mouse brain is sufficient to induce ASD/ID-like behavioral and cognitive deficits, suggesting that disruptive ASH1L mutations are likely to have a positive correlation with ASD/ID genesis. However, the core pathophysiological changes in the Ash1l-deficient brain remain largely unknown. Here we show that loss of Ash1l in the mouse brain causes locomotor hyperactivity, high metabolic activity, and hyperactivity-related disturbed sleep and lipid metabolic changes. In addition, the mutant mice display lower thresholds for the convulsant reagent-induced epilepsy and increased neuronal activities in multiple brain regions. Thus, our current study reveals that neural hyperactivity is a core pathophysiological change in the Ash1l-deficient mouse brain, which may function as a brain-level mechanism leading to the Ash1l-deletion-induced brain functional abnormalities and autistic-like behavioral deficits.
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Mylonas D, Machado S, Larson O, Patel R, Cox R, Vangel M, Maski K, Stickgold R, Manoach DS. Dyscoordination of non-rapid eye movement sleep oscillations in autism spectrum disorder. Sleep 2022; 45:6505127. [DOI: 10.1093/sleep/zsac010] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Revised: 12/13/2021] [Indexed: 11/14/2022] Open
Abstract
Abstract
Study Objectives
Converging evidence from neuroimaging, sleep, and genetic studies suggest that dysregulation of thalamocortical interactions mediated by the thalamic reticular nucleus (TRN) contribute to autism spectrum disorder (ASD). Sleep spindles assay TRN function, and their coordination with cortical slow oscillations (SOs) indexes thalamocortical communication. These oscillations mediate memory consolidation during sleep. In the present study, we comprehensively characterized spindles and their coordination with SOs in relation to memory and age in children with ASD.
Methods
Nineteen children and adolescents with ASD, without intellectual disability, and 18 typically developing (TD) peers, aged 9–17, completed a home polysomnography study with testing on a spatial memory task before and after sleep. Spindles, SOs, and their coordination were characterized during stages 2 (N2) and 3 (N3) non-rapid eye movement sleep.
Results
ASD participants showed disrupted SO-spindle coordination during N2 sleep. Spindles peaked later in SO upstates and their timing was less consistent. They also showed a spindle density (#/min) deficit during N3 sleep. Both groups showed significant sleep-dependent memory consolidation, but their relations with spindle density differed. While TD participants showed the expected positive correlations, ASD participants showed the opposite.
Conclusions
The disrupted SO-spindle coordination and spindle deficit provide further evidence of abnormal thalamocortical interactions and TRN dysfunction in ASD. The inverse relations of spindle density with memory suggest a different function for spindles in ASD than TD. We propose that abnormal sleep oscillations reflect genetically mediated disruptions of TRN-dependent thalamocortical circuit development that contribute to the manifestations of ASD and are potentially treatable.
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Affiliation(s)
- Dimitrios Mylonas
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
- Athinoula A. Martinos Center for Biomedical Imaging, Charlestown, MA, USA
| | - Sasha Machado
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Olivia Larson
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
- Department of Psychology, University of Pennsylvania, Philadelphia, PA,USA
| | - Rudra Patel
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Roy Cox
- Department of Psychiatry, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
- Department of Sleep and Cognition, Netherlands Institute for Neuroscience, Amsterdam,The Netherlands
| | - Mark Vangel
- Department of Biostatistics, Massachusetts General Hospital, Harvard Medical School, Boston, MA,USA
| | - Kiran Maski
- Department of Neurology, Boston Children’s Hospital, Boston, MA, USA
| | - Robert Stickgold
- Department of Psychiatry, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Dara S Manoach
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
- Athinoula A. Martinos Center for Biomedical Imaging, Charlestown, MA, USA
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Tse AC, Lee PH, Zhang J, Chan RC, Ho AW, Lai EW. Effects of exercise on sleep, melatonin level, and behavioral functioning in children with autism. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2022; 26:1712-1722. [PMID: 35083939 DOI: 10.1177/13623613211062952] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
LAY ABSTRACT This study examined the impact of physical exercise on sleep and behavioral functioning in children (aged 8-12 years) with autism spectrum disorders. It also investigated whether exercise would alter endogenous melatonin level among the population. Participants were divided into two groups: exercise group (12-week, 30-min morning jogging intervention) and a control group (i.e. did not receive any physical exercise intervention during the study period). Significant improvements on sleep and behavioral functioning were found in the exercise group, but not in the control group Moreover, a significant increase in melatonin level was also shown in the exercise group. Findings of this study reconfirmed the sleep and behavioral benefits of exercise in children with autism spectrum disorder. Melatonin-mediated mechanism should be further explored to develop an effective treatment intervention.
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Affiliation(s)
- Andy Cy Tse
- The Education University of Hong Kong, Hong Kong
| | | | - Jihui Zhang
- The Chinese University of Hong Kong, Hong Kong
| | - Roy Cy Chan
- The Education University of Hong Kong, Hong Kong
| | - Amy Wy Ho
- The Chinese University of Hong Kong, Hong Kong
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Whelan S, Mannion A, Madden A, Berger F, Costello R, Ghadiri S, Leader G. Examining the Relationship Between Sleep Quality, Social Functioning, and Behavior Problems in Children with Autism Spectrum Disorder: A Systematic Review. Nat Sci Sleep 2022; 14:675-695. [PMID: 35444482 PMCID: PMC9015051 DOI: 10.2147/nss.s239622] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Accepted: 04/06/2022] [Indexed: 11/23/2022] Open
Abstract
Over forty percent of autistic children experience poor sleep quality, and social interaction difficulties are a core characteristic of autism. However, the relationship between sleep quality and social functioning and behavior remains poorly understood. This systematic review examined the evidence concerning the impact of sleep quality on the social functioning and behavior problems in autistic children and adolescents. It also identified key related factors and evaluated how this issue has been researched to date. Seven key journals were hand-searched and five databases were systematically searched, using keywords. Titles and abstracts of 4123 items were screened against eligibility criteria by two researchers. Relevant studies were retained if they were peer-reviewed empirical papers, published in English between 2000 and 2021. Then, the full text of 97 papers was screened and if they met the eligibility criteria, their reference lists were hand-searched. Forty-six studies were included in the final review. Data were systematically extracted and two authors critically appraised the strengths and weaknesses of studies using Critical Appraisal Skills Programme tools. Key themes were identified, because a meta-analysis was not possible due to the studies' heterogeneity. The review identified that sleep quality and social functioning are associated with one another and there is a small amount of evidence that a bi-directional causal relationship may exist. Evidence suggests that several nights of suboptimal sleep duration and a lack of deep continuous sleep negatively impact externalizing and internalizing behavior. Sleep quality is also reduced by anxiety and sensory sensitivity. However, longitudinal studies with larger samples are needed to establish causality. Future research needs to examine confounding factors and to develop consensus regarding best-practice processes for the objective measurement of sleep with autistic children. Additional research also needs to further examine the consequences of poor sleep quality on internalizing behavior, and the impact of socio-cultural practices.
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Affiliation(s)
- Sally Whelan
- Irish Center for Autism and Neurodevelopmental Research (ICAN), School of Psychology, National University of Ireland, Galway, Ireland
| | - Arlene Mannion
- Irish Center for Autism and Neurodevelopmental Research (ICAN), School of Psychology, National University of Ireland, Galway, Ireland
| | - Azeem Madden
- Irish Center for Autism and Neurodevelopmental Research (ICAN), School of Psychology, National University of Ireland, Galway, Ireland
| | - Fine Berger
- Irish Center for Autism and Neurodevelopmental Research (ICAN), School of Psychology, National University of Ireland, Galway, Ireland
| | - Rachel Costello
- Irish Center for Autism and Neurodevelopmental Research (ICAN), School of Psychology, National University of Ireland, Galway, Ireland
| | - Saeid Ghadiri
- Irish Center for Autism and Neurodevelopmental Research (ICAN), School of Psychology, National University of Ireland, Galway, Ireland
| | - Geraldine Leader
- Irish Center for Autism and Neurodevelopmental Research (ICAN), School of Psychology, National University of Ireland, Galway, Ireland
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Schwichtenberg AJ, Janis A, Lindsay A, Desai H, Sahu A, Kellerman A, Chong PLH, Abel EA, Yatcilla JK. Sleep in Children with Autism Spectrum Disorder: A Narrative Review and Systematic Update. CURRENT SLEEP MEDICINE REPORTS 2022; 8:51-61. [PMID: 36345553 PMCID: PMC9630805 DOI: 10.1007/s40675-022-00234-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/13/2022] [Indexed: 11/06/2022]
Abstract
Purpose of Review Sleep problems are a common comorbidity for children with autism spectrum disorder (ASD), and research in this area has a relatively long history. Within this review, we first outline historic patterns in the field of sleep and ASD. Second, we conducted a systematic update and coded these studies based on their alignment with historic patterns. Research on ASD and sleep over the past two decades has primarily focused on four principal areas: (1) documenting the prevalence and types of sleep problems; (2) sleep problem treatment options and efficacy; (3) how sleep problems are associated with other behavioral, contextual, or biological elements; and (4) the impact of child sleep problems on families and care providers. The systematic update in this paper includes empirical studies published between 2018 and 2021 with terms for sleep and ASD within the title, keywords, or abstract. Recent Findings In sum, 60 studies fit the inclusion/exclusion criteria and most fit within the historic patterns noted above. Notable differences included more global representation in study samples, studies on the impacts of COVID-19, and a growing body of work on sleep problems as an early marker of ASD. The majority of studies focus on correlates of sleep problems noting less optimal behavioral, contextual, and biological elements are associated with sleep problems across development for children with ASD. Summary Recommendations for future directions include continued expansion of global and age representation across samples, a shift toward more treatment and implementation science, and studies that inform our mechanistic understanding of how sleep and ASD are connected. Supplementary Information The online version contains supplementary material available at 10.1007/s40675-022-00234-5.
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Affiliation(s)
- A. J. Schwichtenberg
- Department of Human Development and Family Studies at Purdue University, West Lafayette, IN USA
| | - Amy Janis
- Department of Human Development and Family Studies at Purdue University, West Lafayette, IN USA
| | - Alex Lindsay
- Department of Human Development and Family Studies at Purdue University, West Lafayette, IN USA
| | - Hetvi Desai
- Department of Human Development and Family Studies at Purdue University, West Lafayette, IN USA
| | - Archit Sahu
- Department of Human Development and Family Studies at Purdue University, West Lafayette, IN USA
| | - Ashleigh Kellerman
- Department of Human Development and Family Studies at Purdue University, West Lafayette, IN USA
| | - Pearlynne Li Hui Chong
- Department of Human Development and Family Studies at Purdue University, West Lafayette, IN USA
| | - Emily A. Abel
- Department of Human Development and Family Studies at Purdue University, West Lafayette, IN USA
| | - Jane Kinkus Yatcilla
- Libraries and School of Information Studies at Purdue University, West Lafayette, IN USA
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Burstein O, Geva R. The Brainstem-Informed Autism Framework: Early Life Neurobehavioral Markers. Front Integr Neurosci 2021; 15:759614. [PMID: 34858145 PMCID: PMC8631363 DOI: 10.3389/fnint.2021.759614] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Accepted: 10/18/2021] [Indexed: 12/27/2022] Open
Abstract
Autism spectrum disorders (ASD) have long-term implications on functioning at multiple levels. In this perspective, we offer a brainstem-informed autism framework (BIAF) that traces the protracted neurobehavioral manifestations of ASD to early life brainstem dysfunctions. Early life brainstem-mediated markers involving functions of autonomic/arousal regulation, sleep-wake homeostasis, and sensorimotor integration are delineated. Their possible contributions to the early identification of susceptible infants are discussed. We suggest that the BIAF expands our multidimensional understanding of ASD by focusing on the early involvement of brainstem systems. Importantly, we propose an integrated BIAF screener that brings about the prospect of a sensitive and reliable early life diagnostic scheme for weighing the risk for ASD. The BIAF screener could provide clinicians substantial gains in the future and may carve customized interventions long before the current DSM ASD phenotype is manifested using dyadic co-regulation of brainstem-informed autism markers.
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Affiliation(s)
- Or Burstein
- Department of Psychology, Bar-Ilan University, Ramat Gan, Israel
| | - Ronny Geva
- Department of Psychology, Bar-Ilan University, Ramat Gan, Israel
- Gonda Multidisciplinary Brain Research Center, Bar-Ilan University, Ramat Gan, Israel
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Brewer R, Murphy J, Bird G. Atypical interoception as a common risk factor for psychopathology: A review. Neurosci Biobehav Rev 2021; 130:470-508. [PMID: 34358578 PMCID: PMC8522807 DOI: 10.1016/j.neubiorev.2021.07.036] [Citation(s) in RCA: 48] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Revised: 07/09/2021] [Accepted: 07/31/2021] [Indexed: 02/06/2023]
Abstract
The inadequacy of a categorial approach to mental health diagnosis is now well-recognised, with many authors, diagnostic manuals and funding bodies advocating a dimensional, trans-diagnostic approach to mental health research. Variance in interoception, the ability to perceive one's internal bodily state, is reported across diagnostic boundaries, and is associated with atypical functioning across symptom categories. Drawing on behavioural and neuroscientific evidence, we outline current research on the contribution of interoception to numerous cognitive and affective abilities (in both typical and clinical populations), and describe the interoceptive atypicalities seen in a range of psychiatric conditions. We discuss the role that interoception may play in the development and maintenance of psychopathology, as well as the ways in which interoception may differ across clinical presentations. A number of important areas for further research on the role of interoception in psychopathology are highlighted.
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Affiliation(s)
- Rebecca Brewer
- Department of Psychology, Royal Holloway, University of London, United Kingdom
| | - Jennifer Murphy
- Department of Psychology, Royal Holloway, University of London, United Kingdom.
| | - Geoffrey Bird
- Department of Experimental Psychology, University of Oxford, United Kingdom; Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, United Kingdom
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Autism Spectrum Disorder and Intellectual Disability: A Pilot Study Exploring Associations between Child Sleep Problems, Child Factors and Parent Factors. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182111377. [PMID: 34769894 PMCID: PMC8583620 DOI: 10.3390/ijerph182111377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Revised: 10/18/2021] [Accepted: 10/26/2021] [Indexed: 12/04/2022]
Abstract
Sleep problems are common in children with autism spectrum disorder (ASD). However, few studies have undertaken group comparisons of sleep profiles and factors associated with poorer sleep between children with ASD without intellectual disability (ID; hereafter referred to as ASD) and ASD with co-occurring ID (hereafter referred to as ASD + ID). This study aimed to (1) compare child (sleep problems and emotional and behavioural problems (EBPs)) and parent factors (parenting stress and mental health) for children with ASD compared to children with ASD + ID, and (2) examine the associations between sleep problems and child and parent factors in both groups. Parents of 56 children with ASD (22 ASD, 34 ASD + ID) aged 6–13 years took part in the study. No statistically significant differences in sleep problems were found between children with ASD compared to children with ASD + ID. However, total EBPs were independently associated with child sleep problems in both groups. Further, ‘Self-Absorbed’ and ‘Communication Disturbance’ EBPs were significantly greater in the ASD + ID compared to the ASD group. Overall treatment outcomes for children with ASD may be further improved if consideration is given to the specific types of EBPs being experienced by the child and their association with sleep problems.
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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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Seo WS. An update on the cause and treatment of sleep disturbance in children and adolescents with autism spectrum disorder. Yeungnam Univ J Med 2021; 38:275-281. [PMID: 34510867 PMCID: PMC8688794 DOI: 10.12701/yujm.2021.01410] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Accepted: 08/25/2021] [Indexed: 11/30/2022] Open
Abstract
Autism spectrum disorder (ASD) is a neurodevelopmental disorder characterized by abnormalities in social communication/interaction and restrictive, repetitive patterns of behavior. ASD is a relatively common psychiatric disorder, with a prevalence of approximately 1.7% in children. Although many children and adolescents with ASD visit the hospital for medical help for emotional and behavioral problems such as mood instability and self-harming behavior, there are also many visits for sleep disturbances such as insomnia and sleep resistance. Sleep disturbances are likely to increase fatigue and daytime sleepiness, impaired concentration, negatively impact on daytime functioning, and pose challenges in controlling anger and aggressive behavior. Sleep disturbance in children and adolescents with ASD negatively affects the quality of life, nothing to say the quality of life of their families and school members. In this review, sleep disturbances that are common in children and adolescents with ASD and adolescents are presented. The developmental and behavioral impacts of sleep disturbances in ASD were also considered. Finally, non-pharmacological and pharmacological treatments for sleep disturbances in children and adolescents with ASD and adolescents are reviewed.
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Affiliation(s)
- Wan Seok Seo
- Department of Psychiatry, Yeungnam University College of Medicine, Daegu, Korea
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Subjective and Electroencephalographic Sleep Parameters in Children and Adolescents with Autism Spectrum Disorder: A Systematic Review. J Clin Med 2021; 10:jcm10173893. [PMID: 34501341 PMCID: PMC8432113 DOI: 10.3390/jcm10173893] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Revised: 08/18/2021] [Accepted: 08/26/2021] [Indexed: 01/01/2023] Open
Abstract
Background: Sleep problems have commonly manifested in children and adolescents with autism spectrum disorder (ASD) with a complex and multifactorial interaction between clinical and etiological components. These disorders are associated with functional impairment, and provoke significant physical and mental affliction. The purpose of this study is to update the existing literature about objective and subjective sleep parameters in children and adolescents with ASD, extrapolating information from polysomnography or sleep electroencephalography, and sleep related questionnaires. Methods: We have conducted a systematic review of case-control studies on this topic, performing a web-based search on PubMed, Scopus and the Web of Science databases according to the Preferred Reporting items for Systematic Review and Meta-analyses (PRISMA) guidelines. Results: Data collected from 20 survey result reports showed that children and adolescents with ASD experienced a higher rate of sleep abnormalities than in typically developing children. The macrostructural sleep parameters that were consistent with subjective parent reported measures unveil a greater percentage of nighttime signs of insomnia. Sleep microstructure patterns, in addition, pointed towards the bidirectional relationship between brain dysfunctions and sleep problems in children with ASD. Conclusions: Today’s literature acknowledges that objective and subjective sleep difficulties are more often recognized in individuals with ASD, so clinicians should assess sleep quality in the ASD clinical population, taking into consideration the potential implications on treatment strategies. It would be worthwhile in future studies to examine how factors, such as age, cognitive level or ASD severity could be related to ASD sleep abnormalities. Future research should directly assess whether sleep alterations could represent a specific marker for atypical brain development in ASD.
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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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Black B. Sleep and Autism: An impactful and complex relationship that requires a personalized medicine approach. Sleep 2021; 44:6320054. [PMID: 34255079 DOI: 10.1093/sleep/zsab178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- Benjamin Black
- University of Missouri, Department of Child Health, Columbia, MO, United States of America
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47
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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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48
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Earl RK, Ward T, Gerdts J, Eichler EE, Bernier RA, Hudac CM. Sleep Problems in Children with ASD and Gene Disrupting Mutations. The Journal of Genetic Psychology 2021; 182:317-334. [PMID: 33998396 DOI: 10.1080/00221325.2021.1922869] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Sleep difficulties are pervasive in autism spectrum disorder (ASD), yet how sleep problems relate to underlying biological mechanisms such as genetic etiology is unclear, despite recent reports of profound sleep problems in children with ASD-associated de novo likely gene disrupting (dnLGD) mutations, CHD8, DYRK1A, and ADNP. We aimed to inform etiological contributions to ASD and sleep by characterizing sleep problems in individuals with dnLGD mutations. Participants (N = 2886) were families who completed dichotomous questions about sleep problems within a medical history interview for their child with ASD (age 3-28 years). Confirmatory factor analyses compared between those with ASD and a dnLGD mutation and those with idiopathic ASD (i.e., no known genetic event, NON) highlighted four domains (sleep onset, breathing issues, nighttime awakenings, and daytime tiredness) with sleep onset as a strong factor for both groups. Overall, participant predictors indicated that internalizing behavioral problems and lower cognitive scores were related to increased sleep problems. Internalizing problems were also related to increase nighttime awakenings in the dnLGD group. As an exploratory aim, patterns of sleep issues are described for genetic subgroups with unique patterns including more overall sleep issues in ADNP (n = 19), problems falling asleep in CHD8 (n = 22), and increased daytime naps in DYRK1A (n = 23). Implications for considering genetically defined subgroups when approaching sleep problems in children with ASD are discussed.
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Affiliation(s)
- Rachel K Earl
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, Washington, USA
| | - Tracey Ward
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, Washington, USA
| | - Jennifer Gerdts
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, Washington, USA
| | - Evan E Eichler
- Department of Genome Sciences, University of Washington, Seattle, Washington, USA.,Howard Hughes Medical Institute, Seattle, Washington, USA
| | - Raphael A Bernier
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, Washington, USA
| | - Caitlin M Hudac
- Center for Youth Development and Intervention and Department of Psychology, University of Alabama, Tuscaloosa, Alabama, USA
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49
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Ansari S, AdibSaber F, Elmieh A, Gholamrezaei S. The effect of water-based intervention on sleep habits and two sleep-related cytokines in children with autism. Sleep Med 2021; 82:78-83. [PMID: 33906043 DOI: 10.1016/j.sleep.2021.03.045] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2020] [Revised: 03/27/2021] [Accepted: 03/31/2021] [Indexed: 12/17/2022]
Abstract
OBJECTIVE Previous studies have shown that children with autism have sleep disturbances and elevated levels of pro-inflammatory cytokines. This study aimed to evaluate the effect of aquatic exercise on sleep habits and two certain sleep-related cytokines of children with autism spectrum disorders (ASD). METHODS Forty boys with ASD (aged 6-14) were recruited and randomly assigned to an aquatic exercise (n = 20) or a control group (n = 20). Participants in aquatic exercise group performed water-based activities for 10 weeks/2 sessions per week/60 min, while control group didn't get any intervention. The serum levels of Interleukin-1 beta (IL-1β) and Tumor necrosis factor-α (TNF-α) and sleep quality were measured before and after the intervention. RESULTS Results revealed that aquatic exercise may improve sleep quality and reduce the serum levels of IL-1β and TNF-α in children with ASD compared to control group. CONCLUSIONS Overall, it is recommended that physicians and educators should provide a safe and effective exercise environment for ASD children to alleviate sleep issues and inflammatory biomarkers.
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Affiliation(s)
- Soleyman Ansari
- Department of Physical Education, Rasht Branch, Islamic Azad University, Rasht, Iran.
| | - Fahimeh AdibSaber
- Department of Physical Education, Rasht Branch, Islamic Azad University, Rasht, Iran.
| | - Alireza Elmieh
- Department of Physical Education, Rasht Branch, Islamic Azad University, Rasht, Iran.
| | - Shahram Gholamrezaei
- Department of Physical Education, Rasht Branch, Islamic Azad University, Rasht, Iran.
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50
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Manelis-Baram L, Meiri G, Ilan M, Faroy M, Michaelovski A, Flusser H, Menashe I, Dinstein I. Sleep Disturbances and Sensory Sensitivities Co-Vary in a Longitudinal Manner in Pre-School Children with Autism Spectrum Disorders. J Autism Dev Disord 2021; 52:923-937. [PMID: 33835353 PMCID: PMC8033551 DOI: 10.1007/s10803-021-04973-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/10/2021] [Indexed: 12/29/2022]
Abstract
Previous research has demonstrated that sleep disturbances are positively correlated with sensory sensitivities in children with ASD. Most of these studies, however, were based on cross-sectional analyses, where the relationship across symptom domains was examined at a single time-point. Here, we examined the development of 103 pre-school children with ASD over a 1–3-year period. The results revealed that spontaneous longitudinal changes in sleep disturbances were specifically correlated with changes in sensory sensitivities and not with changes in other sensory processing domains nor with changes in core ASD symptoms. These finding demonstrate a consistent longitudinal relationship between sleep disturbances and sensory sensitivities, which suggests that these symptoms may be generated by common or interacting underlying physiological mechanisms.
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Affiliation(s)
- Liora Manelis-Baram
- Psychology Department, Ben-Gurion University of the Negev, Beer Sheva, Israel. .,National Autism Research Center of Israel, Beer Sheva, Israel. .,The Academic College of Tel-Aviv-Yaffo, Tel-Aviv, Israel.
| | - Gal Meiri
- National Autism Research Center of Israel, Beer Sheva, Israel.,Pre-School Psychiatry Unit, Soroka University Medical Center, Beer Sheva, Israel
| | - Michal Ilan
- Psychology Department, Ben-Gurion University of the Negev, Beer Sheva, Israel.,National Autism Research Center of Israel, Beer Sheva, Israel.,Pre-School Psychiatry Unit, Soroka University Medical Center, Beer Sheva, Israel
| | - Michal Faroy
- Psychology Department, Ben-Gurion University of the Negev, Beer Sheva, Israel.,National Autism Research Center of Israel, Beer Sheva, Israel.,The Academic College of Tel-Aviv-Yaffo, Tel-Aviv, Israel.,Pre-School Psychiatry Unit, Soroka University Medical Center, Beer Sheva, Israel
| | - Analya Michaelovski
- National Autism Research Center of Israel, Beer Sheva, Israel.,Zusman Child Development Center, Soroka University Medical Center, Beer Sheva, Israel
| | - Hagit Flusser
- National Autism Research Center of Israel, Beer Sheva, Israel.,Zusman Child Development Center, Soroka University Medical Center, Beer Sheva, Israel
| | - Idan Menashe
- National Autism Research Center of Israel, Beer Sheva, Israel.,Public Health Department, Ben-Gurion University of the Negev, Beer Sheva, Israel
| | - Ilan Dinstein
- Psychology Department, Ben-Gurion University of the Negev, Beer Sheva, Israel.,National Autism Research Center of Israel, Beer Sheva, Israel.,Cognitive and Brain Sciences Department, Ben-Gurion University of the Negev, Beer Sheva, Israel
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