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Wenzell ML, Johnson CR, Lecavalier L, Barto L, Mulligan A, Williams A, Ousley O, Kim SY, Schiltz NK, Scahill L. Exploring the Congruence of actigraphy and the Pediatric Autism Insomnia rating Scale. Sleep Med 2024; 123:49-53. [PMID: 39241463 DOI: 10.1016/j.sleep.2024.08.029] [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: 04/17/2024] [Revised: 08/23/2024] [Accepted: 08/27/2024] [Indexed: 09/09/2024]
Abstract
OBJECTIVE/BACKGROUND Insomnia is common in children with autism spectrum disorder (ASD). We recently developed and validated the 21-item Pediatric Autism Insomnia Rating Scale (PAIRS). This report explores the associations and agreements between actigraphy and PAIRS. PARTICIPANTS METHODS Children with ASD, with and without sleep problems, were assessed with a battery of parent-rated and clinician measures (N = 134). In a subset (n = 70), a wrist-worn actigraph measured sleep for five consecutive nights. Parents completed logs for scoring sleep intervals. Spearman correlations evaluated associations with the PAIRS and actigraphy indices (sleep onset latency = SOL, wake after sleep onset = WASO, total sleep time = TST, sleep efficiency = SE%). Agreements on "poor sleepers" based on PAIRS total score (≥33) and conventional thresholds for TST and SE% were evaluated with Cohen's Kappa and McNemar's test. RESULTS Actigraphy data were averaged over 4.64 ± 0.68 nights in 70 children (mean age = 7.3 ± 2.9, 74.3 % male). There were no significant correlations between PAIRS and any actigraphy indices. On TST, 48.6 % (n = 34) and on SE% 52.9 % (n = 37) were classified as "poor sleepers" compared to 32.9 % (n = 23) on PAIRS (kappa = 0.11 for TST and 0.27 for SE%). P-values on McNemar's Chi square test for PAIRS with TST and with SE% were 0.072 and 0.011, respectfully. CONCLUSIONS These results suggest that actigraphy and PAIRS do not agree. Actigraphy TST captures movement and an estimate of specific sleep parameters. PAIRS is a broader measure that incorporates sleep disturbance and sleep-related impairment.
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Affiliation(s)
- Megan L Wenzell
- Case Western Reserve University Frances Payne Bolton School of Nursing, 9501 Euclid Ave, Cleveland, OH, 44106, USA
| | - Cynthia R Johnson
- Cleveland Clinic Children's Center for Autism, Lerner College of Medicine at Case Western Reserve University, 2801 Martin Luther King Jr. Dr., Cleveland, OH, 44104, USA
| | - Luc Lecavalier
- The Ohio State University Nisonger Center and Department of Psychology, 1581 Dodd Drive, Columbus, OH, 43210, USA
| | - Leah Barto
- Cleveland Clinic Children's Center for Autism, Lerner College of Medicine at Case Western Reserve University, 2801 Martin Luther King Jr. Dr., Cleveland, OH, 44104, USA
| | - Arielle Mulligan
- The Ohio State University Nisonger Center, 1581 Dodd Drive, Columbus, OH, 43210, USA
| | - Auscia Williams
- Emory University School of Medicine, Marcus Autism Center, 1920 Briarcliff Rd. NE, Atlanta, GA, 30033, USA
| | - Opal Ousley
- Emory University of Medicine, 2015 Uppergate Drive, Atlanta, GA, 30307, USA
| | - Soo Youn Kim
- The Ohio State University Nisonger Center, 1581 Dodd Drive, Columbus, OH, 43210, USA; Nationwide Children's Hospital, 700 Childrens Drive, Columbus, OH, 43205, USA
| | - Nicholas K Schiltz
- Case Western Reserve University Frances Payne Bolton School of Nursing, 9501 Euclid Ave, Cleveland, OH, 44106, USA
| | - Lawrence Scahill
- Emory University School of Medicine, Marcus Autism Center, 1920 Briarcliff Rd. NE, Atlanta, GA, 30033, USA.
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Hao Y, Zhou X, Razman R, Peng S, Ahmad NS. Compliance with the 24-hour movement behaviour guidelines among children and adolescents with disabilities: a systematic review and meta-analysis. BMC Public Health 2024; 24:2357. [PMID: 39215263 PMCID: PMC11363391 DOI: 10.1186/s12889-024-19842-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2024] [Accepted: 08/21/2024] [Indexed: 09/04/2024] Open
Abstract
BACKGROUND Compliance with the 24-Hour Movement Guidelines (24-HMG: physical activity (PA), screen time (ST), and sleep) has been associated with numerous beneficial health outcomes among children and adolescents. However, there is a lack of consensus on the overall compliance with the 24-HMG specifically among children and adolescents with disabilities. Therefore, this systematic review and meta-analysis aimed to examine the extent to which children and adolescents with disabilities adhere to the 24-HMG globally. METHOD Quantitative studies published in English until May 2023 were sought by searching seven electronic databases: Web of Science, PubMed, SPORTDiscus, CINAHL, MEDLINE, Scopus, Psychology and Behavioural Sciences Collection. This review included studies that identified participants as individuals with disabilities and reported the overall (non) compliance with the 24-HMG among children and adolescents with disabilities. RESULTS A total of 13 studies, involving 21,101 individuals (65.95% males), aged 6 to 21 years from 9 countries, were included in the analysis. In general, 7% (95%CI: 0.05-0.09, p < 0.01) of children and adolescents with disabilities met all three 24-HMG, while 16% (95%CI: 0.13-020, p < 0.01) did not meet any of the three recommendations. Regarding adherence to individual 24-hour movement behaviour, the rates of compliance were 22% (95%CI: 0.18-0.25, p < 0.01) for PA, 49% (95%CI: 0.41-0.56, p < 0.01) for ST, and 59% (95%CI: 0.56-0.61, p < 0.01) sleep. In relation to numbers of those meeting the 24-HMG, 43% (95%CI: 0.41-0.45, p < 0.01) met one guideline, while 32% (95%CI: 0.28-0.36, p < 0.01) met two guidelines. CONCLUSION There is a notable percentage of children and adolescents with disabilities who do not meet the recommended the 24-HMG, which encompasses PA, ST, and sleep. This underscores the pressing requirement to create and execute evidence-based strategies that effectively encourage and assist these individuals with disabilities in adopting and maintaining these movement behaviours.
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Affiliation(s)
- Yaru Hao
- School of Sports Science, Changsha Normal University, Changsha, China
| | - Xiaogang Zhou
- School of Educational Studies, Universiti Sains Malaysia, Penang, Malaysia
| | - Rizal Razman
- Faculty of Sports and Exercise Science, Universiti Malaya, Kuala Lumpur, 50603, Malaysia.
| | - Sanying Peng
- Department of Physical Education, Hohai University, Nanjing, China
| | - Nor Shafrin Ahmad
- School of Educational Studies, Universiti Sains Malaysia, Penang, Malaysia
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Galion AW, Farmer JG, Connolly HV, Allhusen VD, Bennett A, Coury DL, Lam J, Neumeyer AM, Sohl K, Witmans M, Malow BA. A Practice Pathway for the Treatment of Night Wakings in Children with Autism Spectrum Disorder. J Autism Dev Disord 2024; 54:2926-2945. [PMID: 37358787 PMCID: PMC11300650 DOI: 10.1007/s10803-023-06026-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/26/2023] [Indexed: 06/27/2023]
Abstract
Children with autism spectrum disorder (ASD) report high rates of sleep problems. In 2012, the Autism Treatment Network/ Autism Intervention Research Network on Physical Health (ATN/AIR-P) Sleep Committee developed a pathway to address these concerns. Since its publication, ATN/AIR-P clinicians and parents have identified night wakings as a refractory problem unaddressed by the pathway. We reviewed the existing literature and identified 76 scholarly articles that provided data on night waking in children with ASD. Based on the available literature, we propose an updated practice pathway to identify and treat night wakings in children with ASD.
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Affiliation(s)
- Anjalee W Galion
- Division of Neurology, Children's Hospital of Orange County, 1201 W. La Veta Avenue, Orange, CA, 92868, USA.
| | - Justin G Farmer
- Massachusetts General Hospital for Children, Boston, MA, USA
| | | | - Virginia D Allhusen
- Division of Neurology, Children's Hospital of Orange County, 1201 W. La Veta Avenue, Orange, CA, 92868, USA
| | - Amanda Bennett
- Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | | | - Janet Lam
- Kennedy Krieger Institute, Baltimore, MD, USA
| | - Ann M Neumeyer
- Massachusetts General Hospital for Children, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Kristin Sohl
- University of Missouri School of Medicine, Columbia, MO, USA
| | | | - Beth A Malow
- Vanderbilt University Medical Center, Nashville, TN, USA
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Scahill L, Lecavalier L, Edwards MC, Wenzell ML, Barto LM, Mulligan A, Williams AT, Ousley O, Sinha CB, Taylor CA, Youn Kim S, Johnson LM, Gillespie SE, Johnson CR. Toward better outcome measurement for insomnia in children with autism spectrum disorder. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2024:13623613241255814. [PMID: 39075748 DOI: 10.1177/13623613241255814] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/31/2024]
Abstract
LAY ABSTRACT Insomnia, trouble falling asleep or staying asleep, is common in autistic children. In a previous report, we described the results of focus groups with parents of autistic children toward the development of the Pediatric Autism Insomnia Rating Scale. In this article, we report on the steps taken to complete the Pediatric Autism Insomnia Rating Scale. With help from the Simons Foundation registry, we collected information from parents on 1185 children with autism spectrum disorder to test the new measure. These results were evaluated using standard statistical methods such as factor analysis. To confirm the validity of the new measure, we enrolled a separate sample of 134 autistic children for a detailed assessment by video conference. This step showed that the Pediatric Autism Insomnia Rating Scale is clearly measuring symptoms of insomnia in children with autism spectrum disorder and not related problems such as hyperactivity, repetitive behavior, or anxiety. We also showed that the total score on the Pediatric Autism Insomnia Rating Scale is stable when repeated over a brief period of time. This is important because a measure that is not stable over a brief period of time would not be suitable as an outcome measure. In summary, the Pediatric Autism Insomnia Rating Scale is a brief and valid measure of insomnia in children with autism spectrum disorder that provides reliable scores.
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Affiliation(s)
| | | | | | | | - Leah M Barto
- Case Western Reserve University, USA
- Cleveland Clinic, USA
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Poe AR, Zhu L, Tang SH, Valencia E, Kayser MS. Energetic demands regulate sleep-wake rhythm circuit development. eLife 2024; 13:RP97256. [PMID: 39037919 PMCID: PMC11262794 DOI: 10.7554/elife.97256] [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] [Indexed: 07/24/2024] Open
Abstract
Sleep and feeding patterns lack strong daily rhythms during early life. As diurnal animals mature, feeding is consolidated to the day and sleep to the night. In Drosophila, circadian sleep patterns are initiated with formation of a circuit connecting the central clock to arousal output neurons; emergence of circadian sleep also enables long-term memory (LTM). However, the cues that trigger the development of this clock-arousal circuit are unknown. Here, we identify a role for nutritional status in driving sleep-wake rhythm development in Drosophila larvae. We find that in the 2nd instar larval period (L2), sleep and feeding are spread across the day; these behaviors become organized into daily patterns by the 3rd instar larval stage (L3). Forcing mature (L3) animals to adopt immature (L2) feeding strategies disrupts sleep-wake rhythms and the ability to exhibit LTM. In addition, the development of the clock (DN1a)-arousal (Dh44) circuit itself is influenced by the larval nutritional environment. Finally, we demonstrate that larval arousal Dh44 neurons act through glucose metabolic genes to drive onset of daily sleep-wake rhythms. Together, our data suggest that changes to energetic demands in developing organisms trigger the formation of sleep-circadian circuits and behaviors.
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Affiliation(s)
- Amy R Poe
- Department of Psychiatry, Perelman School of Medicine, University of PennsylvaniaPhiladelphiaUnited States
| | - Lucy Zhu
- Department of Psychiatry, Perelman School of Medicine, University of PennsylvaniaPhiladelphiaUnited States
| | - Si Hao Tang
- Department of Psychiatry, Perelman School of Medicine, University of PennsylvaniaPhiladelphiaUnited States
| | - Ella Valencia
- Department of Psychiatry, Perelman School of Medicine, University of PennsylvaniaPhiladelphiaUnited States
| | - Matthew S Kayser
- Department of Psychiatry, Perelman School of Medicine, University of PennsylvaniaPhiladelphiaUnited States
- Chronobiology and Sleep Institute, Perelman School of Medicine, University of PennsylvaniaPhiladelphiaUnited States
- Department of Neuroscience, Perelman School of Medicine, University of PennsylvaniaPhiladelphiaUnited States
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Robeson M, Hayes K, Rossetti K, Ahlich E, Zlomke K. What is in a Day? Investigating the Relationship Between Sleep Quality and Quality of Life Among Caregivers of Children With Autism. J Dev Behav Pediatr 2024; 45:e317-e324. [PMID: 39023857 DOI: 10.1097/dbp.0000000000001278] [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: 09/20/2023] [Accepted: 03/18/2024] [Indexed: 07/20/2024]
Abstract
OBJECTIVE The purpose of this study was to investigate the relationship between sleep quality and quality of life (QOL), or overall level of well-being, in caregivers of children with autism spectrum disorder (ASD) on the daily level. METHOD This study utilizes mobile ecological momentary assessment (mEMA) to capture daily experiences of caregivers of children with ASD over a period of 14 days. Utilizing mEMA, this study examines relations between sleep quality and QOL and the role of mood and physical health as mediators on the daily level, specifically for caregivers of children with ASD (n = 51). The data were analyzed using multilevel modeling by MLMed macro. RESULTS The results suggest that there is a significant positive relation between sleep quality and QOL across individuals. Surprisingly, there was a negative relation between sleep quality and QOL within individuals. The positive relationship between sleep quality and QOL across participants was explained through positive mood across individuals. Furthermore, this relationship also occurred through better physical health across and within individuals. CONCLUSION For caregivers of children with ASD, daily positive mood and better physical health explain the relationship between daily sleep quality and QOL. Understanding daily experiences of caregivers of children with ASD may inform interventions and practices aimed at improving sleep and its associated outcomes to ultimately improve caregiver well-being.
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Dalrymple RA, Wright CM. Is melatonin safe to use long term in children with neurodevelopmental disorders? Arch Dis Child 2024:archdischild-2024-327072. [PMID: 38937060 DOI: 10.1136/archdischild-2024-327072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2024] [Accepted: 05/13/2024] [Indexed: 06/29/2024]
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Shuffrey LC, Rennie B, Li X, Galai N, Pini N, Akbaryan A, Alshawabkeh A, Aschner J, Vargas JC, Costello L, D'Sa V, Deoni S, Dunlop A, Elliott AJ, Fifer WP, Hash J, Koinis-Mitchell D, Lai JS, Leventhal BL, Lewis J, Lucchini M, McArthur KL, Morales S, Nozadi SS, O'Connor TG, O'Shea TM, Page GP, Propper C, Sania A, Shuster C, Zimmerman E, Margolis AE. Combining developmental and sleep health measures for autism spectrum disorder screening: an ECHO study. Pediatr Res 2024:10.1038/s41390-024-03306-0. [PMID: 38867029 DOI: 10.1038/s41390-024-03306-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2024] [Revised: 05/01/2024] [Accepted: 05/20/2024] [Indexed: 06/14/2024]
Abstract
BACKGROUND Sleep problems are reported for up to 80% of autistic individuals. We examined whether parsimonious sets of items derived from the Modified Checklist for Autism in Toddlers, Revised (M-CHAT-R) and the Brief Infant Sleep Questionnaire (BISQ) are superior to the standard M-CHAT-R in predicting subsequent autism spectrum disorder (ASD) diagnoses. METHODS Participants from 11 Environmental influences on Child Health Outcomes (ECHO) cohorts were included. We performed logistic LASSO regression models with 10-fold cross-validation to identify whether a combination of items derived from the M-CHAT-R and BISQ are superior to the standard M-CHAT-R in predicting ASD diagnoses. RESULTS The final sample comprised 1552 children. The standard M-CHAT-R had a sensitivity of 44% (95% CI: 34, 55), specificity of 92% (95% CI: 91, 94), and AUROC of 0.726 (95% CI: 0.663, 0.790). A higher proportion of children with ASD had difficulty falling asleep or resisted bedtime during infancy/toddlerhood. However, LASSO models revealed parental reports of sleep problems did not improve the accuracy of the M-CHAT-R in predicting ASD diagnosis. CONCLUSION While children with ASD had higher rates of sleep problems during infancy/toddlerhood, there was no improvement in ASD developmental screening through the incorporation of parent-report sleep metrics. IMPACT Parental-reported sleep problems are common in autism spectrum disorder (ASD). We investigated whether the inclusion of parental-reports of infant/toddler sleep patterns enhanced the effectiveness of developmental screening for autism. We reported higher rates of difficulty falling asleep and resisting bedtime during infancy and toddlerhood among children later diagnosed with ASD; however, we did not find an improvement in ASD developmental screening through the incorporation of parent-report sleep metrics. In our sample, the standard M-CHAT-R had a sensitivity of 39% among children of mothers with government insurance compared with a sensitivity of 53% among children of mothers with employer-based insurance.
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Affiliation(s)
- Lauren C Shuffrey
- Department of Child and Adolescent Psychiatry, NYU Grossman School of Medicine, New York, NY, USA.
| | - Brandon Rennie
- Department of Pediatrics, University of New Mexico, Albuquerque, NM, USA
| | - Xiuhong Li
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
| | - Noya Galai
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
- Department of Statistics, University of Haifa, Mt Carmel, Israel
| | - Nicolò Pini
- Department of Psychiatry, Columbia University Irving Medical Center, New York, NY, USA
| | - Anahid Akbaryan
- Department of Child and Adolescent Psychiatry, NYU Grossman School of Medicine, New York, NY, USA
| | | | - Judy Aschner
- Department of Pediatrics, Hackensack Meridian School of Medicine, Nutley, NJ, USA
| | - Julianna Collazo Vargas
- Department of Child and Adolescent Psychiatry, NYU Grossman School of Medicine, New York, NY, USA
| | - Lauren Costello
- Department of Child and Adolescent Psychiatry, NYU Grossman School of Medicine, New York, NY, USA
| | - Viren D'Sa
- Department of Pediatrics, Brown University, Providence, RI, USA
| | - Sean Deoni
- Maternal Newborn and Child Health: Discovery & Tools, The Bill & Melinda Gates Foundation, Seattle, WA, USA
| | - Anne Dunlop
- Department of Gynecology & Obstetrics, Emory University, Atlanta, Georgia
| | - Amy J Elliott
- Center for Pediatric and Community Research, Avera Research Institute, Sioux Falls, SD, USA
| | - William P Fifer
- Department of Psychiatry, Columbia University Irving Medical Center, New York, NY, USA
- Division of Developmental Neuroscience, New York State Psychiatric Institute, New York, NY, USA
| | - Jonica Hash
- Department of Child, Family, and Population Health Nursing, University of Washington, Seattle, WA, USA
| | - Daphne Koinis-Mitchell
- Departments of Pediatrics and Psychiatry and Human Behavior, The Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Jin-Shei Lai
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Bennett L Leventhal
- Department of Pediatrics, University of New Mexico, Albuquerque, NM, USA
- Department of Psychiatry and Behavioral Neuroscience, The University of Chicago, Chicago, IL, USA
| | - Johnnye Lewis
- Department of Pediatrics, University of New Mexico, Albuquerque, NM, USA
| | - Maristella Lucchini
- Department of Psychiatry, Columbia University Irving Medical Center, New York, NY, USA
| | - Kristen L McArthur
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
| | - Santiago Morales
- Departments of Psychology and Pediatrics, Developmental and Brain and Cognitive Science Areas, University of Southern California, Los Angeles, CA, USA
| | - Sara S Nozadi
- Community Environmental Health Program, University of New Mexico Health Sciences Center, Albuquerque, NM, USA
| | - Thomas G O'Connor
- Department of Psychiatry, University of Rochester Medical Center, Rochester, NY, USA
| | - T Michael O'Shea
- Department of Pediatrics, University of North Carolina School of Medicine, Chapel Hill, NC, USA
| | - Grier P Page
- Analytics Program, RTI International, Research Triangle Park, NC, USA
| | - Cathi Propper
- School of Nursing, University of North Carolina, Chapel Hill, NC, USA
| | - Ayesha Sania
- Department of Psychiatry, Columbia University Irving Medical Center, New York, NY, USA
| | - Coral Shuster
- The Brown Center for the Study of Children at Risk, Woman & Infants Hospital of Rhode Island, Providence, RI, USA
| | - Emily Zimmerman
- Department of Communication Sciences and Disorders, Northeastern University, Chicago, IL, USA
| | - Amy E Margolis
- Department of Psychiatry, Columbia University Irving Medical Center, New York, NY, USA
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Kiarashi Y, Suresha PB, Rad AB, Reyna MA, Anderson C, Foster J, Lantz J, Villavicencio T, Hamlin T, Clifford GD. Off-body Sleep Analysis for Predicting Adverse Behavior in Individuals with Autism Spectrum Disorder. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2024:2024.01.23.24301681. [PMID: 38343835 PMCID: PMC10854324 DOI: 10.1101/2024.01.23.24301681] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/18/2024]
Abstract
Poor sleep quality in Autism Spectrum Disorder (ASD) individuals is linked to severe daytime behaviors. This study explores the relationship between a prior night's sleep structure and its predictive power for next-day behavior in ASD individuals. The motion was extracted using a low-cost near-infrared camera in a privacy-preserving way. Over two years, we recorded overnight data from 14 individuals, spanning over 2,000 nights, and tracked challenging daytime behaviors, including aggression, self-injury, and disruption. We developed an ensemble machine learning algorithm to predict next-day behavior in the morning and the afternoon. Our findings indicate that sleep quality is a more reliable predictor of morning behavior than afternoon behavior the next day. The proposed model attained an accuracy of 74% and a F1 score of 0.74 in target-sensitive tasks and 67% accuracy and 0.69 F1 score in target-insensitive tasks. For 7 of the 14, better-than-chance balanced accuracy was obtained (p-value<0.05), with 3 showing significant trends (p-value<0.1). These results suggest off-body, privacy-preserving sleep monitoring as a viable method for predicting next-day adverse behavior in ASD individuals, with the potential for behavioral intervention and enhanced care in social and learning settings.
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Affiliation(s)
- Yashar Kiarashi
- Department of Biomedical Informatics, Emory University, Atlanta, GA
| | | | - Ali Bahrami Rad
- Department of Biomedical Informatics, Emory University, Atlanta, GA
| | - Matthew A Reyna
- Department of Biomedical Informatics, Emory University, Atlanta, GA
| | | | | | | | | | | | - Gari D Clifford
- Department of Biomedical Informatics, Emory University, Atlanta, GA
- Department of Biomedical Engineering, Georgia Institute of Technology, Atlanta, GA
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Jiang X, Chen X, Su J, Liu N. Prevalence of autism spectrum disorder in mainland china over the past 6 years: a systematic review and meta-analysis. BMC Psychiatry 2024; 24:404. [PMID: 38811881 PMCID: PMC11137880 DOI: 10.1186/s12888-024-05729-9] [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: 11/05/2023] [Accepted: 03/28/2024] [Indexed: 05/31/2024] Open
Abstract
BACKGROUND Coupled with its rising prevalence, Autism spectrum disorder (ASD) has become a globally recognized public health concern. Nevertheless, large-scale, multicenter studies that analyze the epidemiology of ASD in China are relatively scarce. METHODS Literature searches were conducted in PubMed/Medline, Embase, the Cochrane Library, Wanfang Data Knowledge Service Platform, China Biology Medicine database (CBM), China Science and Technology Journal Database (CSTJ), and China National Knowledge Infrastructure (CNKI) to retrieve studies published before April 8, 2023, related to ASD prevalence among children aged 0 to 14 years in mainland China. Meta-analysis was conducted using RevMan 5.2 and Stata 14.0. RESULTS Twenty-one articles were included. The ASD prevalence among children in mainland China has been 0.7% (95% confidence interval(CI): 0.006-0.008) since 2017. The prevalence of ASD among boys was 1.0% (95% CI: 0.008-0.011), which was significantly higher than that among girls at 0.2% (95% CI: 0.002-0.003), with a statistically significant difference (OR = 3.198, 95% CI: 2.489-4.109, P = 0.000). Among the included studies, 18 reported an ASD prevalence of 0.8% (95% CI: 0.007-0.010), while 3 studies reported an autistic disorder (AD) prevalence of 0.7% (95% CI: 0.006-0.008). The prevalence of autism among urban children was 23.9% (95% CI: 0.149-0.328), and in rural areas, it was 0.7% (95% CI: 0.002-0.013), with no statistically significant difference (OR = 1.342, 95% CI: 0.258-6.975, P = 0.727). Regression analysis showed that factors such as region (P = 0.000), age (P = 0.000), study period (P = 0.000), sample size (P = 0.000), sampling method (P = 0.002), population source (P = 0.000), disease type (P = 0.000), quality score of the study (P = 0.000), and diagnostic criteria (P = 0.000) might have contributed to the heterogeneity in ASD prevalence. CONCLUSION The prevalence of ASD in China from 2017 to 2023 was 7/1000, showing an upward trend compared to that before 2017 (26.50/10,000). The male-to-female prevalence ratio was 5:1.The overall prevalence remained significantly lower than that reported in foreign countries.
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Affiliation(s)
- Xinhong Jiang
- Department of Rehabilitation, Fujian Medical University Union Hospital, Fuzhou, 350001, Fujian, China
| | - Xianrui Chen
- Department of Pediatric Rehabilitation, Xiamen Rehabilitation Hospital, Xiamen, 361003, Fujian, China
| | - Jingying Su
- Department of Pediatrics, The First Affiliated Hospital of Xiamen University, Xiamen, 361003, Fujian, China.
| | - Nan Liu
- Department of Rehabilitation, Fujian Medical University Union Hospital, Fuzhou, 350001, Fujian, China.
- Fujian Institute of Cerebrovascular Disease, Fuzhou, 350001, Fujian, China.
- Key Laboratory of Brain Aging and Neurodegenerative Diseases, Fujian Key Laboratory of Molecular Neurology, Fujian Medical University, Fuzhou, 350001, Fujian, China.
- Department of Neurology, Fujian Medical University Union Hospital, Fuzhou, 350001, Fujian, China.
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Poe AR, Zhu L, Tang SH, Valencia E, Kayser MS. Energetic Demands Regulate Sleep-Wake Rhythm Circuit Development. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2024:2023.09.19.558472. [PMID: 37786713 PMCID: PMC10541615 DOI: 10.1101/2023.09.19.558472] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
Sleep and feeding patterns lack strong daily rhythms during early life. As diurnal animals mature, feeding is consolidated to the day and sleep to the night. In Drosophila, circadian sleep patterns are initiated with formation of a circuit connecting the central clock to arousal output neurons; emergence of circadian sleep also enables long-term memory (LTM). However, the cues that trigger the development of this clock-arousal circuit are unknown. Here, we identify a role for nutritional status in driving sleep-wake rhythm development in Drosophila larvae. We find that in the 2nd instar larval period (L2), sleep and feeding are spread across the day; these behaviors become organized into daily patterns by the 3rd instar larval stage (L3). Forcing mature (L3) animals to adopt immature (L2) feeding strategies disrupts sleep-wake rhythms and the ability to exhibit LTM. In addition, the development of the clock (DN1a)-arousal (Dh44) circuit itself is influenced by the larval nutritional environment. Finally, we demonstrate that larval arousal Dh44 neurons act through glucose metabolic genes to drive onset of daily sleep-wake rhythms. Together, our data suggest that changes to energetic demands in developing organisms trigger the formation of sleep-circadian circuits and behaviors.
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Affiliation(s)
- Amy R. Poe
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Lucy Zhu
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Si Hao Tang
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Ella Valencia
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Matthew S. Kayser
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
- Chronobiology and Sleep Institute, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
- Department of Neuroscience, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
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12
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Kale G, Addepalli V, Joshi S. A snapshot on introspection of autism spectrum disorder. Mol Biol Rep 2024; 51:610. [PMID: 38704762 DOI: 10.1007/s11033-024-09514-5] [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: 02/09/2024] [Accepted: 04/03/2024] [Indexed: 05/07/2024]
Abstract
Autism spectrum disorder is a neurodevelopmental condition marked by restricted interests and difficulty with social communication. ASD is characterized by heightened neuroinflammation and irregular neuronal connections. ASD is more frequent in male than female with male-female ratio of around 4:1. ASD affects 2.8% or 1 in 36 8-year-olds, based on the CDC's Morbidity and Mortality Weekly Report. Various factors like Environmental, Genetic, Epigenetic and Developmental factors are linked with genesis of ASD. Repetitive behaviors, Impaired communication skills, difficulty with social interaction are some of the clinical features of ASD. Current Pharmacotherapy of ASD limits to management of symptoms only, not cure. The stem cell therapy has a promising potential to be a breakthrough in treating ASD. Various types of stem cells have been successfully tested in children with ASD. AI has a potential to emerge as a tool for early detection of ASD. Robotics can assist the children with ASD to overcome the challenges associated with ASD.
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Affiliation(s)
- Govind Kale
- Dr. D.Y. Patil Institute of Pharmaceutical Sciences and Research, Pimpri, Pune, 411018, Maharashtra, India
| | - Veeranjaneyulu Addepalli
- Dr. D.Y. Patil Institute of Pharmaceutical Sciences and Research, Pimpri, Pune, 411018, Maharashtra, India.
| | - Sharvari Joshi
- Dr. D.Y. Patil Institute of Pharmaceutical Sciences and Research, Pimpri, Pune, 411018, Maharashtra, India
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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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Minhas A, Whitlock K, Rosenfelt C, Shatto J, Finlay B, Zwicker J, Lippe S, Jacquemont S, Hagerman R, Murias K, Bolduc FV. Analyzing the Quality of Life in Individuals with Fragile X Syndrome in Relation to Sleep and Mental Health. J Autism Dev Disord 2024:10.1007/s10803-024-06317-2. [PMID: 38653851 DOI: 10.1007/s10803-024-06317-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/06/2024] [Indexed: 04/25/2024]
Abstract
The purpose of this paper was to examine the physical, emotional, social and school functioning domains of quality of life of individuals with Fragile X Syndrome, in relation to mental health and sleep patterns to gain a better understanding of how these aspects are affected by the disorder. This study included 119 individuals with Fragile X Syndrome who were given different cognitive examinations by a neuropsychologist or by parent-proxy questionnaires. This study focused on the Pediatric Quality of Life Inventory (PedsQoL), the Anxiety, Depression and Mood Scale (ADAMS), the Children's Sleep Habits Questionnaire (CSHQ), but did include other cognitive tests (Vineland Adaptive Behaviour Scales, Nonverbal IQ, Autism Diagnostic Observation Schedule). We identified significant associations between decreases in emotional, social and school domains of PedsQoL and the ADAMS subtests of Generalized Anxiety, Manic/Hyperactivity and Obsessive/Compulsivity, with the subtest of Depressed Mood having associations with lower physical and emotional domains. We also identified a significant impact between CSHQ subtests of Sleep Anxiety, Night Wakings, Daytime Sleepiness, and Parasomnia with the emotional and school domains of PedsQoL. There were associations connecting school functioning with Bedtime Resistance, and additional associations connecting emotional functioning with Sleep Duration and Sleep Onset Delay. Physical functioning was also associated with Sleep Anxiety. Our study shows how mental health and sleep defects impact improper sleep patterns and mental health which leads to decreases in the quality of life for individuals with FXS, and how it is important to screen for these symptoms in order to alleviate issues.
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Affiliation(s)
- Amrita Minhas
- Department of Pediatrics, University of Alberta, Edmonton, AB, Canada
| | - Kerri Whitlock
- Department of Pediatrics, University of Alberta, Edmonton, AB, Canada
| | - Cory Rosenfelt
- Department of Pediatrics, University of Alberta, Edmonton, AB, Canada
| | - Julie Shatto
- Department of Pediatrics, University of Alberta, Edmonton, AB, Canada
| | - Brittany Finlay
- School of Public Policy, University of Calgary, Calgary, AB, Canada
| | - Jennifer Zwicker
- School of Public Policy, University of Calgary, Calgary, AB, Canada
| | - Sarah Lippe
- Hopital Sainte-Justine, Universite de Montreal, Montreal, QC, Canada
| | | | - Randi Hagerman
- MIND Institute, University of California, Sacramento, CA, USA
| | - Kara Murias
- Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Francois V Bolduc
- Department of Pediatrics, University of Alberta, Edmonton, AB, Canada.
- Department of Medical Genetics, University of Alberta, Edmonton, AB, Canada.
- Women and Children Health Research Institute, University of Alberta, Edmonton, AB, Canada.
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Harris HK, Kook M, Boedeker P, Gusick AG, Lyons-Warren AM, Goin-Kochel RP, Murali C, Berry LN, Storch EA. The Impact of Cognitive Behavioral Therapy on Sleep Problems in Autistic Children with Co-occurring Anxiety. J Autism Dev Disord 2024:10.1007/s10803-024-06309-2. [PMID: 38557905 DOI: 10.1007/s10803-024-06309-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/22/2024] [Indexed: 04/04/2024]
Abstract
PURPOSE This study seeks to examine the relationship between anxiety-symptom severity and sleep behaviors in autistic children receiving cognitive behavioral therapy (CBT). METHODS We conducted a secondary-data analysis from a sample of 93 autistic youth, 4 to 14 years, participating in 24 weeks of CBT. Clinicians completed the Pediatric Anxiety Rating Scale (PARS) and parents completed the Children's Sleep Habits Questionnaire, Abbreviated/Short Form (CSHQ-SF) at baseline, mid-treatment, post-treatment and 3 months post-treatment. Mediation analysis evaluated the role of anxiety symptoms in mediating the effect of time in treatment on sleep. RESULTS There was a negative association between time in treatment and scores on the CSHQ-SF (b = - 3.23, SE = 0.493, t = - 6.553, p < 0.001). Increased time in treatment was associated with decreased anxiety (b = - 4.66, SE = 0.405, t = - 11.507, p < 0.001), and anxiety symptoms decreased with CSHQ-SF scores (b = 0.322, SE = 0.112, t = 2.869, p = 0.005). The indirect effect of time in treatment on CSHQ-SF scores through PARS reduction was negative, but not statistically significant. CONCLUSION Increased time in CBT was associated with decreased anxiety severity and improved sleep behaviors. Reductions in anxiety symptoms may mediate improvements in sleep problems, but larger sample sizes are necessary to explore this further.
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Affiliation(s)
- Holly K Harris
- Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA.
- Division of Developmental-Behavioral Pediatrics, Meyer Center for Developmental Pediatrics and Autism, 8080 North Stadium Drive, Suite 100, Houston, TX, 77054, USA.
| | - Minjee Kook
- Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA
| | - Peter Boedeker
- Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA
- Department of Education, Innovation and Technology, Baylor College of Medicine, Houston, TX, USA
| | - Andrew G Gusick
- Department of Psychiatry, University of Pennsylvania, Philadelphia, PA, USA
| | - Ariel M Lyons-Warren
- Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA
- Jan and Dan Duncan Neurological Research Institute, Texas Children's Hospital, Houston, TX, USA
| | - Robin P Goin-Kochel
- Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA
- Autism Program, Meyer Center for Developmental and Behavioral Pediatrics, Texas Children's Hospital, Houston, TX, USA
| | - Chaya Murali
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, TX, USA
| | - Leandra N Berry
- Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA
- Autism Program, Meyer Center for Developmental and Behavioral Pediatrics, Texas Children's Hospital, Houston, TX, USA
| | - Eric A Storch
- Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA
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16
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Sommers L, Papadopoulos N, Fuller-Tyszkiewicz M, Sciberras E, McGillivray J, Howlin P, Rinehart N. The Connection Between Sleep Problems and Emotional and Behavioural Difficulties in Autistic Children: A Network Analysis. J Autism Dev Disord 2024:10.1007/s10803-024-06298-2. [PMID: 38526802 DOI: 10.1007/s10803-024-06298-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/17/2024] [Indexed: 03/27/2024]
Abstract
The interactions between sleep problems, autism symptoms and emotional and behavioural difficulties were explored using network analysis in 240 autistic children (mean age: 8.8 years, range 5-13 years) with moderate to severe sleep problems. Findings revealed a highly connected and interpretable network, with three separate clusters identified of the modelled variables. Depression, anxiety and behavioural difficulties were the most central variables of the network. Depression, anxiety and restricted repetitive and stereotyped patterns behaviours (RRBs) were the strongest bridging variables in the network model, transmitting activation both within and between other symptom clusters. The results highlight that depression and anxiety were highly connected symptoms within the network, suggesting support in these areas could be helpful, as well as future research.
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Affiliation(s)
- Lucy Sommers
- School of Psychology, Faculty of Health, Deakin University, 1 Gheringhap Street, Geelong, VIC, 3220, Australia.
- School of Psychology, Deakin University, 221 Burwood Hwy, Burwood, VIC, 3125, Australia.
| | - Nicole Papadopoulos
- Monash Krongold Clinic, Faculty of Education, Monash University, 19 Ancora Imparo Way, Clayton, VIC, 3800, Australia
- School of Educational Psychology and Counselling, Faculty of Education, Monash University, 19 Ancora Imparo Way, Clayton, VIC, 3800, Australia
| | - Matthew Fuller-Tyszkiewicz
- School of Psychology, Faculty of Health, Deakin University, 1 Gheringhap Street, Geelong, VIC, 3220, Australia
| | - Emma Sciberras
- School of Psychology, Faculty of Health, Deakin University, 1 Gheringhap Street, Geelong, VIC, 3220, Australia
- Murdoch Children's Research Institute, 50 Flemington Road, Parkville, VIC, 3052, Australia
- Department of Paediatrics, University of Melbourne, Grattan Street, Parkville, VIC, 3010, Australia
| | - Jane McGillivray
- School of Psychology, Faculty of Health, Deakin University, 1 Gheringhap Street, Geelong, VIC, 3220, Australia
| | - Patricia Howlin
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, 16 De Crespigny Park, London, SE5 8AF, UK
| | - Nicole Rinehart
- Monash Krongold Clinic, Faculty of Education, Monash University, 19 Ancora Imparo Way, Clayton, VIC, 3800, Australia
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Gleason E, Malik K, Sannar E, Kamara D, Serrano V, Augustyn M. Challenging Case: A Multidisciplinary Approach to Demystifying Chronic Sleep Impairment in an Infant with a Complex Medical and Behavioral Profile. J Dev Behav Pediatr 2024; 45:e176-e179. [PMID: 38290114 DOI: 10.1097/dbp.0000000000001251] [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] [Indexed: 02/01/2024]
Abstract
CASE X is a 22-month-old White male infant with a complex medical history, including diagnoses of FBXO11 mutation, hypotonia, restrictive lung disease and mild intermittent asthma, laryngotracheomalacia, obstructive sleep apnea (OSA), feeding difficulties with a history of aspiration, gastroesophageal reflux disease (GERD), and developmental delays. X's medical presentation has resulted in multiple prior medical admissions for respiratory failure due to acute illnesses, procedures and treatments including gastrojejunostomy (GJ) tube dependence, supraglottoplasty to reshape tissues of the upper larynx, and the use of biphasic positive airway pressure (BiPAP) at night and room air during the day when he is at baseline. In addition, he has nocturnal events characterized by significant agitation, screaming, crying, body stiffening and limb movements with pauses in breathing, mouth breathing, restless sleep, and difficulty waking in the morning with concomitant daytime fatigue despite above treatments for OSA. There is no history of congenital heart disease or sudden unexplained death. Family history is noncontributory because parents are negative for the FBXO11 variant.X's sleep disruption has led to significant sleep deficits for both X and his caregivers, who spend much of the night strategizing on how to console him. X has undergone several sleep studies, starting when X was aged 4 months, at several children's hospitals across the nation to determine the cause of his chronic sleep disturbance, which yielded limited information and treatment success. As an infant, X received a medical workup and was subsequently treated with a proton pump inhibitor (PPI) for reflux. At 12 months, he was diagnosed with disordered sleep with myoclonic jerks and started on melatonin and gabapentin for involuntary movements. At 13 months, gabapentin was weaned back because of intolerance, and at 15 months, nortriptyline and clonidine were started because of worsening symptoms to target potential neuropathic pain. While most of his symptoms were at night, he had occasional daytime screaming episodes, particularly when experiencing illness. Gabapentin and clonidine were stopped because nortriptyline seemed most effective.At 17 months, the results from a sleep study led to a diagnosis of night terrors, and several clinicians agreed that X's sleep disruption was behavioral in nature. At this time, an infant mental health consultant met with a sleep psychologist on the family's behalf to support family in considering systematic desensitization therapy to increase tolerance to wearing his BiPAP mask, as well as other behavioral and sleep hygiene strategies, which were tried on several occasions and again, resulted in limited improvement in functioning.At 19 months, X's multidisciplinary team reconsidered a night terror diagnosis after a failed trial of clonazepam and pursued a differential diagnosis of periodic limb movement disorder (PLMD). X trialed gabapentin again, but this time only a nighttime dose, per sleep medicine and psychiatry recommendation. While this brought some temporary relief from nighttime distress, despite increasing to the highest dose for age and weight (15 mg/kg/dose), this became less effective, and he was weaned off at 22 months. He had been on iron supplementation since age 6 months and received an iron infusion at 22 months because of persistently low ferritin levels and PLMD in sleep.At 24 months, X was briefly trialed on levetiracetam. While no evidence for seizures on EEG was present, this medication was chosen for involuntary movements and genetic risk for seizures. However, this medication was not useful. At 25 months, an evaluation with a movement disorder physiatrist resulted in a diagnosis of nocturnal paroxysmal dystonia, and he was started on baclofen, which has provided some, but not complete relief to nighttime symptoms. Parents are reporting he has more "good nights" than "bad nights," but "bad nights" come in stretches of a few days in length with no known trigger or relief.Most recently, X was evaluated by general genetics. Whole exome sequencing (WES) was pursued which revealed a pathogenic de novo variant in FBXO11 and provides a likely cause for his neurodevelopmental phenotype. However, he has some features not explained by FBX011; thus, reanalysis of his WES was performed and revealed a de novo variant of uncertain significance in RAF1. Because pathogenic variants in RAF1 have been associated with dilated cardiomyopathy and Noonan spectrum disorder, it was recommended that X be followed periodically in a cardiac genetics clinic. Family is well connected into the FBXO11 community, including supportive Facebook groups. Parents have shared that they do not feel X's breathing issues and pain fit with the phenotype of other children with FBXO11 mutations.X is also enrolled in a medical child care program to facilitate development and social-emotional functioning and receives learning, speech, occupational, physical, and feeding therapy while in attendance. Despite periods of absence due to contracting numerous viral illnesses over the past several months, X continues to make progress across developmental therapies and happily engages when at the program.What additional diagnostic tests and treatment should be considered to better understand X's medical and behavioral presentation? What are the implications of chronic sleep deprivation and stress on the behavior and development of infant with X's profile? What are important psychosocial considerations because it relates to children with medical complexity (CMC), particularly for X and his family to support caregiver, family, and X's quality of life and overall well-being?
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Affiliation(s)
- Erica Gleason
- Child & Adolescent Psychiatry, University of Colorado Medicine, Children's Hospital of Colorado, Aurora, CO
| | - Kristina Malik
- Department of Pulmonary and Sleep Medicine, KidStreet & Special Care Clinic, Children's Hospital of Colorado, Aurora, CO
| | - Elise Sannar
- Child & Adolescent Psychiatry, University of Colorado Medicine, Children's Hospital of Colorado, Aurora, CO
| | - Dana Kamara
- Department of Pediatrics, Pulmonary & Sleep Medicine, University of Colorado Medicine, Children's Hospital of Colorado, Aurora, CO
| | - Verenea Serrano
- Psychiatry, University of Colorado Medicine, Children's Hospital of Colorado, Aurora, CO
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Ginder DE, Tinsley CE, Kaiser ME, Lim MM. SEX-SPECIFIC IMPACTS OF EARLY LIFE SLEEP DISRUPTION: ETHANOL SEEKING, SOCIAL INTERACTION, AND ANXIETY ARE DIFFERENTIALLY ALTERED IN ADOLESCENT PRAIRIE VOLES. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2024:2024.01.03.574112. [PMID: 38260326 PMCID: PMC10802381 DOI: 10.1101/2024.01.03.574112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/24/2024]
Abstract
Early life sleep is important for neuronal development and maturation. Using the highly social prairie vole rodent model, we have previously reported that early-life sleep disruption (ELSD) during the pre-weaning period postnatal day (P)14 to 21 results in adult interference with social bonding and increases ethanol consumption following a stressor. Furthermore, we have reported increased parvalbumin expression and reduced glutamatergic neurotransmission in cortical regions in adult prairie voles that experienced this paradigm. To understand the impact of ELSD on the lifespan, examination of an earlier time in life is necessary. Thus, the aim of the present study was to examine the behavioral outcomes of ELSD on adolescent prairie voles. Here we hypothesized that anxiety and reward related behaviors, as measured by light/dark box, 2-bottle choice and social interactions, would be negatively impacted by ELSD in adolescent male and female prairie voles. Male ELSD voles were no different from control voles in measures of anxiety and ethanol preference or consumption, but affiliative social interactions were significantly reduced. ELSD differentially impacted female prairie voles, with increased anxiety-like behavior and reductions in ethanol consumption compared to Controls, but no impact on ethanol preference or social interactions. Together, these results suggest both male and female prairie voles experience differential changes to reward seeking behaviors, but only female prairie voles showed increases in anxiety-like behavior. These results further suggest that early-life sleep is critically important for neurotypical behaviors in adolescence, a time where reward-seeking and risky behaviors are adaptive for learning and promoting survival.
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Bianca B, Silvia G, Elisa F, Deny M, Giovanni V, Lino N, Stefano V. Insomnia in Children with Autism Spectrum Disorder: A Cross-Sectional Study on Clinical Correlates and Parental Stress. J Autism Dev Disord 2024; 54:46-55. [PMID: 36310306 DOI: 10.1007/s10803-022-05793-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/10/2022] [Indexed: 03/12/2023]
Abstract
Insomnia is one of the most common co-occurring disorders in children with autism spectrum disorder (ASD). The purpose of this cross-sectional cohort study of 270 children with ASD was to assess the prevalence of insomnia using the Pediatric Sleep Clinical Global Impression Scale and to correlate sleep problems with cognitive level, adaptive behavior, parental stress, behavioral and emotional problems, and severity of core symptoms. Our findings revealed that one-third of children had insomnia and were related to reduced adaptive behaviors and higher levels of parental stress and behavioral and emotional problems. Insomnia must be evaluated in children with ASD to define an appropriate intervention to potentially alleviate the severity of clinical correlates and parental burden.
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Affiliation(s)
- Berloco Bianca
- Child and Adolescent Psychiatric Unit, Department of Neuroscience, Bambino Gesù Children's Hospital, IRCCS, Piazza Sant'Onofrio 4, 00165, Rome, Italy
- Department of Neuroscience-Rehabilitation-Ophthalmology-Genetics-Child and Maternal Health (DINOGMI), University of Genoa, Genoa, Italy
| | - Guerrera Silvia
- Child and Adolescent Psychiatric Unit, Department of Neuroscience, Bambino Gesù Children's Hospital, IRCCS, Piazza Sant'Onofrio 4, 00165, Rome, Italy
| | - Fucà Elisa
- Child and Adolescent Psychiatric Unit, Department of Neuroscience, Bambino Gesù Children's Hospital, IRCCS, Piazza Sant'Onofrio 4, 00165, Rome, Italy
| | - Menghini Deny
- Child and Adolescent Psychiatric Unit, Department of Neuroscience, Bambino Gesù Children's Hospital, IRCCS, Piazza Sant'Onofrio 4, 00165, Rome, Italy.
| | - Valeri Giovanni
- Child and Adolescent Psychiatric Unit, Department of Neuroscience, Bambino Gesù Children's Hospital, IRCCS, Piazza Sant'Onofrio 4, 00165, Rome, Italy
| | - Nobili Lino
- Department of Neuroscience-Rehabilitation-Ophthalmology-Genetics-Child and Maternal Health (DINOGMI), University of Genoa, Genoa, Italy
- Child Neuropsychiatry, IRCCS Istituto G. Gaslini, Genoa, Italy
| | - Vicari Stefano
- Child and Adolescent Psychiatric Unit, Department of Neuroscience, Bambino Gesù Children's Hospital, IRCCS, Piazza Sant'Onofrio 4, 00165, Rome, Italy
- Department of Life Sciences and Public Health, Catholic University, Rome, Italy
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Alhowikan AM, Elamin NE, Aldayel SS, AlSiddiqi SA, Alrowais FS, Hassan WM, El-Ansary A, Alghamdi FA, AL-Ayadhi LY. Children with Autism Spectrum Disorder Exhibit Elevated Physical Activity and Reduced Sedentary Behavior. Brain Sci 2023; 13:1575. [PMID: 38002535 PMCID: PMC10670306 DOI: 10.3390/brainsci13111575] [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: 10/03/2023] [Revised: 11/03/2023] [Accepted: 11/05/2023] [Indexed: 11/26/2023] Open
Abstract
According to previous research, individuals with autism spectrum disorder (ASD) have lower levels of physical activity than their typically developed (TD) counterparts. There have been conflicting reports about physical activity (PA) levels in people with ASD. Given the conflicting evidence, further investigation is required. We believe that evaluating PA in individuals with ASD is critical in order to offer PA intervention plans aiming at increasing their health-related physical fitness on a daily, systematic, and individualized basis. In the current study, an ActiGraph monitor (GT3X+) was used to accurately measure PA and sedentary activity in 21 children with autism aged 6.43 ± 2.29 years and 30 TD children aged 7.2 ± 3.14 years. Our data indicated that while the light and moderate activity counts were not significantly different between the two groups, the vigorous activity was significantly higher in ASD compared to TD. This finding was attributed to ASD characteristic stereotypy and self-stimulating behaviors. The significantly higher vigorous PA is discussed in relation to altered neurochemistry, oxidative stress, and neuroinflammation as etiological mechanisms in ASD. This research provides a better understanding of the status of PA participation in individuals with ASD.
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Affiliation(s)
- Abdulrahman M. Alhowikan
- Department of Physiology, College of Medicine, King Saud University, P.O. Box 2925, Riyadh 11461, Saudi Arabia;
| | - Nadra E. Elamin
- Autism Research and Treatment Center, Department of Physiology, Faculty of Medicine, King Saud University, Riyadh 11461, Saudi Arabia;
| | - Sarah S. Aldayel
- Department of Medicine, College of Medicine, King Saud University, Riyadh 11461, Saudi Arabia; (S.S.A.); (F.S.A.)
| | - Sara A. AlSiddiqi
- King Abdullah Bin Abdulaziz University Hospital (KAAUH), Riyadh 11461, Saudi Arabia;
| | - Fai S. Alrowais
- Department of Medicine, College of Medicine, King Saud University, Riyadh 11461, Saudi Arabia; (S.S.A.); (F.S.A.)
| | - Wail M. Hassan
- Department of Biomedical Sciences, University of Missouri-Kansas City School of Medicine, Kansas City, MO 64108, USA;
| | - Afaf El-Ansary
- Autism Research and Treatment Center, Department of Physiology, Faculty of Medicine, King Saud University, Riyadh 11461, Saudi Arabia;
- Autism Center, Lotus Holistic Medical Center, Abu Dhabi P.O. Box 110281, United Arab Emirates
| | - Farah Ali Alghamdi
- College of Medicine, Dar Al-Olum University (DAU), Riyadh 13314, Saudi Arabia;
| | - Laila Y. AL-Ayadhi
- Department of Physiology, College of Medicine, King Saud University, P.O. Box 2925, Riyadh 11461, Saudi Arabia;
- Autism Research and Treatment Center, Department of Physiology, Faculty of Medicine, King Saud University, Riyadh 11461, Saudi Arabia;
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21
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Bernardi K, Prono F, Bruni G, Panerai S, Ferri R, Bruni O. Sleep disturbances in subjects with autism spectrum disorder: A parental perspective. Sleep Med 2023; 110:220-224. [PMID: 37643569 DOI: 10.1016/j.sleep.2023.08.020] [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: 04/02/2023] [Revised: 08/17/2023] [Accepted: 08/18/2023] [Indexed: 08/31/2023]
Abstract
OBJECTIVE To investigate the prevalence of sleep disturbances (SDs), their related comorbidities, interventions and the impact on the family for individuals with current SDs and those who had SDs in the past. METHODS Members of the Italian national association of parents of persons with autism (ANGSA) completed an anonymous online survey collecting demographic data, the presence of comorbidities and specific information on sleep arrangement and sleep disorders using a modified version of the of the Sleep Disturbance Scale for Children (SDSC). RESULTS The final sample consisted of 143 participants, 90 patients presented current SDs (C_SDs) and 53 reported previous SDs (P_SDs). In the C_SDs group, the most prevalent sleep disorders were related to insomnia and, especially, difficulty falling asleep; a high number of individuals presented with restless sleep. Also, the parents in the P_SDs group retrospectively reported a high prevalence of insomnia with difficulty falling asleep, night awakenings and restless sleep. Parents reported that sleep hygiene practice were effective in less than one third of cases in both groups and the most used compound was immediate-release melatonin, followed by antihistamines and then benzodiazepines, antipsychotics, and antidepressants, with approximately 60-70% reported efficacy. Parents of both groups reported that insomnia negatively affected their children behavior and caused stress, mood changes or physical fatigue in their daily life. CONCLUSION Our study shows that insomnia is most prevalent in individuals with autism with several consequences on children and family behavior and quality of life. As reported by parents, melatonin might be helpful for sleep disturbances in these children and the causes of restless sleep need further investigations.
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Affiliation(s)
- Katerina Bernardi
- Child Neurology and Psychiatry Unit, Sapienza University, Human Neurosciences, Rome, Italy
| | - Federica Prono
- Child Neurology and Psychiatry Unit, Sapienza University, Human Neurosciences, Rome, Italy
| | - Ginevra Bruni
- Sapienza University, Faculty of Medicine and Dentistry, Rome, Italy
| | | | | | - Oliviero Bruni
- Sapienza University, Department of Developmental and Social Psychology, Rome, Italy.
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22
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O'Hora KP, Schleifer CH, Bearden CE. Sleep in 22q11.2 Deletion Syndrome: Current Findings, Challenges, and Future Directions. Curr Psychiatry Rep 2023; 25:479-491. [PMID: 37721640 PMCID: PMC10627929 DOI: 10.1007/s11920-023-01444-6] [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] [Accepted: 07/28/2023] [Indexed: 09/19/2023]
Abstract
PURPOSE OF REVIEW To summarize current literature available on sleep in 22q11.2 Deletion Syndrome (22q11.2DS; Velocardiofacial or DiGeorge Syndrome), a neurogenetic disorder caused by a hemizygous deletion in a genomic region critical for neurodevelopment. Due to the greatly increased risk of developmental psychiatric disorders (e.g., autism and schizophrenia) in 22q11.2DS, this review focuses on clinical correlates of sleep disturbances and potential neurobiological underpinnings of these relationships. RECENT FINDINGS Sleep disturbances are widely prevalent in 22q11.2DS and are associated with worse behavioral, psychiatric, and physical health outcomes. There are reports of sleep architecture and sleep neurophysiology differences, but the literature is limited by logistical challenges posed by objective sleep measures, resulting in small study samples to date. Sleep disturbances in 22q11.2DS are prevalent and have a substantial impact on well-being. Further investigation of sleep in 22q11.2DS utilizing multimodal sleep assessments has the potential to provide new insight into neurobiological mechanisms and a potential trans-diagnostic treatment target in 22q11.2DS.
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Affiliation(s)
- Kathleen P O'Hora
- Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, University of California, 760 Westwood Plaza, Los Angeles, CA, 90095, USA
- Neuroscience Interdepartmental Program, University of California, Los Angeles, CA, USA
| | - Charles H Schleifer
- Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, University of California, 760 Westwood Plaza, Los Angeles, CA, 90095, USA
- Neuroscience Interdepartmental Program, University of California, Los Angeles, CA, USA
- David Geffen School of Medicine, University of California, Los Angeles, CA, USA
| | - Carrie E Bearden
- Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, University of California, 760 Westwood Plaza, Los Angeles, CA, 90095, USA.
- Department of Psychology, University of California, Los Angeles, CA, USA.
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23
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László K, Vörös D, Correia P, Fazekas CL, Török B, Plangár I, Zelena D. Vasopressin as Possible Treatment Option in Autism Spectrum Disorder. Biomedicines 2023; 11:2603. [PMID: 37892977 PMCID: PMC10603886 DOI: 10.3390/biomedicines11102603] [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: 08/10/2023] [Revised: 09/13/2023] [Accepted: 09/21/2023] [Indexed: 10/29/2023] Open
Abstract
Autism spectrum disorder (ASD) is rather common, presenting with prevalent early problems in social communication and accompanied by repetitive behavior. As vasopressin was implicated not only in salt-water homeostasis and stress-axis regulation, but also in social behavior, its role in the development of ASD might be suggested. In this review, we summarized a wide range of problems associated with ASD to which vasopressin might contribute, from social skills to communication, motor function problems, autonomous nervous system alterations as well as sleep disturbances, and altered sensory information processing. Beside functional connections between vasopressin and ASD, we draw attention to the anatomical background, highlighting several brain areas, including the paraventricular nucleus of the hypothalamus, medial preoptic area, lateral septum, bed nucleus of stria terminalis, amygdala, hippocampus, olfactory bulb and even the cerebellum, either producing vasopressin or containing vasopressinergic receptors (presumably V1a). Sex differences in the vasopressinergic system might underline the male prevalence of ASD. Moreover, vasopressin might contribute to the effectiveness of available off-label therapies as well as serve as a possible target for intervention. In this sense, vasopressin, but paradoxically also V1a receptor antagonist, were found to be effective in some clinical trials. We concluded that although vasopressin might be an effective candidate for ASD treatment, we might assume that only a subgroup (e.g., with stress-axis disturbances), a certain sex (most probably males) and a certain brain area (targeting by means of virus vectors) would benefit from this therapy.
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Affiliation(s)
- Kristóf László
- Institute of Physiology, Medical School, University of Pécs, 7624 Pecs, Hungary; (K.L.); (D.V.); (P.C.); (C.L.F.); (B.T.); (I.P.)
- Center of Neuroscience, University of Pécs, 7624 Pecs, Hungary
- Szentágothai Research Center, University of Pécs, 7624 Pecs, Hungary
| | - Dávid Vörös
- Institute of Physiology, Medical School, University of Pécs, 7624 Pecs, Hungary; (K.L.); (D.V.); (P.C.); (C.L.F.); (B.T.); (I.P.)
- Center of Neuroscience, University of Pécs, 7624 Pecs, Hungary
- Szentágothai Research Center, University of Pécs, 7624 Pecs, Hungary
| | - Pedro Correia
- Institute of Physiology, Medical School, University of Pécs, 7624 Pecs, Hungary; (K.L.); (D.V.); (P.C.); (C.L.F.); (B.T.); (I.P.)
- Center of Neuroscience, University of Pécs, 7624 Pecs, Hungary
- Szentágothai Research Center, University of Pécs, 7624 Pecs, Hungary
- Hungarian Research Network, Institute of Experimental Medicine, 1083 Budapest, Hungary
| | - Csilla Lea Fazekas
- Institute of Physiology, Medical School, University of Pécs, 7624 Pecs, Hungary; (K.L.); (D.V.); (P.C.); (C.L.F.); (B.T.); (I.P.)
- Center of Neuroscience, University of Pécs, 7624 Pecs, Hungary
- Szentágothai Research Center, University of Pécs, 7624 Pecs, Hungary
- Hungarian Research Network, Institute of Experimental Medicine, 1083 Budapest, Hungary
| | - Bibiána Török
- Institute of Physiology, Medical School, University of Pécs, 7624 Pecs, Hungary; (K.L.); (D.V.); (P.C.); (C.L.F.); (B.T.); (I.P.)
- Center of Neuroscience, University of Pécs, 7624 Pecs, Hungary
- Szentágothai Research Center, University of Pécs, 7624 Pecs, Hungary
- Hungarian Research Network, Institute of Experimental Medicine, 1083 Budapest, Hungary
| | - Imola Plangár
- Institute of Physiology, Medical School, University of Pécs, 7624 Pecs, Hungary; (K.L.); (D.V.); (P.C.); (C.L.F.); (B.T.); (I.P.)
- Center of Neuroscience, University of Pécs, 7624 Pecs, Hungary
- Szentágothai Research Center, University of Pécs, 7624 Pecs, Hungary
| | - Dóra Zelena
- Institute of Physiology, Medical School, University of Pécs, 7624 Pecs, Hungary; (K.L.); (D.V.); (P.C.); (C.L.F.); (B.T.); (I.P.)
- Center of Neuroscience, University of Pécs, 7624 Pecs, Hungary
- Szentágothai Research Center, University of Pécs, 7624 Pecs, Hungary
- Hungarian Research Network, Institute of Experimental Medicine, 1083 Budapest, Hungary
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24
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Colreavy E, Keenan L, Downes M. The impact of the COVID-19 pandemic on sleep in children with Tourette syndrome in Ireland and the United Kingdom. J Clin Sleep Med 2023; 19:1485-1493. [PMID: 37132250 PMCID: PMC10394359 DOI: 10.5664/jcsm.10628] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Revised: 03/31/2023] [Accepted: 03/31/2023] [Indexed: 05/04/2023]
Abstract
STUDY OBJECTIVES The aim of this mixed-methods study was to gain an insight through qualitative and quantitative means into the impact of the coronavirus disease 2019 (COVID-19) pandemic on children with and without Tourette syndrome (TS). METHODS Parents/guardians of children and adolescents with TS (n = 95; mean age = 11.2 years, standard deviation = 2.68 years) and typically developing controls (n = 86; mean age = 10.7 years, standard deviation = 2.8 years) in the United Kingdom and Ireland completed an online questionnaire examining sleep, with open-ended questions pertaining to their perceived impact of COVID-19 on the sleep of their children. Nine items from the Sleep Disturbance Scale for Children were used to supplement qualitative data. RESULTS A negative impact of the pandemic on the sleep of both groups was observed, including exacerbated tics, sleep deprivation, and anxiety, with particular disruption for children with TS. Parents of children with TS reported poorer sleep patterns than parents of typically developing children on the Sleep Disturbance Scale for Children. Analyses showed that group and age predicted 43.8% of variance in sleep duration: F (4, 176) = 34.2, P < .001. CONCLUSIONS Findings suggest that sleep patterns of children with TS may be more impacted by the pandemic than the average child. Given that there are generally more sleep issues reported in children with TS, further research is warranted in relation to the sleep health of children with TS in a postpandemic era. By identifying sleep issues potentially persisting after COVID-19, the true impact of the pandemic on the sleep of children and adolescents with Tourette syndrome may be ascertained. CITATION Colreavy E, Keenan L, Downes M. The impact of the COVID-19 pandemic on sleep in children with Tourette syndrome in Ireland and the United Kingdom. J Clin Sleep Med. 2023;19(8):1485-1493.
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Affiliation(s)
- Eleanor Colreavy
- University College Dublin, UCD School of Psychology, Dublin, Ireland
| | - Lisa Keenan
- University College Dublin, UCD School of Psychology, Dublin, Ireland
| | - Michelle Downes
- University College Dublin, UCD School of Psychology, Dublin, Ireland
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25
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Molcho-Haimovich A, Tikotzky L, Meiri G, Ilan M, Michaelovski A, Schtaierman H, Golan HM, Sadaka Y, Menashe I, Dinstein I. Sleep disturbances are associated with irritability in ASD children with sensory sensitivities. J Neurodev Disord 2023; 15:21. [PMID: 37480057 PMCID: PMC10362763 DOI: 10.1186/s11689-023-09491-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Accepted: 06/29/2023] [Indexed: 07/23/2023] Open
Abstract
BACKGROUND Parent reports suggest that 44-84% of children with ASD exhibit sleep disturbances that are of clinical concern. Previous studies have reported that, in children with ASD, the severity of sleep disturbances is associated with the severity of either sensory problems or aberrant behaviors, but none have performed combined analyses with measures of both sensory and aberrant behaviors symptom domains from the same children. METHODS We examined parent reports of 237 children with ASD, 1.4-8.7 years old, using the child sleep habits questionnaire (CSHQ), sensory profile (SP), and aberrant behaviors checklist (ABC). RESULTS The analyses revealed that sleep disturbances were most strongly associated with SP sensory sensitivity and ABC irritability scores. Together these scores explained 35% of the variance in total CSHQ scores. Moreover, sensory sensitivity scores moderated the association between irritability and sleep disturbances, indicating that sleep disturbances were significantly associated with irritability only in children with moderate to severe sensory sensitivities. CONCLUSION We suggest that the three symptom domains may interact and exacerbate each other such that successful intervention in one symptom domain may have positive impact on the others. Further intervention studies testing this hypothesis are highly warranted.
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Affiliation(s)
- Alona Molcho-Haimovich
- Department of Psychology, Ben-Gurion University of the Negev, Beer Sheva, Israel.
- The Azrieli National Centre for Autism and Neurodevelopment Research (ANCAN), Ben Gurion 1, Beer-Sheva, Israel.
| | - Liat Tikotzky
- Department of Psychology, Ben-Gurion University of the Negev, Beer Sheva, Israel
| | - Gal Meiri
- The Azrieli National Centre for Autism and Neurodevelopment Research (ANCAN), Ben Gurion 1, Beer-Sheva, Israel
- Pre-School Psychiatry Unit, Soroka University Medical Center, Beer Sheva, Israel
| | - Michal Ilan
- Department of Psychology, Ben-Gurion University of the Negev, Beer Sheva, Israel
- The Azrieli National Centre for Autism and Neurodevelopment Research (ANCAN), Ben Gurion 1, Beer-Sheva, Israel
- Pre-School Psychiatry Unit, Soroka University Medical Center, Beer Sheva, Israel
| | - Analya Michaelovski
- The Azrieli National Centre for Autism and Neurodevelopment Research (ANCAN), Ben Gurion 1, Beer-Sheva, Israel
- Zusman Child Development Center, Soroka University Medical Center, Beer Sheva, Israel
| | - Hen Schtaierman
- Child Development Center, Maccabi Health Services, Beer Sheva, Israel
| | - Hava M Golan
- The Azrieli National Centre for Autism and Neurodevelopment Research (ANCAN), Ben Gurion 1, Beer-Sheva, Israel
- Department of Physiology and Cell Biology, Faculty of Health Sciences, Ben Gurion University of the Negev, Beer Sheva, Israel
| | - Yair Sadaka
- Child Development Center, Ministry of Health, Beer Sheva, Israel
| | - Idan Menashe
- The Azrieli National Centre for Autism and Neurodevelopment Research (ANCAN), Ben Gurion 1, Beer-Sheva, Israel
- Public Health Department, Ben-Gurion University of the Negev, Beer Sheva, Israel
| | - Ilan Dinstein
- Department of Psychology, Ben-Gurion University of the Negev, Beer Sheva, Israel
- The Azrieli National Centre for Autism and Neurodevelopment Research (ANCAN), Ben Gurion 1, Beer-Sheva, Israel
- Cognitive & Brain Sciences Department, Ben-Gurion University of the Negev, Beer Sheva, Israel
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26
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Mammarella V, Orecchio S, Cameli N, Occhipinti S, Marcucci L, De Meo G, Innocenti A, Ferri R, Bruni O. Using pharmacotherapy to address sleep disturbances in autism spectrum disorders. Expert Rev Neurother 2023; 23:1261-1276. [PMID: 37811652 DOI: 10.1080/14737175.2023.2267761] [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: 06/02/2023] [Accepted: 10/03/2023] [Indexed: 10/10/2023]
Abstract
INTRODUCTION Sleep disorders are the second most common medical comorbidity in autism spectrum disorder (ASD), with effects on daytime behavior and functioning, mood and anxiety, and autism core features. In children with ASD, insomnia also has a negative impact on the whole family's quality of life. Therefore, treatment of sleep disturbances should be considered as a primary goal in the management of ASD patients, and it is important to clarify the scientific evidence to inappropriate treatments. AREAS COVERED The authors review the current literature concerning the pharmacological treatment options for the management of sleep-related disorders in patients with ASD (aged 0-18 years) using the PubMed and Cochrane Library databases with the search terms: autism, autistic, autism spectrum disorder, ASD, drug, drug therapy, drug intervention, drug treatment, pharmacotherapy, pharmacological treatment, pharmacological therapy, pharmacological intervention, sleep, sleep disturbance, and sleep disorder. EXPERT OPINION Currently, clinicians tend to select medications for the treatment of sleep disorders in ASD based on the first-hand experience of psychiatrists and pediatricians as well as expert opinion. Nevertheless, at the present time, the only compound for which there is sufficient evidence is melatonin, although antihistamines, trazodone, clonidine, ramelteon, gabapentin, or suvorexant can also be considered for selection.
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Affiliation(s)
- Valeria Mammarella
- Child Neuropsychiatry Unit, Department of Human Neuroscience, Sapienza University, Rome, Italy
| | - Silvia Orecchio
- Child Neuropsychiatry Unit, Department of Human Neuroscience, Sapienza University, Rome, Italy
| | - Noemi Cameli
- Child Neuropsychiatry Unit, Department of Human Neuroscience, Sapienza University, Rome, Italy
| | - Sara Occhipinti
- Child Neuropsychiatry Unit, Department of Human Neuroscience, Sapienza University, Rome, Italy
| | - Lavinia Marcucci
- Child Neuropsychiatry Unit, Department of Human Neuroscience, Sapienza University, Rome, Italy
| | - Giuliano De Meo
- Child Neuropsychiatry Unit, Department of Human Neuroscience, Sapienza University, Rome, Italy
| | - Alice Innocenti
- Child Neuropsychiatry Unit, Department of Human Neuroscience, Sapienza University, Rome, Italy
| | - Raffaele Ferri
- Sleep Research Centre, Oasi Research Institute - IRCCS, Troina, Italy
| | - Oliviero Bruni
- Department of Social and Developmental Psychology, Sapienza University, Rome, Italy
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27
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Cano-Villagrasa A, Moya-Faz FJ, Cortés-Ramos A, López-Zamora M. Emotional and behavioral alterations and their relationship with executive functioning in the pediatric population with autism spectrum disorder and epilepsy: a comparative study. Front Psychol 2023; 14:1219177. [PMID: 37457105 PMCID: PMC10348750 DOI: 10.3389/fpsyg.2023.1219177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Accepted: 06/07/2023] [Indexed: 07/18/2023] Open
Abstract
Introduction The pediatric population with Autism Spectrum Disorder (ASD) and epilepsy presents behavioral and emotional alterations that hinder their correct developmental maturation as well as their integration in different contexts such as school, family or social. This population shows atypical behavioral and emotional patterns, with difficulties in emotional regulation, understanding of emotions, aggressiveness, or low frustration tolerance. They also present alterations in executive functions, which significantly influence the emotional and behavioral characteristics of this population. Research suggests that epilepsy worsens the emotional, behavioral, and executive functioning status. Objective To explore differences in behavioral, emotional, and executive functioning profile in individuals with a diagnosis of ASD, epilepsy, and ASD with epilepsy. Method In this quasi-experimental and cross-sectional study, a total of 170 participants were selected and distributed into three groups: a group of participants with ASD, a group with epilepsy, and a group of participants with ASD and epilepsy. The SENA, BASC-3, and ENFEN tests were administered to verify the behavioral, emotional, and executive functioning profile in the three groups. Results The results indicate that individuals diagnosed with ASD and epilepsy present greater emotional, behavioral, and executive functioning alterations compared to those who only present ASD or epilepsy. Conclusion Individuals with ASD and epilepsy present significant alterations in emotional, behavioral, and executive functioning processes, which hinder their adaptation to different contexts, as well as decreasing their quality of life and that of their family.
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Affiliation(s)
- Alejandro Cano-Villagrasa
- Health Sciences PhD Program, Departamento de Psicología Básica, Facultad de Ciencias de la Salud, Universidad Católica de Murcia UCAM, Murcia, Spain
- Universidad Internacional de Valencia, Valencia, Spain
| | - Francisco J. Moya-Faz
- Cátedra Psicogeriatría, Facultad de Medicina, Universidad Católica San Antonio de Murcia, Murcia, Spain
| | - Antonio Cortés-Ramos
- Departamento de Psicología Evolutiva y de la Educación, Facultad de Psicología y Logopedia, Universidad de Málaga, Málaga, Spain
| | - Miguel López-Zamora
- Departamento de Psicología Evolutiva y de la Educación, Facultad de Psicología y Logopedia, Universidad de Málaga, Málaga, Spain
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28
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Delorme TC, Ozell-Landry W, Cermakian N, Srivastava LK. Behavioral and cellular responses to circadian disruption and prenatal immune activation in mice. Sci Rep 2023; 13:7791. [PMID: 37179433 PMCID: PMC10182998 DOI: 10.1038/s41598-023-34363-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Accepted: 04/28/2023] [Indexed: 05/15/2023] Open
Abstract
Most individuals with neurodevelopmental disorders (NDDs), including schizophrenia and autism spectrum disorders, experience disruptions in sleep and circadian rhythms. Epidemiological studies indicate that exposure to prenatal infection increases the risk of developing NDDs. We studied how environmental circadian disruption contributes to NDDs using maternal immune activation (MIA) in mice, which models prenatal infection. Pregnant dams were injected with viral mimetic poly IC (or saline) at E9.5. Adult poly IC- and saline-exposed offspring were subjected to 4 weeks of each of the following: standard lighting (LD1), constant light (LL) and standard lighting again (LD2). Behavioral tests were conducted in the last 12 days of each condition. Poly IC exposure led to significant behavioral differences, including reduced sociability (males only) and deficits in prepulse inhibition. Interestingly, poly IC exposure led to reduced sociability specifically when males were tested after LL exposure. Mice were exposed again to either LD or LL for 4 weeks and microglia were characterized. Notably, poly IC exposure led to increased microglial morphology index and density in dentate gyrus, an effect attenuated by LL exposure. Our findings highlight interactions between circadian disruption and prenatal infection, which has implications in informing the development of circadian-based therapies for individuals with NDDs.
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Affiliation(s)
- Tara C Delorme
- Douglas Mental Health University Institute, 6875 Boulevard LaSalle, Montréal, QC, H4H 1R3, Canada
- Integrated Program in Neuroscience, McGill University, Montréal, QC, H3A 2B4, Canada
| | - William Ozell-Landry
- Douglas Mental Health University Institute, 6875 Boulevard LaSalle, Montréal, QC, H4H 1R3, Canada
| | - Nicolas Cermakian
- Douglas Mental Health University Institute, 6875 Boulevard LaSalle, Montréal, QC, H4H 1R3, Canada.
- Department of Psychiatry, McGill University, Montréal, QC, H3A 1A1, Canada.
| | - Lalit K Srivastava
- Douglas Mental Health University Institute, 6875 Boulevard LaSalle, Montréal, QC, H4H 1R3, Canada.
- Department of Psychiatry, McGill University, Montréal, QC, H3A 1A1, Canada.
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29
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Jones-Tinsley CE, Olson RJ, Mader M, Wickham PT, Gutowsky K, Wong C, Chu SS, Milman NEP, Cao H, Lim MM. Early life sleep disruption has long lasting, sex specific effects on later development of sleep in prairie voles. Neurobiol Sleep Circadian Rhythms 2023; 14:100087. [PMID: 36712905 PMCID: PMC9879777 DOI: 10.1016/j.nbscr.2022.100087] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Revised: 12/09/2022] [Accepted: 12/15/2022] [Indexed: 12/23/2022] Open
Abstract
In mammals, sleep duration is highest in the early postnatal period of life and is critical for shaping neural circuits that control the development of complex behaviors. The prairie vole is a wild, highly social rodent that serves as a unique model for the study of complex, species-typical social behaviors. Previous work in our laboratory has found that early life sleep disruption (ELSD) in prairie voles during a sensitive window of postnatal development leads to long lasting changes in social and cognitive behaviors as well as structural changes in excitatory and inhibitory neural circuits in the brain. However, it is currently unknown how later sleep is impacted by ELSD, both shortly after ELSD and over the long term. Therefore, the aim of this study was to describe the effects of ELSD on later life sleep, compared to sleep in normally developing prairie voles. First, we conducted tethered electroencephalogram/electromyogram (EEG/EMG) recordings in juvenile prairie voles undergoing ELSD, compared to Control conditions. Second, we conducted 24 h of home cage tethered EEG/EMG recordings in either adolescent or adult male and female prairie voles that had previously undergone ELSD or Control conditions as juveniles. We found that, as adults, male ELSD prairie voles showed persistently lower REM sleep duration and female ELSD prairie voles showed persistently higher NREM sleep duration compared to Controls, but no other sleep parameters differed. We concluded that 1) persistent effects of ELSD on sleep into adulthood may contribute to the social and cognitive deficits observed in adult voles, and 2) sleep disruption early in life can influence later sleep patterns in adulthood.
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Affiliation(s)
- Carolyn E Jones-Tinsley
- VA Portland Health Care System, Portland, OR, USA.,Oregon Health and Science University, Portland, OR, USA
| | - Randall J Olson
- VA Portland Health Care System, Portland, OR, USA.,Oregon Health and Science University, Portland, OR, USA
| | | | | | | | - Claire Wong
- VA Portland Health Care System, Portland, OR, USA
| | - Sung Sik Chu
- University of California Irvine, Irvine, CA, USA
| | - Noah E P Milman
- VA Portland Health Care System, Portland, OR, USA.,Oregon Health and Science University, Portland, OR, USA
| | - Hung Cao
- University of California Irvine, Irvine, CA, USA
| | - Miranda M Lim
- VA Portland Health Care System, Portland, OR, USA.,Oregon Health and Science University, Portland, OR, USA
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30
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Maurer JJ, Choi A, An I, Sathi N, Chung S. Sleep disturbances in autism spectrum disorder: Animal models, neural mechanisms, and therapeutics. Neurobiol Sleep Circadian Rhythms 2023; 14:100095. [PMID: 37188242 PMCID: PMC10176270 DOI: 10.1016/j.nbscr.2023.100095] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Revised: 03/16/2023] [Accepted: 04/08/2023] [Indexed: 05/17/2023] Open
Abstract
Sleep is crucial for brain development. Sleep disturbances are prevalent in children with autism spectrum disorder (ASD). Strikingly, these sleep problems are positively correlated with the severity of ASD core symptoms such as deficits in social skills and stereotypic behavior, indicating that sleep problems and the behavioral characteristics of ASD may be related. In this review, we will discuss sleep disturbances in children with ASD and highlight mouse models to study sleep disturbances and behavioral phenotypes in ASD. In addition, we will review neuromodulators controlling sleep and wakefulness and how these neuromodulatory systems are disrupted in animal models and patients with ASD. Lastly, we will address how the therapeutic interventions for patients with ASD improve various aspects of sleep. Together, gaining mechanistic insights into the neural mechanisms underlying sleep disturbances in children with ASD will help us to develop better therapeutic interventions.
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31
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Distefano G, Calderoni S, Apicella F, Cosenza A, Igliozzi R, Palermo G, Tancredi R, Tritto G, Craig F, Muratori F, Turi M. Impact of sleep disorders on behavioral issues in preschoolers with autism spectrum disorder. Front Psychiatry 2023; 14:1181466. [PMID: 37181873 PMCID: PMC10169650 DOI: 10.3389/fpsyt.2023.1181466] [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: 03/07/2023] [Accepted: 04/06/2023] [Indexed: 05/16/2023] Open
Abstract
Background Sleep disorders are one of the most common problems in children with Autism Spectrum Disorder (ASD). However, they often tend to be underdiagnosed and incorrectly treated in clinical practice. This study aims to identify sleep disorders in preschool children with ASD and to explore their relationship with the core symptoms of autism, the child's developmental and cognitive level as well as the psychiatric comorbidities. Methods We recruited 163 preschool children with a diagnosis of ASD. The Children's Sleep Habits Questionnaire (CSHQ) assessed sleep conditions. Multiple standardized tests were used to evaluate intellectual abilities, the presence of repetitive behaviors (through the Repetitive Behavior Scale-Revised), as well as the emotional-behavioral problems and the psychiatric comorbidities (through the Child Behavior Checklist -CBCL 11/2-5). Results The results showed that poor disorders had consistently higher scores in all areas assessed by the CSHQ and on the CBCL across all domains. The correlational analysis showed that severe sleep disorders were associated with higher scores in internalizing, externalizing, and total problems at the CBCL syndromic scales, and in all DSM-oriented CBCL subscales. Moreover, we found that the association between sleep disorders and restricted and repetitive behaviors (RRBs) is explained by the anxiety-related symptoms. Conclusion Based on these findings, the study recommends that screening for sleep problems followed by early intervention should constitute a routine part of clinical practice for children with ASD.
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Affiliation(s)
- Giacomo Distefano
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Sara Calderoni
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
- IRCCS Fondazione Stella Maris, Pisa, Italy
| | | | | | | | | | | | | | - Francesco Craig
- Department of Cultures, Education and Society, University of Calabria, Cosenza, Italy
| | | | - Marco Turi
- Department of Human and Social Studies, University of Salento, Lecce, Italy
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32
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Nogueira HA, de Castro CT, da Silva DCG, Pereira M. Melatonin for sleep disorders in people with autism: Systematic review and meta-analysis. Prog Neuropsychopharmacol Biol Psychiatry 2023; 123:110695. [PMID: 36584862 DOI: 10.1016/j.pnpbp.2022.110695] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2022] [Revised: 12/08/2022] [Accepted: 12/09/2022] [Indexed: 12/29/2022]
Abstract
Melatonin is a potential therapeutic intervention for improving sleep quality in people with autistic spectrum disorder (ASD). We investigate the effect of using melatonin as a sleep disorder treatment in people with ASD. Interventionist studies were searched in seven databases. A total of 595 references were identified, 15 of which were eligible for the systemic review and meta-analysis. Melatonin use presented a positive effect on total sleep time (standardized mean difference- SMD = 0.78; 95%CI = 0.35; 1.21; I2 = 91%), on sleep latency (SMD = 1.23; 95%CI = 0.35; 2.11; I2 = 94%), and on sleep efficiency (SMD = -0.70; 95%CI = -1.23; -0.16; I2 = 91%) when comparing the intervention group with the placebo/control group via the global analysis. According to the global analysis, the wake after sleep onset and night awakening parameters were not statistically significant. Melatonin has possible efficacy over total time, latency, and efficiency sleep parameters.
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Affiliation(s)
- Hellen Araujo Nogueira
- Center for Biological and Health Sciences, Universidade Federal do Oeste da Bahia, Barreiras, BA, Brazil
| | - Caroline Tianeze de Castro
- Institute of Collective Health, Federal University of Bahia, R. Basílio da Gama, s/n - Canela, Salvador 45760-030, Bahia, Brazil
| | | | - Marcos Pereira
- Institute of Collective Health, Federal University of Bahia, R. Basílio da Gama, s/n - Canela, Salvador 45760-030, Bahia, Brazil.
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33
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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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34
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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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35
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Tan-MacNeill KM, Smith IM, Corkum PV. Acceptability of an online intervention for insomnia in children with neurodevelopmental disorders. RESEARCH IN DEVELOPMENTAL DISABILITIES 2023; 134:104423. [PMID: 36640741 DOI: 10.1016/j.ridd.2023.104423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Revised: 06/21/2022] [Accepted: 01/01/2023] [Indexed: 06/17/2023]
Abstract
BACKGROUND Most children with neurodevelopmental disorders (NDDs) experience insomnia. Online interventions may provide a way to reduce barriers to treatment access. AIMS We explored whether parents of children with NDDs and their health care professionals (HCPs) perceived an online insomnia intervention as acceptable and the perceived pros and cons of this intervention delivery method. METHODS AND PROCEDURES Participants included 43 parents of children with NDDs and 44 HCPs who work with children with NDDs. During focus groups/interviews participants shared their perceptions of a hypothetical online insomnia intervention. Responses were analyzed using qualitative content analysis and codes were grouped into pros and cons. OUTCOMES AND RESULTS Parents and HCPs reported similar pros and cons. Pros focused on the intervention's accessibility, credibility, usability, usefulness, and design, whereas cons focused on feasibility of implementation. Participants felt that external support (e.g., an online coach) would improve the intervention's acceptability. CONCLUSIONS AND IMPLICATIONS Overall, the majority of parents and HCPs perceived an online intervention for insomnia as acceptable but concerns about implementation were noted and need to be taken into account when developing online interventions.
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Affiliation(s)
- Kim M Tan-MacNeill
- Department of Psychology & Neuroscience, Dalhousie University, Life Sciences Centre, 1355 Oxford Street, Halifax, NS, B3H 4R2 Canada.
| | - Isabel M Smith
- Department of Psychology & Neuroscience, Dalhousie University, Life Sciences Centre, 1355 Oxford Street, Halifax, NS, B3H 4R2 Canada; Department of Pediatrics, Dalhousie University, IWK Health Centre, 5850 University Avenue, P.O. Box 9700, Halifax, NS, B3K 6R8 Canada; IWK Health Centre, 5980 University Ave, Halifax, NS, B3K 6R8 Canada.
| | - Penny V Corkum
- Department of Psychology & Neuroscience, Dalhousie University, Life Sciences Centre, 1355 Oxford Street, Halifax, NS, B3H 4R2 Canada; Department of Pediatrics, Dalhousie University, IWK Health Centre, 5850 University Avenue, P.O. Box 9700, Halifax, NS, B3K 6R8 Canada; IWK Health Centre, 5980 University Ave, Halifax, NS, B3K 6R8 Canada; Department of Psychiatry, Dalhousie University, 5909 Veterans' Memorial Lane, 8th Floor, Abbie J. Lane Memorial Building, QEII Health Sciences Centre, Halifax, NS, B3H 2E2 Canada.
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36
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Andrade Correia LT, Coimbra DG, Gitaí DLG, Gitaí LLG, de Andrade TG. Associations between chronotype, sleep quality, maternal mental health, and child development in mother-infant dyads. Sleep Med 2023; 106:90-96. [PMID: 37075531 DOI: 10.1016/j.sleep.2023.03.023] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Revised: 03/06/2023] [Accepted: 03/23/2023] [Indexed: 04/03/2023]
Abstract
OBJECTIVE/BACKGROUND Studies on circadian rhythms throughout development and their physiological and behavioral impacts at early stages are still scarce. Previous studies have shown that mother-infant interactions are important for both sleep and child development. In this cross-sectional study we investigated whether infants' chronotype, sleep and development were associated with their respective mothers' chronotype, sleep, mental health and socioeconomic status. PATIENTS/METHODS the following were used to evaluate mothers: the Morningness-Eveningness Questionnaire (MEQ), Pittsburgh Sleep Quality Index (PSQI), Epworth Sleepiness Scale (ESS) and Self-Reporting Questionnaire 20 (SRQ-20). To assess the infants' characteristics, the following were used: the 19th question from the Morningness-Eveningness Questionnaire (MEQ), infant nocturnal midpoint of sleep (iMSF), Brief Infant Sleep Questionnaire (BISQ) and Ages and Stages Questionnaire-3 (ASQ3). Socioeconomic aspects were assessed using the Brazilian Economic Class Criterion of the Brazilian Association of Research Companies (ABEP). RESULTS A hundred and eight mother-infant dyads participated in the study. Sleep disorders were observed in 38 (35%) infants and atypical development (ASQ3) in 35 (32%). The infants' sleep phases were partially explained by the mother's chronotype. Infants' sleep duration was negatively correlated with sleep latency, which was higher in the group with atypical development. Mothers of infants with sleep disorders or discordant chronotypes (32%) had higher Pittsburgh scores (worse sleep quality) and higher SRQ-20 scores (screen for Common Mental Disorders). CONCLUSIONS We found evidence for the contribution of sleep quality and chronotypes to mothers' mental health and infant development. However, further studies are needed to confirm the influence of sleep and circadian phenotypes in the early stages.
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Affiliation(s)
| | - Daniel Gomes Coimbra
- Circadian Medicine Center, Faculty of Medicine, Federal University of Alagoas, Maceió, Alagoas, Brazil.
| | - Daniel Leite Góes Gitaí
- Department of Cellular and Molecular Biology, Institute of Biological Sciences and Health, Federal University of Alagoas, Brazil.
| | - Lívia Leite Góes Gitaí
- Circadian Medicine Center, Faculty of Medicine, Federal University of Alagoas, Maceió, Alagoas, Brazil.
| | - Tiago Gomes de Andrade
- Circadian Medicine Center, Faculty of Medicine, Federal University of Alagoas, Maceió, Alagoas, Brazil.
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37
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Xiong M, Li F, Liu Z, Xie X, Shen H, Li W, Wei L, He R. Efficacy of Melatonin for Insomnia in Children with Autism Spectrum Disorder: A Meta-analysis. Neuropediatrics 2023; 54:167-173. [PMID: 36827993 PMCID: PMC10166641 DOI: 10.1055/s-0043-1761437] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/26/2023]
Abstract
AIM This study aimed to evaluate the effectiveness of melatonin in treating insomnia in children with autism spectrum disorder (ASD). METHODS Comprehensive searches were conducted in the PubMed, EMBASE, and Web of Science databases from their inception to April 20, 2022. Data were extracted and assessed for quality by two researchers. Statistical analysis was performed using the Stata 15.0 software. RESULTS Four studies including 238 patients were included. The results showed that compared with the control group, melatonin could shorten the sleep-onset latency (standardized mean difference [SMD] = - 1.34, 95% CI: -2.19 to -0.48), reduce the number of awakenings (SMD = -2.35, 95% CI: -4.62 to -0.08), and prolong the total sleep time (SMD = 1.42, 95% CI: 0.5-2.33) in children with ASD. CONCLUSION Melatonin has a certain effect on relieving sleep disturbances in children with ASD, which can shorten sleep latency, reduce the number of awakenings, and prolong total sleep time. Larger studies are required to verify this hypothesis.
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Affiliation(s)
- Mei Xiong
- Department of Nursing, The Affiliated Hospital of Southwest Medical University, Luzhou, China.,Department of Pediatric Surgery, Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Fang Li
- Department of Cardiology, People's Hospital of Jianyang City, Jianyang, China
| | - Zhaohua Liu
- Department of Nursing, The Affiliated Hospital of Southwest Medical University, Luzhou, China.,Department of Cardiothoracic Surgery, The Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Xin Xie
- Department of Nursing, The Affiliated Hospital of Southwest Medical University, Luzhou, China.,Department of Nephrology, The Affiliated Hospital of Southwest Medical University, Luzhou, China.,Sichuan Clinical Research Center for Nephropathy, The Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Hongli Shen
- Department of Nursing, The Affiliated Hospital of Southwest Medical University, Luzhou, China.,Department of Pediatric Surgery, Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Weiteng Li
- Department of Nursing, The Affiliated Hospital of Southwest Medical University, Luzhou, China.,Department of Pediatric Surgery, Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Liping Wei
- Department of Nursing, The Affiliated Hospital of Southwest Medical University, Luzhou, China.,Department of Pediatric Surgery, Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Rongfang He
- Department of Nursing, The Affiliated Hospital of Southwest Medical University, Luzhou, China.,Department of Psychiatry, The Affiliated Hospital of Southwest Medical University, Luzhou, China
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Hausman NL, Falligant JM, Bednar MK, Carver AN, Connaughton K. Behavioral Treatment of Sleep Problems using Wake-Time Fading with Individuals with Autism: A Brief Report. Dev Neurorehabil 2023; 26:130-133. [PMID: 36458344 DOI: 10.1080/17518423.2022.2152119] [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: 12/03/2022]
Abstract
Difficulties with sleep, such as delayed onset, night waking, and early waking, are pervasive among individuals with developmental disabilities and autism. Interventions that seek to improve sleep outcomes are particularly useful when these individuals have experienced extended hospitalizations where low activity levels and decreased exposure to light-dark cycles maintain or increase disturbance in sleep patterns. The current study examines the effects of wake-time phase advances on the sleep patterns of a 16-year-old male and 17-year-old female, both of whom presented with significant sleep disturbance, autism, developmental delays, and severe problem behavior in a hospital-based setting. For both individuals, clinically significant increases in appropriate sleep and decreases in latency to sleep were observed throughout the course of their admission as a result of wake-time phase advances. Together, these results replicate and extend limited research in this area by using behavioral interventions to decrease disrupted sleep in inpatient contexts.
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Affiliation(s)
| | - John M Falligant
- Department of Behavioral Psychology, Kennedy Krieger Institute & Johns Hopkins University School of Medicine, Baltimore, MD, USA
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39
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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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40
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Estes A, Munson J, St John T, Finlayson R, Pandey J, Gottlieb B, Herrington J, Schultz RT. Sleep problems in autism: Sex differences in the school-age population. Autism Res 2023; 16:164-173. [PMID: 36341856 PMCID: PMC9839593 DOI: 10.1002/aur.2848] [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: 06/15/2022] [Accepted: 10/22/2022] [Indexed: 11/09/2022]
Abstract
Clinically significant sleep problems affect up to 86% of the autistic population in school-age. Sleep problems can have negative impacts on child cognition, behavior, and health. However, sex differences in the prevalence and types of sleep problems are not well understood in autism. To evaluate sex differences in sleep problems in the school-age autistic population, we obtained parent-report of sleep problems on the Children's Sleep Habits Questionnaire and conducted direct assessments to establish diagnosis and intellectual ability in 6-12-year-old children (autism n = 250; typical development [TD] n = 114). Almost 85% of autistic females demonstrated sleep problems compared to 65.8% of autistic males, 44.8% of TD females, and 42.4% of TD males; a statistically significant increase for autistic females. Autistic females demonstrated increased bedtime resistance, sleep anxiety, and sleepiness, and decreased sleep duration, but did not differ in sleep onset delay, night wakings, parasomnias, or disordered breathing compared with autistic males. Intellectual ability was not related to increased sleep problems. Higher anxiety scores were associated with more sleep problems for males but not females. In one of the first studies to evaluate sex differences in sleep in the school-age, autistic population, autistic females demonstrated increased sleep problems compared to autistic males, TD females, and TD males. Current autism assessment and intervention practices may benefit from increased attention to sleep problems in autistic school-age females and to anxiety in autistic males to enhance well-being and behavioral and health outcomes.
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Affiliation(s)
- Annette Estes
- Department of Speech and Hearing Science, Box 357920, UW Autism Center, University of Washington, Seattle, Washington, USA
| | - Jeffrey Munson
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, Washington, USA
| | - Tanya St John
- Department of Speech and Hearing Science, Box 357920, UW Autism Center, University of Washington, Seattle, Washington, USA
| | - Robin Finlayson
- College of Education, University of Washington, Seattle, Washington, USA
| | - Juhi Pandey
- Department of Psychiatry, Center for Autism Research, Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Bridget Gottlieb
- Center for Autism Research, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - John Herrington
- Department of Psychiatry, Center for Autism Research, Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Robert T Schultz
- Department of Psychiatry, Center for Autism Research, Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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Linke AC, Chen B, Olson L, Ibarra C, Fong C, Reynolds S, Apostol M, Kinnear M, Müller RA, Fishman I. Sleep Problems in Preschoolers With Autism Spectrum Disorder Are Associated With Sensory Sensitivities and Thalamocortical Overconnectivity. BIOLOGICAL PSYCHIATRY. COGNITIVE NEUROSCIENCE AND NEUROIMAGING 2023; 8:21-31. [PMID: 34343726 PMCID: PMC9826645 DOI: 10.1016/j.bpsc.2021.07.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Revised: 07/08/2021] [Accepted: 07/21/2021] [Indexed: 01/18/2023]
Abstract
BACKGROUND Projections between the thalamus and sensory cortices are established early in development and play an important role in regulating sleep as well as in relaying sensory information to the cortex. Atypical thalamocortical functional connectivity frequently observed in children with autism spectrum disorder (ASD) might therefore be linked to sensory and sleep problems common in ASD. METHODS Here, we investigated the relationship between auditory-thalamic functional connectivity measured during natural sleep functional magnetic resonance imaging, sleep problems, and sound sensitivities in 70 toddlers and preschoolers (1.5-5 years old) with ASD compared with a matched group of 46 typically developing children. RESULTS In children with ASD, sleep problems and sensory sensitivities were positively correlated, and increased sleep latency was associated with overconnectivity between the thalamus and auditory cortex in a subsample with high-quality magnetic resonance imaging data (n = 29). In addition, auditory cortex blood oxygen level-dependent signal amplitude was elevated in children with ASD, potentially reflecting reduced sensory gating or a lack of auditory habituation during natural sleep. CONCLUSIONS These findings indicate that atypical thalamocortical functional connectivity can be detected early in development and may play a crucial role in sleep problems and sensory sensitivities in ASD.
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Affiliation(s)
- Annika Carola Linke
- Brain Development Imaging Laboratories, Department of Psychology, San Diego State University, San Diego, California.
| | - Bosi Chen
- Brain Development Imaging Laboratories, Department of Psychology, San Diego State University, San Diego, California; San Diego State University/University of California San Diego Joint Doctoral Program in Clinical Psychology, San Diego, California
| | - Lindsay Olson
- Brain Development Imaging Laboratories, Department of Psychology, San Diego State University, San Diego, California; San Diego State University/University of California San Diego Joint Doctoral Program in Clinical Psychology, San Diego, California
| | - Cynthia Ibarra
- Brain Development Imaging Laboratories, Department of Psychology, San Diego State University, San Diego, California
| | - Chris Fong
- Brain Development Imaging Laboratories, Department of Psychology, San Diego State University, San Diego, California; San Diego State University/University of California San Diego Joint Doctoral Program in Clinical Psychology, San Diego, California
| | - Sarah Reynolds
- Brain Development Imaging Laboratories, Department of Psychology, San Diego State University, San Diego, California
| | - Michael Apostol
- Brain Development Imaging Laboratories, Department of Psychology, San Diego State University, San Diego, California
| | - Mikaela Kinnear
- Brain Development Imaging Laboratories, Department of Psychology, San Diego State University, San Diego, California
| | - Ralph-Axel Müller
- Brain Development Imaging Laboratories, Department of Psychology, San Diego State University, San Diego, California; San Diego State University/University of California San Diego Joint Doctoral Program in Clinical Psychology, San Diego, California; SDSU Center for Autism and Developmental Disorders, San Diego, California
| | - Inna Fishman
- Brain Development Imaging Laboratories, Department of Psychology, San Diego State University, San Diego, California; San Diego State University/University of California San Diego Joint Doctoral Program in Clinical Psychology, San Diego, California; SDSU Center for Autism and Developmental Disorders, San Diego, California
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Hammond L, Joly V, Kapasi A, Kryska K, Andrew G, Oberlander TF, Pei J, Rasmussen C. Adaptive behavior, sleep, and physical activity in adolescents with fetal alcohol spectrum disorder. RESEARCH IN DEVELOPMENTAL DISABILITIES 2022; 131:104366. [PMID: 36279676 DOI: 10.1016/j.ridd.2022.104366] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Revised: 07/08/2022] [Accepted: 10/13/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND Fetal alcohol spectrum disorder (FASD) is broadly associated with impairments to adaptive behavior and dysfunctional sleep. Associations between sleep, adaptive behavior, and physical activity are frequently drawn in discussions of typical development and other clinical conditions. AIMS In this study, we sought to characterize patterns of sleep, adaptive behavior, and physical activity in adolescents with FASD. We also investigated the associations between sleep, adaptive behavior, and physical activity within this population. METHODS AND PROCEDURES Twenty-seven adolescents aged 11- to 17-years with a diagnosis of FASD and their caregivers participated in this study. All participants completed parent and youth questionnaires on adaptive behavior, sleep, and physical activity. OUTCOMES AND RESULTS Adolescents with FASD displayed significant impairments to all domains of adaptive behavior and considerable sleep disturbance. Worse sleep was associated with older age and sleep-related breathing disturbances were associated with poorer social adaptive behavior. Participation in physical activity, particularly organized sport, was strongly associated with better adaptive behavior. CONCLUSIONS AND IMPLICATIONS Adolescents with FASD experience considerable challenges with regards to sleep and adaptive behavior. Physical activity, particularly organized sport, may provide opportunities for the improvement of adaptive behavior in this population.
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Affiliation(s)
- Leah Hammond
- Department of Pediatrics, University of Alberta, Edmonton, AB, Canada
| | - Vannesa Joly
- Department of Educational Psychology, University of Alberta, Edmonton, AB, Canada
| | - Aamena Kapasi
- Department of Educational Psychology, University of Alberta, Edmonton, AB, Canada
| | - Kathryn Kryska
- Department of Pediatrics, University of Alberta, Edmonton, AB, Canada
| | - Gail Andrew
- Department of Pediatrics, University of Alberta, Edmonton, AB, Canada; Glenrose Rehabilitation Hospital, Edmonton, AB, Canada
| | - Tim F Oberlander
- Department of Pediatrics, School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
| | - Jacqueline Pei
- Department of Educational Psychology, University of Alberta, Edmonton, AB, Canada
| | - Carmen Rasmussen
- Department of Pediatrics, University of Alberta, Edmonton, AB, Canada.
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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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44
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Lampinen LA, Zheng S, Taylor JL, Adams RE, Pezzimenti F, Asarnow LD, Bishop SL. Patterns of sleep disturbances and associations with depressive symptoms in autistic young adults. Autism Res 2022; 15:2126-2137. [PMID: 36082844 PMCID: PMC9677950 DOI: 10.1002/aur.2812] [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: 02/08/2022] [Accepted: 08/19/2022] [Indexed: 12/15/2022]
Abstract
Autistic individuals are at an increased risk for both sleep disturbances and depression. While studies in the general population and in autistic adults have drawn general links between sleep disturbances and mental health, few studies have examined the extent to which specific sleep problems may be implicated in the extremely high rates of depression among autistic adults. This study aimed to describe the patterns of sleep disturbances in autistic young adults, and their associations with depressive symptoms while controlling for relevant demographic factors. A sample of 304 legally independent adults (age 18-35 years old) with a childhood diagnosis of autism spectrum disorder self-reported on their average sleep behaviors during the past week and depressive symptoms on the Beck Depressive Inventory-II. A significant proportion (86.01%) of autistic young adults experienced at least one of the primary sleep disturbances of interest, including short total sleep time (39.59%), poor sleep efficiency (60.07%), and delayed sleep phase (36.18%). Additionally, lower sleep efficiency and delayed sleep phase were both associated with higher depressive symptoms. The associations between sleep and depressive symptoms identified in our study suggest that sleep treatments may hold potential for ameliorating depressive symptoms in autistic adults who also experience sleep problems. Further research using daily sleep diaries and objective measures of sleep behaviors, as well as longitudinal studies, are needed to understand how changes in sleep may relate to changes in depressive symptoms in autistic adults.
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Affiliation(s)
- Linnea A Lampinen
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, California, USA
| | - Shuting Zheng
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, California, USA
| | - Julie Lounds Taylor
- Department of General Pediatrics, Vanderbilt University Medical Center. One Magnolia Circle, Nashville, Tennessee, USA
| | - Ryan E Adams
- Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Florencia Pezzimenti
- Department of General Pediatrics, Vanderbilt University Medical Center. One Magnolia Circle, Nashville, Tennessee, USA
| | - Lauren D Asarnow
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, California, USA
| | - Somer L Bishop
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, California, USA
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Rolling J, Rabot J, Schroder CM. Melatonin Treatment for Pediatric Patients with Insomnia: Is There a Place for It? Nat Sci Sleep 2022; 14:1927-1944. [PMID: 36325278 PMCID: PMC9621019 DOI: 10.2147/nss.s340944] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Accepted: 09/18/2022] [Indexed: 01/24/2023] Open
Abstract
Sleep is a vital physiological function that is impaired in ranges from 10% in the typically developing pediatric population to over 80% in populations of children with neurodevelopmental disorders and/or psychiatric comorbidities. Pediatric insomnia disorder is an increasing public health concern given its negative impact on synaptic plasticity involved in learning and memory consolidation but also on mood regulation, hormonal development and growth, and its significant impact on quality of life of the child, the adolescent and the family. While first-line treatment of pediatric insomnia should include parental education on sleep as well as sleep hygiene measures and behavioural treatment approaches, pharmacological interventions may be necessary if these strategies fail. Melatonin treatment has been increasingly used off-label in pediatric insomnia, given its benign safety profile. This article aims to identify the possible role of melatonin treatment for pediatric insomnia, considering its physiological role in sleep regulation and the differential effects of immediate release (IR) versus prolonged release (PR) melatonin. For the physician dealing with pediatric insomnia, it is particularly important to be able to distinguish treatment rationales implying different dosages and times of treatment intake. Finally, we discuss the benefit-risk ratio for melatonin treatment in different pediatric populations, ranging from the general pediatric population to children with different types of neurodevelopmental disorders, such as autism spectrum disorder or ADHD.
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Affiliation(s)
- Julie Rolling
- Department of Child and Adolescent Psychiatry, Strasbourg University Hospitals, Strasbourg, France
- CNRS UPR3212- Research Team “Light, Circadian Rhythms, Sleep Homeostasis and Neuropsychiatry”, Institute of Cellular and Integrative Neurosciences, Strasbourg, France
- Excellence Centre for Autism and Neurodevelopmental Disorders STRAS&ND, Strasbourg, France
- Sleep Disorders Centre & International Research Centre for ChronoSomnology (Circsom), University Hospitals Strasbourg, Strasbourg, France
| | - Juliette Rabot
- Department of Child and Adolescent Psychiatry, Strasbourg University Hospitals, Strasbourg, France
- CNRS UPR3212- Research Team “Light, Circadian Rhythms, Sleep Homeostasis and Neuropsychiatry”, Institute of Cellular and Integrative Neurosciences, Strasbourg, France
- Excellence Centre for Autism and Neurodevelopmental Disorders STRAS&ND, Strasbourg, France
- Expert Centre for High-Functioning Autism, Fondation FondaMental, Strasbourg, France
- Autism Resources Centre 67 for Children and Adolescents, Strasbourg, France
| | - Carmen M Schroder
- Department of Child and Adolescent Psychiatry, Strasbourg University Hospitals, Strasbourg, France
- CNRS UPR3212- Research Team “Light, Circadian Rhythms, Sleep Homeostasis and Neuropsychiatry”, Institute of Cellular and Integrative Neurosciences, Strasbourg, France
- Excellence Centre for Autism and Neurodevelopmental Disorders STRAS&ND, Strasbourg, France
- Sleep Disorders Centre & International Research Centre for ChronoSomnology (Circsom), University Hospitals Strasbourg, Strasbourg, France
- Expert Centre for High-Functioning Autism, Fondation FondaMental, Strasbourg, France
- Autism Resources Centre 67 for Children and Adolescents, Strasbourg, France
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Deng W, Wang S, Li F, Wang F, Xing YP, Li Y, Lv Y, Ke H, Li Z, Lv PJ, Hao H, Chen Y, Xiao X. Gastrointestinal symptoms have a minor impact on autism spectrum disorder and associations with gut microbiota and short-chain fatty acids. Front Microbiol 2022; 13:1000419. [PMID: 36274684 PMCID: PMC9585932 DOI: 10.3389/fmicb.2022.1000419] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Accepted: 09/05/2022] [Indexed: 11/13/2022] Open
Abstract
Children with autism spectrum disorder (ASD) experience gastrointestinal (GI) issues more frequently and severely than children who are typically developing (TD). The connections between gastrointestinal problems, microbiota, and short-chain fatty acids (SCFAs) in ASD are still being debated. We enrolled 90 children, 45 of whom were diagnosed with ASD, and examined the impact of GI disorders on ASD. The six-item GI Severity Index questionnaire was used to evaluate gastrointestinal symptoms, while the Social Responsiveness Scale was used to evaluate autism symptoms. Further, the Children’s Sleep Habits Questionnaire and the Children’s Eating Behavior Questionnaire are used to assess sleep and eating disorders in children. We assessed fecal microbiota by 16S rRNA gene sequencing, and SCFA concentrations by gas chromatography/mass spectrometry. The results revealed that children with ASD exhibited a high rate of gastrointestinal issues (78%), as well as higher rates of social impairment and poor sleeping habits, compared to TD children. However, GI disturbances have a minor impact on autism. In addition, the levels of propionic acid, butyric acid, and valeric acid were significantly higher in the ASD group. Besides, the ASD, TD, and GI subgroups possessed distinct microbiome profiles. These findings suggest that gastrointestinal disturbances have no discernible effect on the core symptoms of autism. Although autism may not cause an increase in GI symptoms directly, alterations in metabolites, such as SCFAs, may cause GI symptoms.
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Affiliation(s)
- Wenlin Deng
- Department of Pediatrics, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
- *Correspondence: Wenlin Deng,
| | - Siqi Wang
- Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Fang Li
- Department of Gastroenterology, Gastroenterology Endoscopy Center, Hainan General Hospital, Hainan Affiliated Hospital of Hainan Medical University, Haikou, China
| | - Fang Wang
- Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Yi Pei Xing
- Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Yongchun Li
- Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Ying Lv
- Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Haoran Ke
- Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Zitong Li
- Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Pin Jing Lv
- Department of Pediatrics, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Hu Hao
- Department of Pediatrics, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Ye Chen
- Nanfang Hospital, Southern Medical University, Guangzhou, China
- Shenzhen Hospital, Southern Medical University, Shenzhen, China
| | - Xin Xiao
- Department of Pediatrics, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
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Saini L, Mukherjee S, Gunasekaran PK, Malhi P, Saini AG, De D, Padhy S, Ahuja C, Suthar R, Sahu JK, Sankhyan N, Yadav J, Sharawat IK. Sleep Problems in Children With Neurocutaneous Syndromes: A Cross-Sectional Study. J Child Neurol 2022; 37:864-870. [PMID: 35918819 DOI: 10.1177/08830738221114560] [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: 11/17/2022]
Abstract
Introduction: The prevalence and patterns of sleep disturbances in neurocutaneous syndromes are variable and understudied. Methods: Cross-sectional study for 18 months at a tertiary care pediatric hospital, involving 100 children with neurocutaneous syndromes aged between 4 and 10 years using the Children's Sleep Habits Questionnaire-Abbreviated. Results: In 100 children with neurocutaneous syndromes, 47 (47%) had significant sleep problems. In subgroup analysis, 7 of 17 children with neurofibromatosis 1, 24 of 63 children with tuberous sclerosis complex, 10 of 12 children with Sturge-Weber syndrome, 2 of 3 children with linear nevus sebaceous syndrome, and each of the children with hypomelanosis of Ito, McCune-Albright syndrome, megalencephaly-capillary malformation syndrome, and unclassified neurocutaneous syndrome had significant sleep problems. Conclusion: The prevalence of sleep problems in our study population was not more than that observed in the general pediatric population. Prospective multicentric studies are needed to comprehend sleep problems in children with neurocutaneous syndromes.
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Affiliation(s)
- Lokesh Saini
- Department of Pediatrics, 410775All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Swetlana Mukherjee
- Department of Pediatrics, 29751Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | | | - Prahbhjot Malhi
- Department of Pediatrics, 29751Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Arushi Gahlot Saini
- Department of Pediatrics, 29751Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Dipankar De
- Department of Dermatology, Venereology and Leprosy, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Susanta Padhy
- Department of Psychiatry, 410730All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | - Chirag Ahuja
- Department of Radiodiagnosis, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Renu Suthar
- Department of Pediatrics, 29751Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Jitendra Kumar Sahu
- Department of Pediatrics, 29751Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Naveen Sankhyan
- Department of Pediatrics, 29751Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Jaivinder Yadav
- Department of Pediatrics, 29751Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Indar Kumar Sharawat
- Department of Pediatrics, 442339All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
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48
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Chua B, Neoh M, Jeon M, Joyce A, Iandolo G, Hayton J, Esposito G, Dimitriou D. Impact of sleep on attention in primary school-aged autistic children: Exploratory cross-cultural comparison between Singapore and UK children. RESEARCH IN DEVELOPMENTAL DISABILITIES 2022; 128:104271. [PMID: 35759855 DOI: 10.1016/j.ridd.2022.104271] [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: 03/06/2022] [Revised: 05/17/2022] [Accepted: 05/28/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND There is a growing body of research studying the impact sleep has on attention among typically developing (TD) children, but research is lacking among autistic children. AIMS The present study aimed to explore, for the first time, differences in (1) attention, (2) sleep parameters among primary school-aged Singaporean autistic children (N = 26) and Singaporean TD children (N = 20), and with UK autistic (N = 11) and UK TD children (N = 16), and (3) the impact of sleep on attention. METHODS AND PROCEDURES Actigraphy was used to objectively assess sleep, and a Continuous Performance Task was used to measure attentional domains. OUTCOMES AND RESULTS There were inconclusive findings indicating that autistic children had poorer sustained attention than TD children. Although autistic children did not display more sleep difficulties than TD children, they showed shorter actual sleep duration (Singapore ASD = 7:00 h, UK ASD = 7:35 h, p < .01) and longer sleep latency (Singapore ASD = 30:15 min, UK ASD = 60:00 min, p < .01) than clinical recommendations. Sleep difficulties were also present among Singaporean and UK TD children. Both TD groups had less actual sleep duration than recommended (Singapore TD = 6:32 h, UK TD = 8:07 h). Singaporean TD children had sleep efficiency below recommended criterion (78.15%). Sleep impacted attention across all groups, but effects were different for autistic and TD groups. CONCLUSIONS AND IMPLICATIONS The study highlighted the importance for practitioners and carers to adopt a child-centred approach to assessing sleep and attentional difficulties, especially among autistic children due to the high variability in performance within the group. The impact of cultural and school-setting differences on sleep was also raised.
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Affiliation(s)
- Beatrice Chua
- Sleep Education and Research Laboratory, UCL Institute of Education, London, UK
| | - Michelle Neoh
- Psychology Program, School of Social Sciences, Nanyang Technological University, Singapore, Singapore
| | - Mina Jeon
- Sleep Education and Research Laboratory, UCL Institute of Education, London, UK
| | - Anna Joyce
- Sleep Education and Research Laboratory, UCL Institute of Education, London, UK; Faculty of Health and Life Sciences, Coventry University, UK
| | - Giuseppe Iandolo
- Department of Psychology, School of Biomedical Sciences, European University of Madrid, Madrid, Spain; Observation and Functional Diagnosis Division, PSISE Clinical and Developmental Psychological Service, Madrid, Spain
| | - Jessica Hayton
- Sleep Education and Research Laboratory, UCL Institute of Education, London, UK
| | - Gianluca Esposito
- Department of Psychology and Cognitive Science, University of Trento, Rovereto, Italy
| | - Dagmara Dimitriou
- Sleep Education and Research Laboratory, UCL Institute of Education, London, UK.
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49
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Álvarez C. Alteraciones del sueño en trastornos del neurodesarrollo. REVISTA MÉDICA CLÍNICA LAS CONDES 2022. [DOI: 10.1016/j.rmclc.2022.07.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022] Open
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50
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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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