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McKenna K, Prasad S, Cooper J, King AM, Shahzeidi S, Mittal J, Zalta M, Mittal R, Eshraghi AA. Incidence of Otolaryngological Manifestations in Individuals with Autism Spectrum Disorder: A Special Focus on Auditory Disorders. Audiol Res 2024; 14:35-61. [PMID: 38247561 PMCID: PMC10801499 DOI: 10.3390/audiolres14010005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Revised: 12/14/2023] [Accepted: 12/26/2023] [Indexed: 01/23/2024] Open
Abstract
Autism Spectrum Disorder (ASD) is a neurodevelopmental disorder characterized by stereotyped and repetitive behavior patterns. In addition to neurological and behavioral problems, individuals with ASD commonly experience otolaryngological comorbidities. Individuals with ASD often have auditory disorders including hearing loss and auditory processing disorders such as central auditory processing disorder (CAPD), as well as both chronic and recurrent otitis media. These challenges negatively impact a person's ability to effectively communicate and may further impact their neurological functioning, particularly when not appropriately treated. Individuals diagnosed with ASD also have difficulty sleeping which contributes to increased irritability and may further aggravate the core behavioral symptoms of autism. The individuals with ASD also have a higher rate of sinusitis which contributes to the worsening of the autism behavior phenotype. The high prevalence of otolaryngological comorbidities in individuals with ASD warrants a better collaboration between their various healthcare providers and otolaryngologists with expertise in auditory, sleep, and sinus disorders in pursuit of improving the quality of life of affected individuals and their families/caregivers.
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Affiliation(s)
- Keelin McKenna
- Hearing Research and Cochlear Implant Laboratory, Department of Otolaryngology, University of Miami Miller School of Medicine, Miami, FL 33136, USA; (K.M.); (S.P.); (J.C.); (A.M.K.); (J.M.); (R.M.)
- Herbert Wertheim College of Medicine, Florida International University, Miami, FL 33199, USA
| | - Soumil Prasad
- Hearing Research and Cochlear Implant Laboratory, Department of Otolaryngology, University of Miami Miller School of Medicine, Miami, FL 33136, USA; (K.M.); (S.P.); (J.C.); (A.M.K.); (J.M.); (R.M.)
| | - Jaimee Cooper
- Hearing Research and Cochlear Implant Laboratory, Department of Otolaryngology, University of Miami Miller School of Medicine, Miami, FL 33136, USA; (K.M.); (S.P.); (J.C.); (A.M.K.); (J.M.); (R.M.)
- School of Medicine, New York Medical College, Valhalla, NY 10595, USA
| | - Ava M. King
- Hearing Research and Cochlear Implant Laboratory, Department of Otolaryngology, University of Miami Miller School of Medicine, Miami, FL 33136, USA; (K.M.); (S.P.); (J.C.); (A.M.K.); (J.M.); (R.M.)
| | | | - Jeenu Mittal
- Hearing Research and Cochlear Implant Laboratory, Department of Otolaryngology, University of Miami Miller School of Medicine, Miami, FL 33136, USA; (K.M.); (S.P.); (J.C.); (A.M.K.); (J.M.); (R.M.)
| | - Max Zalta
- Hearing Research and Cochlear Implant Laboratory, Department of Otolaryngology, University of Miami Miller School of Medicine, Miami, FL 33136, USA; (K.M.); (S.P.); (J.C.); (A.M.K.); (J.M.); (R.M.)
| | - Rahul Mittal
- Hearing Research and Cochlear Implant Laboratory, Department of Otolaryngology, University of Miami Miller School of Medicine, Miami, FL 33136, USA; (K.M.); (S.P.); (J.C.); (A.M.K.); (J.M.); (R.M.)
| | - Adrien A. Eshraghi
- Hearing Research and Cochlear Implant Laboratory, Department of Otolaryngology, University of Miami Miller School of Medicine, Miami, FL 33136, USA; (K.M.); (S.P.); (J.C.); (A.M.K.); (J.M.); (R.M.)
- Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, FL 33136, USA
- Department of Biomedical Engineering, University of Miami, Coral Gables, FL 33146, USA
- Department of Pediatrics, University of Miami Miller School of Medicine, Miami, FL 33136, USA
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Russell M, Baldwin CM, Quan SF. Exploring Sleep in Caregivers of Children with Autism Spectrum Disorder (ASD) and the Relationship to Health-Related Quality of Life (HRQoL) and Family Quality of Life (FQoL). MEDICINA (KAUNAS, LITHUANIA) 2023; 59:2132. [PMID: 38138235 PMCID: PMC10744649 DOI: 10.3390/medicina59122132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Revised: 11/21/2023] [Accepted: 12/04/2023] [Indexed: 12/24/2023]
Abstract
Background and Objectives: To investigate (1) the prevalence of sleep disorder symptoms in caregivers of children with autism spectrum disorder (ASD) and (2) the relationships between caregiver sleep problems and their health-related quality of life and family quality of life. Materials and Methods: Descriptive cross-sectional study of caregivers (N = 62) of children aged 6 to 11 years old diagnosed with ASD and receiving care at a regional autism research and resource center. Results: Participants completed the Sleep Habits Questionnaire (SHQ), the Medical Outcomes Study (MOS) SF-12, and the Beach Center Family Quality of Life Scale (FQoL). Caregivers with longer sleep duration reported better mental health and better family quality of life. Caregivers who reported insomnia symptoms, non-restorative sleep, and insufficient sleep were more likely to report poorer mental health than caregivers who did not report these sleep disorder symptoms. Caregivers with obstructive sleep apnea and restless legs syndrome experienced worse physical quality of life. Conclusions: The physical and mental health of the primary caregiver is essential to the support of the child with ASD and to the functioning of the family. The study findings point to the importance of future research and interventions to enhance sleep health in order to improve quality of life for caregivers of children with ASD.
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Affiliation(s)
- Maureen Russell
- Institute for Human Development, Northern Arizona University, Flagstaff, AZ 86011, USA;
| | - Carol M. Baldwin
- Edson College of Nursing and Health Innovation, Arizona State University, Phoenix, AZ 85287, USA;
| | - Stuart F. Quan
- Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, College of Medicine, University of Arizona, Tucson, AZ 85724, USA
- Division of Sleep and Circadian Disorders, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA 02115, USA
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Johnson CR, Barto L, Worley S, Rothstein R, Alder ML. Telehealth parent training for sleep disturbances in young children with autism spectrum disorder: A randomized controlled trial. Sleep Med 2023; 111:208-219. [PMID: 37806263 DOI: 10.1016/j.sleep.2023.08.033] [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: 05/18/2023] [Revised: 08/29/2023] [Accepted: 08/30/2023] [Indexed: 10/10/2023]
Abstract
BACKGROUND AND PURPOSE Young children with autism spectrum disorder (autism) have bedtime and sleep disturbances at much higher frequency and persistency than their neurotypical counterparts. Hence, access to early, effective treatment is critical in view of the importance of sleep in early childhood. Telehealth delivery could be a means to expand access to such early treatment if efficacious. The aim of this randomized control trial (RCT) was to compare a manualized, telehealth delivered, behaviorally based sleep parent training (SPT) intervention for parents of young children with autism and sleep disturbances to a control condition, a telehealth delivered parent education program with one sleep focused session (SPE). We hypothesized that the SPT group would show more improvements on child measures of sleep outcome measures, and daytime behaviors and parent measures of stress and sense of competence. We further aimed to explore the overall feasibility of telehealth delivery of SPT and SPE. PARTICIPANTS AND METHODS Parents of 77 young children, ages 2-7 years, with autism and co-occurring sleep disturbances were enrolled in this study. Participants were randomized to either SPT or a comparison arm that included non-sleep related parent education except for one session. Each participant was individually administered a 5 session program delivered over 10 weeks. Outcome measures, including child sleep measures, child daytime behavior and parent stress and sense of competency were collected at weeks 5 and 10 after the baseline time point. Feasibility indicators (treatment fidelity, parent adherence, and parent attendance), and safety measures were also collected. RESULTS Of 77 randomized participants, data were available for 36 participants randomized to SPT and 38 participants randomized to SPE. The mean age was 3 years, 8 months. Results support the efficacy of this manualized SPT intervention for bedtime and sleep disturbances. Sleep outcome measures were significantly improved in the SPT group compared to SPE on the Modified Simonds & Parraga Sleep Questionnaire-Composite Sleep Index (MSPSQ - CSI) (p < 0.001) with a large effect size of 0.83 at week 10. Positive response to treatment, as determined from the Clinical Global Impression-Improvement scale (CGI-I) at week 10 was observed in 56% of SPT participants compared to 32% in SPE (p = 0.037). There were no significant group differences in either the ABC-I as measure of daytime behaviors or in parental stress. There were group differences in favor of SPT over SPE on the PSOC, a measure of parent sense of competency. Feasibility and safety were further demonstrated with telehealth delivery. CONCLUSIONS This RCT demonstrated the efficacy of a telehealth delivered parent training intervention for bedtime and sleep disturbances in young autistic children compared to an active control condition. Further, parents in SPT reported more confidence in their parenting role than those in the SPE group, but SPT did not result in overall decreases in parental stress. Telehealth delivery allowed for a much broader reach with enrolled participants from 24 states. This study supports a telehealth approach to a manualized behavioral parent mediated intervention for sleep disturbance in young autistic children and offers an alternative to in-person delivered approaches. This telehealth delivery has the potential to improve access for families who have a young autistic child with sleep disturbances. Given the small sample size, determining predictors and moderators of treatment response was not possible and should be examined in a larger trial.
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Wong LC, Huang CH, Chou WY, Hsu CJ, Tsai WC, Lee WT. The clinical and sleep manifestations in children with FOXG1 syndrome. Autism Res 2023; 16:953-966. [PMID: 36942618 DOI: 10.1002/aur.2916] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2022] [Accepted: 02/25/2023] [Indexed: 03/23/2023]
Abstract
FOXG1 syndrome is a rare neurodevelopmental disorder associated with severe cognitive dysfunction, autistic behavior, and early-onset hyperkinetic movement disorders. Patients have also been reported to experience sleep disturbances. However, these findings are mainly based on subjective caregivers' reports, and limited by small case numbers. Moreover, no studies using objective evaluation tools, such as actigraphy, have been reported. We analyzed the clinical and sleep manifestations of children with FOXG1 syndrome registered in the International FOXG1 Research Foundation registry database. A total of 258 individuals with FOXG1 syndrome were included in this research. 132 (51.16%) had sleep disturbances. The more impaired of language acquisitions (absence of speech, OR: 3.99, 95%CI = 1.69-9.42, p = 0.002), hyperkinetic movement disorders (OR: 2.64, 95%CI = 1.34-5.20 p = 0.005) and feeding difficulties (OR: 2.81, 95% CI = 1.52-5.19, p = 0.001) were significantly associated with an increase in odds of sleep disturbance after adjusting for age, sex, and antiepileptic drugs. We also performed sleep studies on six individuals with FOXG1 syndrome using The Children's Sleep Habits Questionnaire (CSHQ), the Sleep Disturbance Scale for Children (SDSC), and 7-day data from Actiwatch. The Pittsburgh Sleep Quality Index (PSQI) and 7-day data from Actiwatch were also used to evaluate the sleep condition of their parents. The CSHQ scores revealed bedtime resistance, sleep onset delay, sleep duration, sleep anxiety, night-waking, and parasomnia. Sleep-wake transition disorders and disorders of initiating and maintaining sleep were also suggested by the SDSC scores. The children's actigraphy revealed short sleep durations, impaired sleep efficiency, longer wake after sleep onset, and frequent night-waking. All caregivers reported significantly higher PSQI scores, mildly declined sleep efficiency, and shorter total sleep duration. Sleep disturbances, especially in initiating and maintaining sleep, are common in individuals with FOXG1 syndrome and their caregivers. Sleep disorders in patients with FOXG1 syndrome and their caregivers should be investigated.
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Affiliation(s)
- Lee-Chin Wong
- Department of Pediatrics, National Taiwan University Hospital, Taipei City, Taiwan
- Graduate Institute of Clinical Medicine, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Cheng-Hsien Huang
- Department of Pediatrics, Sleep center, Yang-Ming Branch, Taipei City Hospital, Taipei City, Taiwan
- University of Taipei, Taipei City, Taiwan
| | - Wan-Yun Chou
- Department of Medical Research, Cathay General Hospital, Taipei City, Taiwan
| | - Chia-Jui Hsu
- Department of Pediatrics, Hsin-Chu Branch, National Taiwan University Hospital, Hsinchu City, Taiwan
| | - Wen-Che Tsai
- Department of Psychiatry, National Taiwan University Hospital, Taipei City, Taiwan
| | - Wang-Tso Lee
- Department of Pediatrics, National Taiwan University Hospital, Taipei City, Taiwan
- Graduate Institute of Brain and Mind Sciences, National Taiwan University College of Medicine, Taipei City, Taiwan
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Nic Ghiolla Phadraig A, Smyth S. Sleep mediates the relationship between having an autistic child and poor family functioning. Sleep Med 2023; 101:190-196. [PMID: 36402004 DOI: 10.1016/j.sleep.2022.10.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Revised: 10/13/2022] [Accepted: 10/16/2022] [Indexed: 11/09/2022]
Abstract
Sleep is an important biological necessity, a lack of which can have many cognitive, psychological, social, and physical impacts. Children with autism are known to present with sleep difficulties more frequently than their typically developing peers but despite this, there is relatively little research looking at the impact of sleep on the family. To investigate the effect of sleep on families of autistic and typically developing (TD) children, we conducted a study of sleep disturbances among children, sleep quality of their parents in association with their family function. In our study, 239 parents of autistic children and 227 parents of TD children participated. These parents completed a survey about their child's sleep disturbances, their own sleep quality, and their family function, along with a series of demographic questions. Analyses indicated that autistic children experience more sleep difficulties than TD peers, that children's sleep disturbances are associated with parental sleep quality and that parents of autistic children report decreased sleep quality compared to parents of TD children. Parental sleep quality, and child sleep quality were both found to partially mediate the relationship between autism diagnosis and family function.
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Affiliation(s)
| | - Sinéad Smyth
- School of Psychology, Dublin City University, Ireland.
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Varma P, Jackson ML, Junge M, Conduit R. Actigraphy‐measured sleep concordance, night‐wakings, intraindividual sleep variability in parents and their children—Associations with childhood sleep disturbances. J Sleep Res 2022; 32:e13773. [PMID: 36345126 DOI: 10.1111/jsr.13773] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Revised: 10/12/2022] [Accepted: 10/13/2022] [Indexed: 11/10/2022]
Abstract
The relationship between the sleep of parents and their children has primarily been studied using self-reported measures, but data using objective sleep assessments are limited. In particular, objective assessments of sleep disturbance and night-wakings in parents in relation to their children's night-wakings is underexamined. This pilot study employed actigraphy to determine concordance in sleep-wake patterns between parents and their children, and examine temporal links between their wakings lasting five min or longer. The study also explored individual variability in parents' sleep based on parent-reported sleep disturbances in children. A total of 20 parents and children (aged 2-12 years, no co-sleepers) contributed actigraphy data for the 14-night study, totalling 280 nights of data. Parents reported their sleep quality using the Pittsburgh Sleep Quality Index, and children's sleep using the Children Sleep Habits Questionnaire. Concordance analysis of actigraphy data revealed an average of 70.6% match in sleep/wake state between parents and children. Parents were three times more likely to have an awakening within 10 min of their child waking than vice versa. Parent-reported sleep disturbances in children were associated with poorer actigraphic sleep outcomes for both the parent and child. Parents of poorly sleeping children demonstrated greater variability in their bedtime, and wake after sleep onset. Further examination of temporal links between parent-child sleep can improve our understanding of factors that predispose or precipitate sleep disturbances across families. Given the high concordance in parent-child sleep and poorer actigraphy sleep outcomes in parents of children with sleep disturbances, there is a need to deliver efficacious sleep interventions at the family level.
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Affiliation(s)
- Prerna Varma
- School of Health and Biomedical Sciences RMIT University Melbourne Victoria Australia
- Turner Institute for Brain and Mental Health, School of Psychological Sciences Monash University Clayton Victoria Australia
| | - Melinda L. Jackson
- Turner Institute for Brain and Mental Health, School of Psychological Sciences Monash University Clayton Victoria Australia
| | - Moira Junge
- Sleep Health Foundation Blacktown New South Wales Australia
| | - Russell Conduit
- School of Health and Biomedical Sciences RMIT University Melbourne Victoria Australia
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Smith S, Tallon M, Smith J, Angelhoff C, Mörelius E. Parental sleep when their child is sick: A phased principle-based concept analysis. J Sleep Res 2022; 31:e13575. [PMID: 35468663 PMCID: PMC9786861 DOI: 10.1111/jsr.13575] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Revised: 01/28/2022] [Accepted: 02/16/2022] [Indexed: 12/30/2022]
Abstract
Sleep is a common challenge for parents with sick children and can impact parents' health, wellbeing, and caregiving responsibilities. Despite the vast research around parental sleep when their child is sick, the concept is not clearly defined. A phased principle-based concept analysis that includes triangulation of methods and quality criteria assessment was used to explore how the concept is described, used, and measured in the current literature. The aim was to analyse and clarify the conceptual, operational, and theoretical basis of parental sleep when their child is sick to produce an evidence-based definition and to identify knowledge gaps. A systematic literature search including databases CINAHL, Embase, MEDLINE, PsychARTICLES, PsychINFO, Pubmed, Scopus and Web of Science, identified 546 articles. The final dataset comprised 74 articles published between 2005 and 2021 and was assessed using a criteria tool for principle-based concept analysis. Data were managed using NVivo, and thematic analysis was undertaken. A precise definition is not present in the literature. Various tools have been used to measure parents' sleep, as well as exploration via interviews, open-ended questions, and sleep diaries. The terminology used varied. Parental sleep when their child is sick is interrelated with other concepts (e.g., stress). A recommended definition is offered. A conceptual understanding of parental sleep when their child is sick will help to guide translational research and to conduct studies critical to clinical practice and research. Future research includes developing a measurement tool for parental sleep when their child is sick to be used in study design and future interventions.
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Affiliation(s)
- Stephanie Smith
- School of Nursing and MidwiferyEdith Cowan UniversityPerthWAAustralia,Perth Children's HospitalNedlands, PerthWAAustralia
| | - Mary Tallon
- School of NursingCurtin UniversityPerthWAAustralia
| | - James Smith
- Centre for Precision HealthCollaborative Genomics and Translation GroupSchool of Medical and Health SciencesEdith Cowan UniversityPerthWAAustralia,Centre for Healthcare Resilience and Implementation ScienceAustralian Institute for Health InnovationMacquarie UniversitySydneyNSWAustralia
| | - Charlotte Angelhoff
- Crown Princess Victoria's Child and Youth Hospital and Department of Biomedical and Clinical SciencesLinköping UniversityLinköpingSweden
| | - Evalotte Mörelius
- School of Nursing and MidwiferyEdith Cowan UniversityPerthWAAustralia,Perth Children's HospitalNedlands, PerthWAAustralia
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Bin Eid W, Lim M, Gabrieli G, Kölbel M, Halstead E, Esposito G, Dimitriou D. Habilitation of sleep problems among mothers and their children with autism spectrum disorder: Insights from multi-level exploratory dyadic analyses. FRONTIERS IN REHABILITATION SCIENCES 2022; 3:915060. [PMID: 36211831 PMCID: PMC9533106 DOI: 10.3389/fresc.2022.915060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Accepted: 08/29/2022] [Indexed: 11/13/2022]
Abstract
Few habilitation strategies for children with autism spectrum disorder (ASD) consider their sleep-related problems. Together with the fact that caregivers of children with ASD also face issues with sleep, there may be yet-to-be uncovered relationships between caregiver-child sleep patterns and sleep quality, offering a key opportunity for clinicians to consider the needs of both child and caregiver in terms of sleep. 29 dyads of mothers and their children with ASD were recruited for this cohort study and both subjective (self-report questionnaires and sleep diaries) and objective (cortisol samples and actigraphy) measures of sleep were collected to investigate significant predictors of sleep quality. Comparative, correlational, and hierarchical analyses were conducted. Findings indicated that both mother and child experience sleep deprivation in terms of shorter sleep duration and poor sleep quality in terms of longer sleep onset latencies and a higher frequency of wake bouts. Exploratory hierarchical analyses also found that child-related sleep difficulties such as sleep disordered breathing and night waking significantly predict mothers' sleep quality, which may point to the bi-directional influence of mother-child sleep. Based on these findings, it is recommended that clinicians adopt a family systems perspective and consider the sleep environment of the household, particularly that of the caregiver and child, when designing interventions for sleep-related problems in ASD. Finally, there is a need for additional support to promote good quality sleep among caregivers of children with ASD to bolster out-of-clinic care.
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Affiliation(s)
- Wasmiah Bin Eid
- Sleep Education and Research Laboratory, UCL Institute of Education, London, UK
| | - Mengyu Lim
- Psychology Program, School of Social Sciences, Nanyang Technological University, Singapore
| | - Giulio Gabrieli
- Psychology Program, School of Social Sciences, Nanyang Technological University, Singapore
| | - Melanie Kölbel
- Sleep Education and Research Laboratory, UCL Institute of Education, London, UK
- Department of Developmental Neurosciences Unit, UCL Great Ormond Street Institute of Child Health, London, UK
| | - Elizabeth Halstead
- Sleep Education and Research Laboratory, UCL Institute of Education, London, UK
| | - Gianluca Esposito
- Affiliative Behaviour and Physiology Lab, Department of Psychology and Cognitive Science, University of Trento, Italy
| | - Dagmara Dimitriou
- Sleep Education and Research Laboratory, UCL Institute of Education, London, UK
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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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Mignolli E, Scialpi A, Valente D, Berardi A, Galeoto G, Tofani M. Sleep Disturbance Scale for Children: Italian Validation in Autism Spectrum Disorder Population. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:10163. [PMID: 36011798 PMCID: PMC9407824 DOI: 10.3390/ijerph191610163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Revised: 08/09/2022] [Accepted: 08/10/2022] [Indexed: 06/15/2023]
Abstract
Sleep disorders in children with autism spectrum disorders (ASDs) are well-described. However, there is a lack of specific assessment tools to investigate sleep disturbance in this target population. The present investigation reports the Italian validation of the Sleep Disturbance Scale for Children (SDSC) in the ASD population, also investigating the correlation between sleep disorders In both children and parents. Internal consistency and test−retest reliability were investigated using Cronbach’s alpha and intraclass correlation coefficient (ICC), respectively. Concurrent validity was analyzed by comparing the score of the SDSC with the Pittsburgh Sleep Quality Index (PSQI), while the correlation between the SDCS score and the General Sleep Disturbance Scale (GSDS) was used to analyze the correlation between sleep disorders in children and sleep disorders in their parents. In total, 99 children with a diagnosis of ASD participated in the study. Cronbach’s alpha revealed satisfactory value (0.853), as well as reliability (ICC 0.972) and concurrent validity (0.745). Our results also revealed a significant linear correlation between children’s and parents’ sleep disorders (p < 0.05). In conclusion, we found the SDSC to be a useful tool for measuring sleep disorders in ASD children. Our findings offer concrete inputs to achieve adequate pathways for taking care of children with ASDs and their parents.
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Affiliation(s)
- Ester Mignolli
- Department of Anatomical, Histological, Forensic and Orthopaedic Sciences, Sapienza University of Rome, 00185 Rome, Italy
| | - Alessia Scialpi
- Department of Anatomical, Histological, Forensic and Orthopaedic Sciences, Sapienza University of Rome, 00185 Rome, Italy
| | - Donatella Valente
- Department of Human Neurosciences, Sapienza University of Rome, 00185 Rome, Italy
- Neuromed—Istituto Neurologico Mediterraneo, Istituto di Ricovero e Cura a Carattere Scientifico—IRCCS, 86077 Pozzilli, Italy
| | - Anna Berardi
- Department of Human Neurosciences, Sapienza University of Rome, 00185 Rome, Italy
| | - Giovanni Galeoto
- Department of Human Neurosciences, Sapienza University of Rome, 00185 Rome, Italy
- Neuromed—Istituto Neurologico Mediterraneo, Istituto di Ricovero e Cura a Carattere Scientifico—IRCCS, 86077 Pozzilli, Italy
| | - Marco Tofani
- Department of Human Neurosciences, Sapienza University of Rome, 00185 Rome, Italy
- Professional Development, Continuous Education and Research Service, Bambino Gesù Children’s Hospital, Istituto di Ricovero e Cura a Carattere Scientifico—IRCCS, 00165 Rome, Italy
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Lane SJ, Leão MA, Spielmann V. Sleep, Sensory Integration/Processing, and Autism: A Scoping Review. Front Psychol 2022; 13:877527. [PMID: 35656493 PMCID: PMC9152214 DOI: 10.3389/fpsyg.2022.877527] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Accepted: 04/15/2022] [Indexed: 01/09/2023] Open
Abstract
The prevalence of sleep dysfunction is considerably higher in the autistic population than in the non-autistic. Similarly, the incidence of sensory reactivity differences in autism exceeds that in the neurotypical population. The basis of sleep disorders in autism is multifactorial, but sensory integration/processing concerns may play a role. Research that investigates this interplay for autistic individuals is limited but vital. In this scoping review, we examined literature addressing the following research question: What is the relationship between sleep and sensory integration/processing in autism? We included articles if they were peer-reviewed, English or Spanish, purposefully addressed sensory integration/processing differences, were sleep focused and included autism as the primary diagnosis or population. Articles were excluded if the language was not English or Spanish, research was conducted with animals, they were non-peer-reviewed, the primary population was not autistic, the sensory focus reflected a specific sensorineural loss (e.g., blindness, or deafness), there was not a clear inclusion of sensory integration/processing or sleep. We searched six databases and included all citations from the inception of each database through June 2021. The search strategy identified 397 documents that were reduced to 24 included articles after exclusion criteria were applied. The majority of studies we identified characterized the relation between sleep and sensory integration/processing differences in autism. Investigators found multiple sleep concerns such as bedtime resistance, sleep anxiety, delayed sleep onset, night awaking, and short sleep duration in autistic individuals. Identified sensory concerns focused on reactivity, finding hyper- and hypo-reactivity as well as sensory seeking across sensory domains. Co-existence of sleep concerns and sensory integration/processing differences was frequently reported. Few intervention studies showed a clear sensory focus; those that did emphasized pressure, movement, touch, and individual sensory preferences/needs. Swimming programs and massage showed promising results. No studies were of high quality. At a minimum, there is a co-existence of sensory reactivity differences and sleep concerns in autistic children, and possibly autistic adults. The relationship between poor sleep and sensory integration/processing differences is complex and multi-faceted, requiring additional research. Interventions that purposefully include a central sensory component have not been well studied in autistic children or adults. Overall studies with greater rigor and purposeful use of sensation and sensorimotor supports as a component of intervention are needed. This study was not funded.
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Affiliation(s)
- Shelly J. Lane
- Sensory Integration, Play, and Occupational Therapy Research Lab, Department of Occupational Therapy, Colorado State University, Fort Collins, CO, United States
| | - Marco A. Leão
- Sensory Integration, Play, and Occupational Therapy Research Lab, Department of Occupational Therapy, Colorado State University, Fort Collins, CO, United States
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12
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Bin Eid W, Lim M, Gabrieli G, Kölbel M, Halstead E, Esposito G, Dimitriou D. Alterations in Cortisol Profiles among Mothers of Children with ASD Related to Poor Child Sleep Quality. Healthcare (Basel) 2022; 10:healthcare10040666. [PMID: 35455843 PMCID: PMC9032515 DOI: 10.3390/healthcare10040666] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Revised: 03/29/2022] [Accepted: 03/30/2022] [Indexed: 11/25/2022] Open
Abstract
Caregivers of children with autism spectrum disorder (ASD) experience poorer sleep, but studies have not yet used objective measures to investigate how child and caregiver sleep affect each other. In this study, 29 mothers and their child with ASD aged between 6 and 16 years were recruited. Questionnaires measuring child autism, maternal depression, and maternal and child sleep quality were administered. Cortisol salivary samples were also obtained from the mothers over the course of a day. Results revealed that maternal depression is significantly correlated with their subjective sleep quality, sleep latency and daytime dysfunction. Child sleep quality was also found to be significantly correlated with ASD severity. In terms of maternal cortisol profiles, a significant number of mothers showed a flattened diurnal cortisol expression, and children of mothers with a flattened cortisol profile had significantly more sleep problems. Overall, results suggest that maternal and child sleep are affected by the child’s disability but also are mutually related. Future studies may consider employing measures such as actigraphy or somnography to quantify sleep quality and establish causal pathways between sleep, cortisol expression and caregiver and child outcomes. The present study has clinical implications in examining family sleep when considering treatment for ASD.
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Affiliation(s)
- Wasmiah Bin Eid
- Sleep Education and Research Laboratory, UCL Institute of Education, London WC1H 0AA, UK; (W.B.E.); (M.K.); (E.H.)
| | - Mengyu Lim
- Psychology Program, School of Social Sciences, Nanyang Technological University, 48 Nanyang Avenue, Singapore 639818, Singapore; (M.L.); (G.G.)
| | - Giulio Gabrieli
- Psychology Program, School of Social Sciences, Nanyang Technological University, 48 Nanyang Avenue, Singapore 639818, Singapore; (M.L.); (G.G.)
| | - Melanie Kölbel
- Sleep Education and Research Laboratory, UCL Institute of Education, London WC1H 0AA, UK; (W.B.E.); (M.K.); (E.H.)
- Department of Developmental Neurosciences Unit, UCL Great Ormond Street Institute of Child Health, London WC1N 1EH, UK
| | - Elizabeth Halstead
- Sleep Education and Research Laboratory, UCL Institute of Education, London WC1H 0AA, UK; (W.B.E.); (M.K.); (E.H.)
| | - Gianluca Esposito
- Affiliative Behaviour and Physiology Lab, Department of Psychology and Cognitive Science, University of Trento, Corso Bettini, 84, I-38068 Trento, Italy;
| | - Dagmara Dimitriou
- Sleep Education and Research Laboratory, UCL Institute of Education, London WC1H 0AA, UK; (W.B.E.); (M.K.); (E.H.)
- Correspondence:
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13
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Schwichtenberg AJ, Janis A, Lindsay A, Desai H, Sahu A, Kellerman A, Chong PLH, Abel EA, Yatcilla JK. Sleep in Children with Autism Spectrum Disorder: A Narrative Review and Systematic Update. CURRENT SLEEP MEDICINE REPORTS 2022; 8:51-61. [PMID: 36345553 PMCID: PMC9630805 DOI: 10.1007/s40675-022-00234-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/13/2022] [Indexed: 11/06/2022]
Abstract
Purpose of Review Sleep problems are a common comorbidity for children with autism spectrum disorder (ASD), and research in this area has a relatively long history. Within this review, we first outline historic patterns in the field of sleep and ASD. Second, we conducted a systematic update and coded these studies based on their alignment with historic patterns. Research on ASD and sleep over the past two decades has primarily focused on four principal areas: (1) documenting the prevalence and types of sleep problems; (2) sleep problem treatment options and efficacy; (3) how sleep problems are associated with other behavioral, contextual, or biological elements; and (4) the impact of child sleep problems on families and care providers. The systematic update in this paper includes empirical studies published between 2018 and 2021 with terms for sleep and ASD within the title, keywords, or abstract. Recent Findings In sum, 60 studies fit the inclusion/exclusion criteria and most fit within the historic patterns noted above. Notable differences included more global representation in study samples, studies on the impacts of COVID-19, and a growing body of work on sleep problems as an early marker of ASD. The majority of studies focus on correlates of sleep problems noting less optimal behavioral, contextual, and biological elements are associated with sleep problems across development for children with ASD. Summary Recommendations for future directions include continued expansion of global and age representation across samples, a shift toward more treatment and implementation science, and studies that inform our mechanistic understanding of how sleep and ASD are connected. Supplementary Information The online version contains supplementary material available at 10.1007/s40675-022-00234-5.
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Affiliation(s)
- A. J. Schwichtenberg
- Department of Human Development and Family Studies at Purdue University, West Lafayette, IN USA
| | - Amy Janis
- Department of Human Development and Family Studies at Purdue University, West Lafayette, IN USA
| | - Alex Lindsay
- Department of Human Development and Family Studies at Purdue University, West Lafayette, IN USA
| | - Hetvi Desai
- Department of Human Development and Family Studies at Purdue University, West Lafayette, IN USA
| | - Archit Sahu
- Department of Human Development and Family Studies at Purdue University, West Lafayette, IN USA
| | - Ashleigh Kellerman
- Department of Human Development and Family Studies at Purdue University, West Lafayette, IN USA
| | - Pearlynne Li Hui Chong
- Department of Human Development and Family Studies at Purdue University, West Lafayette, IN USA
| | - Emily A. Abel
- Department of Human Development and Family Studies at Purdue University, West Lafayette, IN USA
| | - Jane Kinkus Yatcilla
- Libraries and School of Information Studies at Purdue University, West Lafayette, IN USA
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14
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Ortiz-Rubio A, Torres-Sánchez I, Cabrera-Martos I, Rodríguez-Torres J, López-López L, Prados-Román E, Valenza MC. The Caregiver Burden Inventory as a Sleep Disturbance Screening Tool for Parents of Children with Autism Spectrum Disorder. J Pediatr Nurs 2021; 61:166-172. [PMID: 34090081 DOI: 10.1016/j.pedn.2021.05.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2020] [Revised: 05/10/2021] [Accepted: 05/26/2021] [Indexed: 11/15/2022]
Abstract
PURPOSE The study was conducted to explore the degree to which caregiver burden is associated with sleep quality in parents of children with autism spectrum disorder, and to determine a statistically valid cutoff score for the Caregiver Burden Inventory (CBI) in order to identify parents of risk of poor sleep quality. DESIGN AND METHODS We conducted a cross-sectional analysis. We assessed caregiver burden with the CBI, sleep quality with the Pittsburgh Sleep Quality Index, emotional status with the Hospital Anxiety and Depression Scale, and impact on family with the Impact on Family Scale. Caregiver burden was evaluated with a logistic regression analysis. The best fit model was used in a receiver operating characteristic analysis. Likelihood ratios and post-test probabilities were calculated. RESULTS A total of 116 parents were included in this study. Higher caregiver burden was associated with a reduction in sleep quality in the logistic regression analysis (p < 0.001). The area under the curve for the univariate burden test model (best fit) was 76.70 (p < 0.001). The cutoff score for poor sleep quality was caregiver burden ≥26.50. The post-test probability of poor sleep quality increased to 82.02% from a pre-test probability of 76.72%. CONCLUSIONS Our findings suggest that caregiver burden is associated with sleep quality among parents of children with autism spectrum disorder. The findings suggest that a CBI cutoff score of 26.50 may help to detect risk of poor sleep quality in parents of children with autism spectrum disorder.
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Affiliation(s)
- Araceli Ortiz-Rubio
- Department of Physiotherapy, Faculty of Health Sciences, University of Granada, Spain
| | - Irene Torres-Sánchez
- Department of Physiotherapy, Faculty of Health Sciences, University of Granada, Spain
| | - Irene Cabrera-Martos
- Department of Physiotherapy, Faculty of Health Sciences, University of Granada, Spain
| | | | - Laura López-López
- Department of Physiotherapy, Faculty of Health Sciences, University of Granada, Spain
| | - Esther Prados-Román
- Department of Physiotherapy, Faculty of Health Sciences, University of Granada, Spain
| | - Marie Carmen Valenza
- Department of Physiotherapy, Faculty of Health Sciences, University of Granada, Spain.
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15
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da Estrela C, McGrath J, Booij L, Gouin JP. Heart Rate Variability, Sleep Quality, and Depression in the Context of Chronic Stress. Ann Behav Med 2021; 55:155-164. [PMID: 32525208 DOI: 10.1093/abm/kaaa039] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Disrupted sleep quality is one of the proposed mechanisms through which chronic stress may lead to depression. However, there exist significant individual differences in sleep reactivity, which is the extent to which one experiences sleep disturbances in response to stress. PURPOSE The aim of the current study was to investigate whether low high-frequency heart rate variability (HRV), as a psychophysiological marker of poor emotional and physiological arousal regulation, predicts stress-related sleep disturbances associated with greater risk of depression symptoms. METHODS Using a chronic caregiving stress model, 125 mothers of adolescents with developmental disorders and 97 mothers of typically developing adolescents had their resting HRV and HRV reactivity recorded and completed a measure of depressive symptoms, as well as a 7 day sleep diary to assess their sleep quality. A moderated mediation model tested whether sleep quality mediated the association between chronic stress exposure and depressive symptoms and whether HRV moderated this mediation. RESULTS After controlling for participant age, body mass index, ethnicity, socioeconomic status, and employment status, poor sleep quality mediated the association between chronic stress and depressive symptoms. Resting HRV moderated this indirect effect such that individuals with lower HRV were more likely to report poorer sleep quality in the context of chronic stressor exposure, which, in turn, was related to greater depressive symptoms. CONCLUSIONS Lower HRV, a potential biomarker of increased sleep reactivity to stress, is associated with greater vulnerability to stress-related sleep disturbances, which, in turn, increases the risk for elevated depressive symptoms in response to chronic stress.
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Affiliation(s)
- Chelsea da Estrela
- Department of Psychology, Concordia University, Montréal, Canada.,Center for Clinical Research in Health, Concordia University, Montréal, Canada
| | - Jennifer McGrath
- Department of Psychology, Concordia University, Montréal, Canada.,Center for Clinical Research in Health, Concordia University, Montréal, Canada.,PERFORM Center, Concordia University, Montréal, Canada
| | - Linda Booij
- Department of Psychology, Concordia University, Montréal, Canada.,Center for Clinical Research in Health, Concordia University, Montréal, Canada.,PERFORM Center, Concordia University, Montréal, Canada
| | - Jean-Philippe Gouin
- Department of Psychology, Concordia University, Montréal, Canada.,Center for Clinical Research in Health, Concordia University, Montréal, Canada.,PERFORM Center, Concordia University, Montréal, Canada
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16
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Provenzi L, Grumi S, Rinaldi E, Giusti L. The porridge-like framework: A multidimensional guidance to support parents of children with developmental disabilities. RESEARCH IN DEVELOPMENTAL DISABILITIES 2021; 117:104048. [PMID: 34375793 DOI: 10.1016/j.ridd.2021.104048] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Revised: 07/21/2021] [Accepted: 07/26/2021] [Indexed: 06/13/2023]
Abstract
Parents of children with developmental disabilities face many daily challenges that can lead to emotional and affective problems, difficulties in caregiving, and partial mental representations about themselves and their children. The multi-faceted nature of these parents' needs requires a multi-component approach that should include the analysis of priority support goals and the planning of tailored therapeutic actions. Despite different types of validated interventions are available, the choice of the most appropriate strategy to pursue a family-centered approach to support parents of infants with developmental disabilities is not obvious. In this scenario, we propose a multi-dimensional model, the porridge-like framework of parenting. It considers three interrelated domains in parents' experience - affective (A), behavioral (B), and cognitive (C) aspects - that are intertwined with the specific degree of the child's impairment (D). This ABCD model may provide professionals with pragmatically valid guidance to plan and deliver family-centered healthcare interventions. By covering the multi-dimensional nature of parenting challenges, it provides clinicians with conceptual categories to recognize the specific needs and to choose the most suitable therapeutic action to address them. In addition, it aims to promote an ethical approach to family-centered rehabilitation for children with developmental disabilities, maximizing the potentials of a collaborative assessment approach.
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Affiliation(s)
- Livio Provenzi
- Child Neurology and Psychiatry Unit, IRCCS Mondino Foundation, Pavia, Italy.
| | - Serena Grumi
- Child Neurology and Psychiatry Unit, IRCCS Mondino Foundation, Pavia, Italy
| | - Elisa Rinaldi
- Child Neurology and Psychiatry Unit, IRCCS Mondino Foundation, Pavia, Italy
| | - Lorenzo Giusti
- Faculty of Psychology, Università Cattolica del Sacro Cuore, Milan, Italy
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17
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McLay LL, France KG, Blampied NM, Hunter JE, van Deurs JR, Woodford EC, Gibbs R, Lang R. Collateral Child and Parent Effects of Function‑Based Behavioral Interventions for Sleep Problems in Children and Adolescents with Autism. J Autism Dev Disord 2021; 52:2258-2273. [PMID: 34110556 DOI: 10.1007/s10803-021-05116-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/27/2021] [Indexed: 11/25/2022]
Abstract
This study follows McLay et al., Journal of Autism and Developmental Disorders, (2020) to investigate whether the function-based behavioral sleep interventions received by 41 children and adolescents with autism spectrum disorder (ASD) produced collateral improvements in ASD severity, internalizing and externalizing symptoms and parent relationship quality, ratings of depression, anxiety and stress, and personal sleep quality. Concomitant with reduced sleep problem severity, improvements were found in children's internalizing and externalizing behavior and ASD symptom severity. Small improvements were also found in maternal sleep quality and parental stress. There was little change in parental relationship quality post-treatment, possibly reflecting high baseline scores. Overall, collateral benefits were generally small but positive, consistent with the limited extant research, and underscore the importance of investigating collateral effects across a range of variables.
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Affiliation(s)
- Laurie L McLay
- School of Health Sciences, University of Canterbury, Private bag 4800, Christchurch, New Zealand.
| | - Karyn G France
- School of Health Sciences, University of Canterbury, Private bag 4800, Christchurch, New Zealand
| | - Neville M Blampied
- Psychology Department, School of Psychology, Speech, and Hearing, University of Canterbury, Christchurch, New Zealand
| | - Jolene E Hunter
- School of Health Sciences, University of Canterbury, Private bag 4800, Christchurch, New Zealand
| | - Jenna R van Deurs
- School of Health Sciences, University of Canterbury, Private bag 4800, Christchurch, New Zealand
| | - Emma C Woodford
- School of Health Sciences, University of Canterbury, Private bag 4800, Christchurch, New Zealand
| | - Rosina Gibbs
- School of Health Sciences, University of Canterbury, Private bag 4800, Christchurch, New Zealand
| | - Russell Lang
- Department of Special Education, Center for Autism Research, Evaluation, and Support, Texas State University, San Marcos, TX, USA
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18
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Liu R, Dong H, Wang Y, Lu X, Li Y, Xun G, Ou J, Shen Y, Xia K, Zhao J. Sleep Problems of Children with Autism May Independently Affect Parental Quality of Life. Child Psychiatry Hum Dev 2021; 52:488-499. [PMID: 32725386 DOI: 10.1007/s10578-020-01035-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2020] [Revised: 07/03/2020] [Accepted: 07/21/2020] [Indexed: 12/14/2022]
Abstract
The current study explored how and to what extent sleep problems in children with autism spectrum disorder (ASD) impacted their parents' quality of life (QOL). A total of 440 ASD children and 344 age-matched typically developing (TD) children were included in the case-control designed study. In the TD group, a linear regression model showed that the Children's Sleep Habits Questionnaire (CSHQ) total scores were negatively associated with maternal mental health summary (MCS) scores in the SF-36v2 (β = - 2.831), while in the ASD group, the CSHQ total scores were negatively associated with the parental physical health summary (PCS) scores (β = - 3.030 for mothers, β = - 3.651 for fathers). Path analysis showed that sleep problems in ASD children had both direct and indirect effects on maternal PCS scores. The results indicated that sleep problems in children with ASD might affect parental QOL differently from TD children, and act as independent impact factors on parental physical health.
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Affiliation(s)
- Ruiting Liu
- National Clinical Research Center for Mental Disorders and Department of Psychiatry, The Second Xiangya Hospital, Central South University, Changsha, 410011, Hunan, China.,Center for Medical Genetics and Hunan Key Laboratory of Medical Genetics, School of Life Sciences, Central South University, Changsha, Hunan, China
| | - Huixi Dong
- National Clinical Research Center for Mental Disorders and Department of Psychiatry, The Second Xiangya Hospital, Central South University, Changsha, 410011, Hunan, China.,Mental Health Center of Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Ying Wang
- National Clinical Research Center for Mental Disorders and Department of Psychiatry, The Second Xiangya Hospital, Central South University, Changsha, 410011, Hunan, China
| | - Xiaozi Lu
- Qingdao Mental Health Center, Qingdao, Shandong, China
| | - Yamin Li
- Clinical Nursing Teaching and Research Section, the Second Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Guanglei Xun
- Shandong Mental Health Center, Jinan, Shandong, China
| | - Jianjun Ou
- National Clinical Research Center for Mental Disorders and Department of Psychiatry, The Second Xiangya Hospital, Central South University, Changsha, 410011, Hunan, China.
| | - Yidong Shen
- National Clinical Research Center for Mental Disorders and Department of Psychiatry, The Second Xiangya Hospital, Central South University, Changsha, 410011, Hunan, China.
| | - Kun Xia
- Center for Medical Genetics and Hunan Key Laboratory of Medical Genetics, School of Life Sciences, Central South University, Changsha, Hunan, China
| | - Jingping Zhao
- National Clinical Research Center for Mental Disorders and Department of Psychiatry, The Second Xiangya Hospital, Central South University, Changsha, 410011, Hunan, China
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19
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MacDonald LL, Gray L, Loring W, Wyatt A, Bonnet K, Schlund D, Gaston ML, Malow BA. A community-based sleep educational intervention for children with autism spectrum disorder. RESEARCH IN AUTISM SPECTRUM DISORDERS 2021; 81:101719. [PMID: 34394709 PMCID: PMC8356904 DOI: 10.1016/j.rasd.2020.101719] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
BACKGROUND Sleep problems are common in children with autism spectrum disorder (ASD). Sleep education, effective in improving sleep in ASD, may be difficult to access. We determined if community-based pediatric therapists could successfully deliver sleep educational interventions to caregivers of children with ASD. METHODS A seven-week feasibility study was conducted consisting of 10 children and caregivers. This feasibility study informed the development of a 16-week preliminary effectiveness study, which consisted of 33 children and caregivers. Children, ages 2-12 years, with a clinical diagnosis of autism and caregiver-reported sleep onset delay of 30 min were included. Community therapists underwent comprehensive training in sleep education and then met with caregiver participants to provide sleep education to each family. Semi-structured qualitative interviews were conducted with all families who completed study procedures.In the feasibility and preliminary effectiveness studies, child participants wore an actigraphy watch (at baseline and after sleep education) and caregivers completed the Child Sleep Habits Questionnaire and Family Inventory of Sleep Habits at baseline and after sleep education; the Child Behavior Checklist was also completed by caregivers in the preliminary effectiveness study. RESULTS Educator fidelity to the manualized curriculum was maintained. Caregivers showed appropriate understanding, comfort, and implementation of the curriculum. Qualitative and quantitative measures, including caregiver surveys and actigraphy, showed improvements in child sleep and behavior. CONCLUSIONS Community-based therapists can successfully deliver sleep education to families of children with ASD, which has favorable implications for improving access to care in this population.
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Affiliation(s)
- Lydia L. MacDonald
- Sleep Disorders Division, Department of Neurology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Laura Gray
- College of Health Sciences and Nursing, Belmont University, Nashville, TN, USA
| | - Whitney Loring
- Division of Developmental Medicine, Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Amanda Wyatt
- Sleep Disorders Division, Department of Neurology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Kemberlee Bonnet
- Department of Psychology, Vanderbilt University, Nashville, TN, USA
| | - David Schlund
- Department of Psychology, Vanderbilt University, Nashville, TN, USA
| | - Mary Landis Gaston
- Sleep Disorders Division, Department of Neurology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Beth A. Malow
- Sleep Disorders Division, Department of Neurology, Vanderbilt University Medical Center, Nashville, TN, USA
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20
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Halstead EJ, Jones A, Esposito G, Dimitriou D. The Moderating Role of Parental Sleep Knowledge on Children with Developmental Disabilities and Their Parents' Sleep. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18020746. [PMID: 33467212 PMCID: PMC7830639 DOI: 10.3390/ijerph18020746] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Revised: 01/13/2021] [Accepted: 01/14/2021] [Indexed: 11/16/2022]
Abstract
BACKGROUND Children with intellectual and developmental difficulties often experience sleep problems, which in turn may impact parental sleep patterns. This study explored the role of parental sleep knowledge as a moderator on the relationship between child sleep and parental sleep impairment. METHODS 582 parents or caregivers (92.6% mothers) of children with different developmental disabilities (Age M = 9.34, 29.5% females) such as Down's syndrome, participated in an online survey. Multiple regression analysis was conducted. RESULTS Parental sleep knowledge of child sleep was a moderating variable in the relationship between child sleep nocturnal duration and parental sleep impairment. Although overall, sleep knowledge was high in this sample, two specific knowledge gaps were identified namely child sleep duration requirements, and the recognition of signs of a well-rested child. CONCLUSION This study has provided evidence that increased parental sleep knowledge can positively impact both child and parental sleep outcomes.
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Affiliation(s)
- Elizabeth J. Halstead
- Sleep Education and Research Laboratory (SERL), UCL Institute of Education, London WC1H 0AA, UK; (E.J.H.); (A.J.)
| | - Alexandra Jones
- Sleep Education and Research Laboratory (SERL), UCL Institute of Education, London WC1H 0AA, UK; (E.J.H.); (A.J.)
| | - Gianluca Esposito
- Social and Affective Neuroscience Lab, Psychology Program-SSS, Nanyang Technological University, Singapore 639818, Singapore;
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore 308232, Singapore
- Affiliative Behaviour and Physiology Lab, Department of Psychology and Cognitive Science, University of Trento, 38068 Trento, Italy
| | - Dagmara Dimitriou
- Sleep Education and Research Laboratory (SERL), UCL Institute of Education, London WC1H 0AA, UK; (E.J.H.); (A.J.)
- Correspondence:
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21
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Varma P, Conduit R, Junge M, Jackson ML. Examining Sleep and Mood in Parents of Children with Sleep Disturbances. Nat Sci Sleep 2020; 12:865-874. [PMID: 33154690 PMCID: PMC7608549 DOI: 10.2147/nss.s271140] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Accepted: 09/14/2020] [Indexed: 01/08/2023] Open
Abstract
OBJECTIVE The current study examined sleep and mood associations in parents of children with sleep disturbances across a sample of typically developing children and children with neurodevelopmental disorders. The mediating effect of children's sleep on the relationship between parents' sleep and mood was also assessed. The study explored differences in parents' sleep based on whether 1) the child had a sleep disturbance, and 2) the child was typically developing or had a neurodevelopmental disorder. METHODS A total of 293 parents of children aged 2-12 years completed an online questionnaire. Parental sleep was examined using the Pittsburgh Sleep Quality Index, the Glasgow Sleep Effort Scale and the Pre-sleep Arousal Scale, and mood was assessed using the Profile of Mood States-short form. Measures for children included the Child's Sleep Habits Questionnaire (CSHQ) and the Strengths and Difficulties Questionnaire. RESULTS Across the overall sample, children's sleep disturbances were associated with parents' sleep disturbances, accounting for 22% of the change in parental sleep quality. Children's sleep partially mediated parents' sleep and mood. Significant differences were observed for sleep and mood outcomes in parents of children with sleep disturbances (CSHQ scores ≥41). However, no significant differences were reported for children's sleep disturbances and parents' sleep quality based on whether the child was typically developing or had a neurodevelopmental disorder. CONCLUSION Parents of children with sleep disturbances experience poor sleep and high pre-sleep arousal, indicative of insomnia. Given that these parents experience cognitive arousal and insomnia, it is recommended that parents' sleep problems are addressed and treated in clinical settings.
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Affiliation(s)
- Prerna Varma
- School of Health and Biomedical Sciences, RMIT University, Melbourne, Australia
| | - Russell Conduit
- School of Health and Biomedical Sciences, RMIT University, Melbourne, Australia
| | - Moira Junge
- Sleep Health Foundation, Blacktown, Sydney, Australia
| | - Melinda L Jackson
- School of Health and Biomedical Sciences, RMIT University, Melbourne, Australia
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Clayton, Melbourne, Australia
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Jain A, Ahmed N, Mahour P, Agarwal V, Chandra K, Shrivatav NK. Burden of care perceived by the principal caregivers of autistic children and adolescents visiting health facilities in Lucknow City. Indian J Public Health 2020; 63:282-287. [PMID: 32189645 DOI: 10.4103/ijph.ijph_366_18] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Background Autism is extraordinarily difficult for families to cope with for various reasons. Perceived burden and care for the child with autism, available forms of social support, and the interactions between the autistic child and other family members are areas of significant concern for families. Objective The objective of this study was to determine the burden of care perceived by the principal caregivers of autistic children or adolescent visiting health facilities in Lucknow city. Methods The cross-sectional study was conducted from October 2016 to September 2017 with a sample of 90 principal caregivers (aged <60 years) of autistic children and adolescents aged 3-19 years and diagnosed with autism, attending government and private health facilities providing treatment for autism in Lucknow, Uttar Pradesh, India. Validated tools were used to assess the burden of care and disability level of autistic children. Data were analyzed using the software SPSS version 16. Results The caregivers of autistic children and adolescents perceived the burden of care in different domains in varying extent with "caregiver's routine" and "taking responsibility" domains affected the most. The burden perceived was found to be affected by the permanent residence of caregiver, rural/urban dwelling, type of family, socioeconomic status, age at which diagnosis was made, knowledge about autism and the severity of autism. Conclusions Availability and easy accessibility of autism treatment facilities must be the most probable reason for less burden perceived in three domains, by caregivers of urban settings and those belonging to Lucknow. Furthermore, better knowledge on autism and family and friends' support led to decrease in the burden perceived by the caregivers in various domains. Thus, it was found that the burden perceived can be reduced by universal availability of evidence-based early diagnosis and treatment of autism and improving the knowledge of caregivers about autism.
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Affiliation(s)
- Aparna Jain
- Junior Resident, Department of Community Medicine and Public Health, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Naim Ahmed
- Associate Professor, Department of Community Medicine and Public Health, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Pooja Mahour
- Assistant Professor, Department of Psychiatry, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Vivek Agarwal
- Professor, Department of Psychiatry, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Kanta Chandra
- Professor, Department of Paediatrics, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Nitesh Kumar Shrivatav
- Occupational Therapist, Department of Physical Medicine and Rehabilitation, King George's Medical University, Lucknow, Uttar Pradesh, India
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Maruani A, Dumas G, Beggiato A, Traut N, Peyre H, Cohen-Freoua A, Amsellem F, Elmaleh M, Germanaud D, Launay JM, Bourgeron T, Toro R, Delorme R. Morning Plasma Melatonin Differences in Autism: Beyond the Impact of Pineal Gland Volume. Front Psychiatry 2019; 10:11. [PMID: 30787884 PMCID: PMC6372551 DOI: 10.3389/fpsyt.2019.00011] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2018] [Accepted: 01/09/2019] [Indexed: 12/14/2022] Open
Abstract
While low plasma melatonin, a neuro-hormone synthesized in the pineal gland, has been frequently associated with autism, our understanding of the mechanisms behind it have remained unclear. In this exploratory study, we hypothesized that low melatonin levels in ASD could be linked to a decrease of the pineal gland volume (PGV). PGV estimates with magnetic resonance imaging (MRI) with a voxel-based volumetric measurement method and early morning plasma melatonin levels were evaluated for 215 participants, including 78 individuals with ASD, 90 unaffected relatives, and 47 controls. We first found that both early morning melatonin level and PGV were lower in patients compared to controls. We secondly built a linear model and observed that plasma melatonin was correlated to the group of the participant, but also to the PGV. To further understand the relationship between PGV and melatonin, we generated a normative model of the PGV relationship with melatonin level based on control participant data. We found an effect of PGV on normalized melatonin levels in ASD. Melatonin deficit appeared however more related to the group of the subject. Thus, melatonin variations in ASD could be mainly driven by melatonin pathway dysregulation.
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Affiliation(s)
- Anna Maruani
- Child and Adolescent Psychiatry Department, Robert Debré Hospital, Paris, France.,Human Genetics and Cognitive Functions, Institut Pasteur, Paris, France
| | - Guillaume Dumas
- Human Genetics and Cognitive Functions, Institut Pasteur, Paris, France
| | - Anita Beggiato
- Child and Adolescent Psychiatry Department, Robert Debré Hospital, Paris, France.,Human Genetics and Cognitive Functions, Institut Pasteur, Paris, France
| | - Nicolas Traut
- Human Genetics and Cognitive Functions, Institut Pasteur, Paris, France
| | - Hugo Peyre
- Child and Adolescent Psychiatry Department, Robert Debré Hospital, Paris, France
| | - Alicia Cohen-Freoua
- Child and Adolescent Psychiatry Department, Robert Debré Hospital, Paris, France
| | - Frédérique Amsellem
- Child and Adolescent Psychiatry Department, Robert Debré Hospital, Paris, France.,Human Genetics and Cognitive Functions, Institut Pasteur, Paris, France
| | - Monique Elmaleh
- Pediatric Radiology Department, Robert Debré Hospital, Paris, France
| | - David Germanaud
- Department of Pediatric Neurology, Robert Debré Hospital, AP-HP, Paris, France.,Neuropaediatric Team, UNIACT, NeuroSpin, CEA-Saclay, Gif-sur-Yvette, France
| | - Jean-Marie Launay
- Biochemistry Department, INSERM U942, Lariboisière Hospital, Assistance Publique-Hopitaux de Paris EA 3621, Paris, France
| | - Thomas Bourgeron
- Human Genetics and Cognitive Functions, Institut Pasteur, Paris, France
| | - Roberto Toro
- Human Genetics and Cognitive Functions, Institut Pasteur, Paris, France
| | - Richard Delorme
- Child and Adolescent Psychiatry Department, Robert Debré Hospital, Paris, France.,Human Genetics and Cognitive Functions, Institut Pasteur, Paris, France
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Roberts CA, Smith KC, Sherman AK. Comparison of Online and Face-to-Face Parent Education for Children with Autism and Sleep Problems. J Autism Dev Disord 2018; 49:1410-1422. [DOI: 10.1007/s10803-018-3832-2] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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25
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Díaz-Román A, Zhang J, Delorme R, Beggiato A, Cortese S. Sleep in youth with autism spectrum disorders: systematic review and meta-analysis of subjective and objective studies. EVIDENCE-BASED MENTAL HEALTH 2018; 21:146-154. [PMID: 30361331 PMCID: PMC10270396 DOI: 10.1136/ebmental-2018-300037] [Citation(s) in RCA: 72] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/13/2018] [Revised: 09/10/2018] [Accepted: 09/20/2018] [Indexed: 12/16/2022]
Abstract
BACKGROUND Sleep problems are common and impairing in individuals with autism spectrum disorders (ASD). Evidence synthesis including both subjective (ie, measured with questionnaires) and objective (ie, quantified with neurophysiological tools) sleep alterations in youth with ASD is currently lacking. OBJECTIVE We conducted a systematic review and meta-analysis of subjective and objective studies sleep studies in youth with ASD. METHODS We searched the following electronic databases with no language, date or type of document restriction up to 23 May 2018: PubMed, PsycInfo, Embase+Embase Classic, Ovid Medline and Web of Knowledge. Random-effects models were used. Heterogeneity was assessed with Cochran's Q and I2 statistics. Publication (small studies) bias was assessed with final plots and the Egger's test. Study quality was evaluated with the Newcastle Ottawa Scale. Analyses were conducted using Review Manager and Comprehensive Meta-Analysis. FINDINGS: From a pool of 3359 non-duplicate potentially relevant references, 47 datasets were included in the meta-analyses. Subjective and objective sleep outcome measures were extracted from 37 and 15 studies, respectively. Only five studies were based on comorbidity free, medication-naïve participants. Compared with typically developing controls, youth with ASD significantly differed in 10/14 subjective parameters and in 7/14 objective sleep parameters. The average quality score in the Newcastle-Ottawa Scale was 5.9/9. DISCUSSION AND CLINICAL IMPLICATIONS A number of subjective and, to a less extent, objective sleep alterations might characterise youth with ASD, but future studies should assess the impact of pharmacological treatment and psychiatric comorbidities.
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Affiliation(s)
- Amparo Díaz-Román
- Mind, Brain and Behavior Research Center, University of Granada, Granada, Spain
| | - Junhua Zhang
- School of Education, Jiangsu Key Laboratory for Big Data of Psychology and Cognitive Science, Yancheng Teachers University, Yancheng, China
- Center for Innovation in Mental Health, Academic Unit of Psychology, University of Southampton, Southampton, UK
| | - Richard Delorme
- Unité de Génétique Humaine et Fonctions Cognitives, Département de Neuroscience, Institut Pasteur, Paris, Île-de-France, France
- Département de Psychiatrie de l’Enfant et de l’Adolescent, Hôpital Robert Debré, L’Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Anita Beggiato
- Unité de Génétique Humaine et Fonctions Cognitives, Département de Neuroscience, Institut Pasteur, Paris, Île-de-France, France
- Département de Psychiatrie de l’Enfant et de l’Adolescent, Hôpital Robert Debré, L’Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Samuele Cortese
- Center for Innovation in Mental Health, Academic Unit of Psychology, University of Southampton, Southampton, UK
- Clinical and Experimental Sciences (CNS and Psychiatry), Faculty of Medicine, University of Southampton, Southampton, UK
- Solent NHS Trust, Southampton, UK
- New York University Child Study Center, New York City, New York, USA
- Division of Psychiatry and Applied Psychology, School of Medicine, University of Nottingham, Nottingham, UK
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26
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Micsinszki SK, Ballantyne M, Cleverley K, Green P, Stremler R. Sleep Outcomes for Parents of Children With Neurodevelopmental Disabilities: A Systematic Review. JOURNAL OF FAMILY NURSING 2018; 24:217-249. [PMID: 29739263 DOI: 10.1177/1074840718773381] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Parents of children with Neurodevelopmental Disabilities (NDDs) are at risk of sleep loss. No comprehensive systematic reviews examining parental sleep outcomes in caregivers of children with NDDs exist. A systematic search was conducted between June and August 2016 examining sleep quantity, quality, sleepiness, and fatigue outcomes of caregivers of children with NDDs. Of 7,534 citations retrieved, 33 met eligibility criteria. Most studies ( n = 27) were cross-sectional, included a range of NDDs and were of "poor" ( n = 14) or "fair" ( n = 17) quality. Few good quality studies compared objectively measured sleep in parents of children with NDDs with parents with typically developing children. Parents of children with NDDs consistently reported significantly poorer subjective sleep quality. There is a paucity of good quality comparative studies, using well-validated measures, examining parental sleep outcomes. Future research should aim to fill this gap, providing greater insight to parents' experiences, and identifying targets for intervention design and evaluation.
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Affiliation(s)
| | - Marilyn Ballantyne
- 1 University of Toronto, Ontario, Canada
- 2 Holland Bloorview Kids Rehabilitation Hospital, Toronto, Ontario, Canada
| | | | - Pamela Green
- 2 Holland Bloorview Kids Rehabilitation Hospital, Toronto, Ontario, Canada
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da Estrela C, Barker ET, Lantagne S, Gouin JP. Chronic parenting stress and mood reactivity: The role of sleep quality. Stress Health 2018; 34:296-305. [PMID: 29148160 DOI: 10.1002/smi.2790] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2017] [Revised: 10/17/2017] [Accepted: 10/20/2017] [Indexed: 11/05/2022]
Abstract
Sleep is a basic biological process supporting emotion regulation. The emotion regulation function of sleep may be particularly important in the context of chronic stress. To better understand how chronic stress and sleep interact to predict mood, 66 parents of children with autism completed daily diaries assessing parenting stress, negative mood, and sleep quality for 6 consecutive days. Hierarchical linear modelling revealed that daily negative mood was predicted by between-person differences in parenting stress and between-person differences in sleep efficiency. Further, between-person differences in sleep efficiency and within-person differences in sleep satisfaction moderated the impact of stress on mood. These data suggest that sleep disturbances may exacerbate the association between stress and mood in the context of chronic parenting stress. Further, high parenting stress appears to heighten the impact of transient sleep disturbances on mood.
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Affiliation(s)
- Chelsea da Estrela
- Department of Psychology, Concordia University, Montréal, Canada.,Center for Clinical Research in Health, Concordia University, Montréal, Canada
| | - Erin T Barker
- Department of Psychology, Concordia University, Montréal, Canada.,Center for Research in Human Development, Concordia University, Montréal, Canada
| | - Sarah Lantagne
- Department of Psychology, Concordia University, Montréal, Canada
| | - Jean-Philippe Gouin
- Department of Psychology, Concordia University, Montréal, Canada.,Center for Clinical Research in Health, Concordia University, Montréal, Canada.,PERFORM Center, Concordia University, Montréal, Canada
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28
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Johnson CR, Smith T, DeMand A, Lecavalier L, Evans V, Gurka M, Swiezy N, Bearss K, Scahill L. Exploring sleep quality of young children with autism spectrum disorder and disruptive behaviors. Sleep Med 2018; 44:61-66. [PMID: 29530371 PMCID: PMC5853135 DOI: 10.1016/j.sleep.2018.01.008] [Citation(s) in RCA: 67] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2017] [Revised: 01/17/2018] [Accepted: 01/18/2018] [Indexed: 12/12/2022]
Abstract
BACKGROUND AND PURPOSE Sleep disturbances in autism spectrum disorder (ASD) are common and may impair daytime functioning as well as add to parental burden. In this well characterized sample of young children with ASD and disruptive behaviors, we examine the association of age and IQ in sleep disturbances using the Child Sleep Habits Questionnaire modified for ASD (CSHQ-ASD). We also test whether children with poor sleep have greater daytime behavioral problems than those with better sleep. Finally, we examine whether parental stress is higher in children with greater disruptive behaviors and sleep disturbances. PARTICIPANTS AND METHODS One hundred and seventy-seven children with complete data out of 180 (mean age 4.7) with ASD participated in a randomized clinical trial. Parents completed the CSHQ-ASD and several other measures at study enrollment. The sample was divided into "poor sleepers" (upper quartile on the total score of the CSHQ-ASD) and "good sleepers" (lower quartile) for comparisons. Analyses were conducted to evaluate group differences on age, IQ, daytime disruptive behavior, social disability and parental stress. RESULTS The two groups of young children with ASD, good sleepers versus poor sleepers, were not different on age or cognitive level. Children in the poor sleeping group had significantly higher daytime behavioral problems including irritability, hyperactivity, social withdrawal and stereotypical behaviors. Parents in this group reported significantly higher levels of stress. CONCLUSIONS The finding of no age difference between good and poor sleepers in young children with ASD and disruptive behaviors suggests that sleep problems are unlikely to resolve as might be expected in typically developing children. Likewise, the good and poor sleepers did not significantly differ in IQ. These findings add strong support for the need to screen for sleep disturbances in all children with ASD, regardless of age and cognitive level. Poor sleepers exhibited significantly greater daytime behavioral problems and parents of children in this group reported significantly higher levels of stress. Above and beyond the co-occurring disruptive behavior, poor sleep quality appears to pose substantial additive burden on child and parents.
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Affiliation(s)
- Cynthia R Johnson
- University of Florida, Department of Clinical & Health Psychology, USA.
| | | | | | | | - Victoria Evans
- University of Florida, Department of Clinical & Health Psychology, USA
| | - Matthew Gurka
- University of Florida, Department of Clinical & Health Psychology, USA
| | | | - Karen Bearss
- Seattle Children's Hospital & University of Washington, USA
| | - Lawrence Scahill
- Marcus Autism Center, Children's Healthcare of Atlanta & Emory University, USA
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Kayadjanian N, Schwartz L, Farrar E, Comtois KA, Strong TV. High levels of caregiver burden in Prader-Willi syndrome. PLoS One 2018; 13:e0194655. [PMID: 29579119 PMCID: PMC5868812 DOI: 10.1371/journal.pone.0194655] [Citation(s) in RCA: 51] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2017] [Accepted: 03/07/2018] [Indexed: 11/19/2022] Open
Abstract
Objectives Prader-Willi syndrome (PWS) is a rare genetic neurodevelopmental disorder that is characterized by hyperphagia, developmental delay, incomplete sexual development, mild-to-moderate intellectual disability, and a variety of challenging behavioral and psychiatric symptoms. The characteristics of PWS can be difficult for caregivers to cope with and are likely to cause significant and long- term caregiver burden. The current study examined burden in 142 caregivers of children and adults with PWS living in the US using the Zarit Burden Interview (ZBI). The study aimed to measure the level of burden in caregivers of individuals with PWS, to explore the impact of PWS on caregiver quality of life, and to assess ZBI as an indicator of that impact. Results Caregivers participating in this study were predominantly mothers, 30–59 years old, non-Hispanic Whites, married or in a relationship, with an annual household income slightly distributed towards higher income. Nearly 90% of the caregiver`s children with PWS lived at home. Caregivers experienced high caregiver burden with an average ZBI score of 44.4 ± 15.4. ZBI scores were highest for caregivers of teenage and young adult individuals with PWS (49.2 ± 14.6 and 49.2 ± 14.1, respectively), while those caring for older adults (>30) and the youngest age group had lower scores (38.6 ±10.5 and 34.8 ±12.5, respectively). Caregivers reported that caring for a person with PWS negatively impacted their romantic relationship, ability to work, sleep, and mood. Whereas we did not find strong correlations between family income or level of help the caregiver receives and ZBI scores, the results showed significant correlations and a linear relationship between ZBI scores and caregiver depressed mood, feelings of anxiety, negative romantic relationship impact, as well as sleep and work disruption. Conclusions Our study reveals that PWS incurs high caregiver burden and impacts many aspects of the lives of caregiver. We identified the ZBI as a good predictor of that impact. Our findings draw attention to the critical unmet need for support for caregivers of individuals with PWS.
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Affiliation(s)
- Nathalie Kayadjanian
- Foundation for Prader-Willi Research, Walnut, California, United States of America
- PWS-Clinical Trial Consortium, Walnut, California, United States of America
- * E-mail:
| | - Lauren Schwartz
- Foundation for Prader-Willi Research, Walnut, California, United States of America
- PWS-Clinical Trial Consortium, Walnut, California, United States of America
- Department of Rehabilitation Medicine, University of Washington, Seattle, Washington, United States of America
| | - Evan Farrar
- PWS-Clinical Trial Consortium, Walnut, California, United States of America
- Prader-Willi Syndrome Association (USA), Sarasota, Florida, United States of America
| | - Katherine Anne Comtois
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, Washington, United States of America
| | - Theresa V. Strong
- Foundation for Prader-Willi Research, Walnut, California, United States of America
- PWS-Clinical Trial Consortium, Walnut, California, United States of America
- Department of Genetics, University of Alabama, Birmingham, Alabama, United States of America
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Abstract
OBJECTIVE PAX6 haploinsufficiency ( +/-) can occur due to mutations involving only PAX6 in patients with isolated aniridia or as contiguous gene deletions in patients with Wilms tumor, aniridia, genitourinary anomalies, and range of developmental and intellectual disabilities syndrome. Given the role of PAX6 in pineal development and circadian regulation, adolescents with PAX6+/- may experience sleep-wake disturbances. The purpose of this observational study was to explore sleep-related phenotypes in adolescents with PAX6+/-. METHODS This study compared sleep phenotypes of nine subjects with PAX6+/- (aged 10-19 years) with previously published data on healthy adolescents ( n = 25, aged 10-18 years). Subjects completed the Cleveland Adolescent Sleepiness Questionnaire (CASQ), Patient Reported Outcomes Measurement Information System (PROMIS) Sleep Disturbance (v. 1.0; 8a), and PROMIS Sleep-Related Impairment (v. 1.0; 8b) Questionnaires and wore actigraphs for seven nights to record sleep patterns. RESULTS Total CASQ, PROMIS sleep-related impairment, and PROMIS sleep disturbance scores were not statistically different between the groups ( ps > .15). Actigraph data for lights off to sleep-onset time were found to be significantly higher in subjects with PAX6+/- versus the healthy comparison group (adjusted mean [95% confidence interval]: 20.1 min [8.1, 49.8] vs. 6.2 min [3.7, 10.4], respectively, p = .04). CONCLUSION Both adolescents with PAX6+/- and the healthy comparison group on average slept less than 8 hr/night, and overall sleep deprivation in adolescents may have masked differences between groups. This study used rare genetic disorders with biological vulnerability to sleep problems as a genotype-phenotype model. Knowledge of sleep-related phenotypes will assist in designing studies to manage sleep-related symptoms in adolescents.
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Affiliation(s)
- Alyson E Hanish
- 1 Unit on Metabolism and Neuroendocrinology, Section on Growth and Obesity, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD, USA.,2 National Institute of Nursing Research, National Institutes of Health, Bethesda, MD, USA.,3 College of Nursing, University of Iowa, Iowa City, IA, USA.,4 College of Nursing, University of Nebraska Medical Center, Omaha, NE, USA
| | - Joan C Han
- 1 Unit on Metabolism and Neuroendocrinology, Section on Growth and Obesity, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD, USA.,5 Department of Pediatrics, University of Tennessee Health Science Center, Memphis, TN, USA.,6 Department of Physiology, University of Tennessee Health Science Center, Memphis, TN, USA.,7 Children's Foundation Research Institute, Le Bonheur Children's Hospital, Memphis, TN, USA
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31
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Roberts CA, Hunter J, Cheng AL. Resilience in Families of Children With Autism and Sleep Problems Using Mixed Methods. J Pediatr Nurs 2017; 37:e2-e9. [PMID: 28916433 DOI: 10.1016/j.pedn.2017.08.030] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2016] [Revised: 08/27/2017] [Accepted: 08/28/2017] [Indexed: 10/18/2022]
Abstract
PURPOSE About 80% of children with autism spectrum disorder (ASD) have sleep problems that may disrupt optimal family functioning. We explored the impact of sleep problems on families' resilience. DESIGN AND METHODS An explanatory sequential mixed methods design was used to discern whether resilience differed between families whose children with ASD have or do not have sleep problems, to seek predictors for family hardiness/resilience, and to determine whether narrative findings support, expand, or conflict quantitative findings. RESULTS Seventy complete surveys were returned from parents of children with ASD to compare sleep and family functioning. Fifty-seven children had sleep problems and six interviews regarding eight of these children were conducted. Parents of children with ASD and sleep problems had lower levels of resilience than those who slept well. Predictors of hardiness were social support, coping-coherence (stress management), and lower strain scores. Qualitative content analysis revealed a journey analogy with themes: finding the trailhead, dual pathways, crossing paths and choosing travel companions, forging new paths, resting along the way, and seeing the vistas. CONCLUSIONS Qualitative findings supported quantitative findings regarding the impact of sleep problems but also expanded them by illustrating how families' resilience and children's socialization improved over time. Social support predicted family hardiness. Parents revealed that sleep issues contributed to family strains and described their progression to resilience and embracing their child. PRACTICE IMPLICATIONS Findings support the need for community and provider advocacy and implicates a need for development of sleep interventions on behalf of families and children with ASD.
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Affiliation(s)
| | | | - An-Lin Cheng
- University of Missouri-Kansas City, Kansas City, MO, USA.
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32
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Reynolds KC, Patriquin M, Alfano CA, Loveland KA, Pearson DA. Parent-Reported Problematic Sleep Behaviors in Children with Comorbid Autism Spectrum Disorder and Attention-Deficit/Hyperactivity Disorder. RESEARCH IN AUTISM SPECTRUM DISORDERS 2017; 39:20-32. [PMID: 29081833 PMCID: PMC5656274 DOI: 10.1016/j.rasd.2017.04.003] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
BACKGROUND Sleep problems are frequent and well documented in children with Autism Spectrum Disorders (ASD), children with Attention Deficit/Hyperactivity Disorder (ADHD) and children with internalizing problems, however limited work has examined sleep problems in children presenting with comorbid ASD/ADHD. In healthy children, sleep problems negatively impact social, emotional, and academic functioning. The current study sought to examine diagnostic severity as predictors of sleep problems in children with comorbid ASD/ADHD. Additionally, the association between sleep and "real-life" functional domains (i.e., intellectual functioning, academic achievement, and executive functioning) were assessed. METHOD Sleep, internalizing difficulties, intellectual functioning, academic achievement and executive functioning were assessed in 85 children with who carried the dual diagnoses of ASD and ADHD. RESULTS Internalizing difficulties, rather than ASD or ADHD symptom severity, was the most consistent predictor of problematic sleep behaviors (i.e., nightmares overtiredness, sleeping less than other children, trouble sleeping, and Total Problematic Sleep Behaviors) in this sample. Further, parent report of problematic sleep behaviors was significantly associated with functional domains after controlling for ASD, ADHD, and internalizing symptoms. CONCLUSIONS Results suggest that internalizing symptoms are associated with problematic sleep behaviors in children with comorbid ASD/ADHD and may have implications for the "real-life" functioning among children with comorbid ASD/ADHD.
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Affiliation(s)
- Katharine C. Reynolds
- University of Houston, Department of Psychology; 3695 Cullen Boulevard Room 126 Houston, TX 77204-5022
| | - Michelle Patriquin
- The Menninger Clinic; 12301 S. Main St. Houston TX 77035
- Department of Psychiatry and Behavioral Science, Baylor College of Medicine
| | - Candice A. Alfano
- University of Houston, Department of Psychology; 3695 Cullen Boulevard Room 126 Houston, TX 77204-5022
| | - Katherine A. Loveland
- University of Texas Medical School at Houston; 1941 East Road, Rm. 3.126 BBSB; Houston, TX, 77054
| | - Deborah A. Pearson
- University of Texas Medical School at Houston; 1941 East Road, Rm. 3.126 BBSB; Houston, TX, 77054
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Russell M, Baldwin CM, McClain D, Matthews N, Smith C, Quan SF. Symptoms of Restless Legs Syndrome in Biological Caregivers of Children with Autism Spectrum Disorders. J Clin Sleep Med 2017; 13:105-113. [PMID: 27855729 DOI: 10.5664/jcsm.6400] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2016] [Accepted: 09/20/2016] [Indexed: 11/13/2022]
Abstract
STUDY OBJECTIVES In this study, we investigated the prevalence of symptoms of restless legs syndrome (RLS) in biological caregivers of children with a diagnosis of autism spectrum disorder (ASD).The relationship of RLS symptoms to caregiver health-related quality of life (HRQoL) was also examined. Finally, we compared the sleep quality and daytime behaviors of children with ASD in caregivers with and without symptoms of RLS. METHODS Biological caregivers (n = 50) of children ages 6 to 11 y with a diagnosis of ASD completed a Sleep Habits Questionnaire (SHQ) that included RLS as determined by four questions. HRQoL was assessed using the Medical Outcomes Survey (MOS) 12-Item Short Form (SF-12). Caregivers also completed the Children's Sleep Habits Questionnaire (CSHQ) and Child Behavior Checklist (CBCL6/18). RESULTS Eleven caregivers (22%) fit the criteria for RLS symptomatology and caregivers with RLS reported poorer mental health. Caregivers with RLS described more night waking and greater internalized behavior problems in their children with ASD than the caregivers without RLS. CONCLUSIONS Biological caregivers of children with ASD demonstrated a high prevalence of RLS symptoms and poorer mental health. RLS is known as a sleep disorder that has strong heritability, and it is possible that many of the children with ASD also have symptoms of RLS. RLS as a possible disruptor of sleep should be considered in caregivers and in their children with ASD.
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Affiliation(s)
- Maureen Russell
- College of Nursing and Health Innovation, Arizona State University, Phoenix, AZ
| | - Carol M Baldwin
- College of Nursing and Health Innovation, Arizona State University, Phoenix, AZ
| | - Darya McClain
- College of Nursing and Health Innovation, Arizona State University, Phoenix, AZ
| | | | | | - Stuart F Quan
- University of Arizona, Tucson, AZ.,Harvard Medical School, Boston, MA
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Mihaila I, Hartley SL. Parental sleep quality and behavior problems of children with autism. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2016; 22:236-244. [PMID: 27899714 DOI: 10.1177/1362361316673570] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This study explored the impact of parental sleep quality on the experience of behavior problems by children with autism spectrum disorder. A 14-day daily diary was used in a sample of 176 mother-father couples. Dyadic multilevel models were conducted to examine the between-person and within-person effects of previous-night sleep quality on parents' rating of level of behavior problems by the child with autism spectrum disorder and level of positive and negative affect. Results indicated that persistently poor sleep quality was associated with between-person differences in initial rating of level of behavior problems by the child with autism spectrum disorder for mothers. At a within-person level, previous-night sleep quality moderated the association between rating of level of behavior problems by the child with autism spectrum disorder and level of positive and negative affect in fathers. Child-related stressors exerted less influence on fathers' affect following a day with poor sleep quality. Interventions aimed at enhancing sleep quality in parents of children with autism spectrum disorder may have important effects on parental psychological well-being.
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Kouros CD, El-Sheikh M. Within-Family Relations in Objective Sleep Duration, Quality, and Schedule. Child Dev 2016; 88:1983-2000. [PMID: 27859005 DOI: 10.1111/cdev.12667] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
The current study examined within-family relations between mothers', fathers', and children's objectively assessed sleep. Participants were 163 children (Mage = 10.45 years; SD = 0.62) and their parents. For 7 nights, families wore actigraphs to assess sleep duration (minutes), quality (efficiency, long wake episode, total wake minutes), and schedule (wake time). A sleep log assessed bedtime. Multilevel models indicated that children's sleep minutes, sleep efficiency, wake minutes, and wake time were associated with fluctuations in their mothers', but not fathers', sleep that same night. The duration and quality of mothers' sleep was associated with both fathers' and children's sleep that night, whereas fathers' sleep was positively associated with only mothers' sleep. Findings highlight the importance of examining sleep within a family context.
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Sleep Disturbances and Associated Factors in Chinese Children with Autism Spectrum Disorder: A Retrospective and Cross-Sectional Study. Child Psychiatry Hum Dev 2016; 47:248-58. [PMID: 26072264 DOI: 10.1007/s10578-015-0561-z] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Sleep disturbances in children with autism spectrum disorder (ASD) exist worldwide, but little is known about this issue in non-Western cultures. This study aimed to characterize sleep disturbances in Chinese children with ASD and to examine associated sociodemographic factors and emotional/behavioral problems. Parents of 60 Chinese children with ASD (aged 6-17 years) from Shenzhen, China completed the Children's Sleep Habits Questionnaire (CSHQ), and the Strengths and Difficulties Questionnaire (SDQ). Sleep disturbances were severe and common, with rates of 70.0% for overall disturbances and 15.0% (daytime sleepiness) to 40.0% (sleep duration) for specific domains. The severity and rate of sleep disturbances were higher compared to previous studies in typically developing children from the same region of China and American children with ASD, respectively. Further, there were significant correlations between most CSHQ and SDQ domains. Female gender, older parental age, higher hyperactivity, and poorer prosocial behavior were associated with increased overall sleep disturbances.
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Al-Farsi OA, Al-Farsi YM, Al-Sharbati MM, Al-Adawi S. Stress, anxiety, and depression among parents of children with autism spectrum disorder in Oman: a case-control study. Neuropsychiatr Dis Treat 2016; 12:1943-51. [PMID: 27536117 PMCID: PMC4977076 DOI: 10.2147/ndt.s107103] [Citation(s) in RCA: 71] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Previous studies carried out in Euro-American populations have unequivocally indicated that psychological disorders of the CASD (caregivers of children with autism spectrum disorder) are marked with high levels of stress, anxiety, and depression. This finding has been attributed to the reaction of having to care for a child with neurodevelopmental disorders. While there have been reports on autism spectrum disorder in Arab/Islamic countries such as Oman, there is no study from this region, to our knowledge, reporting the performance of indices of stress, anxiety, and depression among CASD. This study aimed to examine whether there is variation in the performance of indices of stress, depression, and anxiety explored via Depression, Anxiety and Stress Scale 21 among CASD, caregivers of children with intellectual disabilities, and caregivers of typically developing children. All indices of stress, depression, and anxiety were higher in CASD compared to other caregivers in the control group. This study corroborates with other studies carried out in other populations that caring for children impacts the mental health status of caregivers. Therefore, there are strong grounds to contemplate the mechanism to help such a vulnerable group of family caregivers.
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Affiliation(s)
- Omar A Al-Farsi
- Department of Family Medicine and Public Health, College of Medicine and Health Sciences, Sultan Qaboos University, Muscat, Sultanate of Oman
| | - Yahya M Al-Farsi
- Department of Family Medicine and Public Health, College of Medicine and Health Sciences, Sultan Qaboos University, Muscat, Sultanate of Oman; Department of Epidemiology, School of Public Health, Boston, MA, USA
| | - Marwan M Al-Sharbati
- Department of Behavioural Medicine, College of Medicine and Health Sciences, Sultan Qaboos University, Muscat, Sultanate of Oman
| | - Samir Al-Adawi
- Department of Behavioural Medicine, College of Medicine and Health Sciences, Sultan Qaboos University, Muscat, Sultanate of Oman
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Weitzman A. Do Fathers' Sexual Behaviors Vary with the Sex of Firstborns? Evidence from 37 Countries. JOURNAL OF HEALTH AND SOCIAL BEHAVIOR 2015; 56:495-513. [PMID: 26646743 DOI: 10.1177/0022146515611732] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
This article investigates whether men's sexual behavior is influenced by the sex of their firstborn children and, if so, at what stage of firstborns' development this occurs. Using standardized data from 37 Demographic and Health Surveys (N = 61,801), I compare the sexual activities, sexually transmitted infection symptoms, and sexual ideologies of fathers with firstborn sons and fathers with firstborn daughters. I also explore whether fathers' attitudes mediate the effects of firstborn sex. The findings indicate that fathers with firstborn sons are less likely to report using condoms and more likely to report paying for sex and having genital ulcers than fathers with firstborn daughters. These differences are limited to the firstborn's adolescent years and are slightly mediated by attitudinal differences. Together, these results raise new questions about the underlying mechanisms linking men's sexual behavior to their children's gendered development.
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Weiss SK. Caring for a child with severe psychomotor impairment: the impact on parental sleep and quality of life. Dev Med Child Neurol 2014; 56:1136. [PMID: 25088609 DOI: 10.1111/dmcn.12552] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- S K Weiss
- Division of Pediatric Neurology, Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
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Malow BA, Adkins KW, Reynolds A, Weiss SK, Loh A, Fawkes D, Katz T, Goldman SE, Madduri N, Hundley R, Clemons T. Parent-based sleep education for children with autism spectrum disorders. J Autism Dev Disord 2014; 44:216-28. [PMID: 23754339 DOI: 10.1007/s10803-013-1866-z] [Citation(s) in RCA: 131] [Impact Index Per Article: 13.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
This study provided sleep education to parents of children with autism spectrum disorder (ASD) to determine whether an individual or group format was more effective in improving sleep and aspects of daytime behavior and family functioning. Eighty children, ages 2-10 years, with ASD and sleep onset delay completed the study. Actigraphy and parent questionnaires were collected at baseline and 1 month after treatment. Mode of education did not affect outcomes. Sleep latency, insomnia subscales on the Children's Sleep Habits Questionnaire, and other outcomes related to child and family functioning improved with treatment. Parent-based sleep education, delivered in relatively few sessions, was associated with improved sleep onset delay in children with ASD. Group versus individualized education did not affect outcome.
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Affiliation(s)
- Beth A Malow
- Sleep Disorders Division, Department of Neurology and Vanderbilt Kennedy Center, Vanderbilt University School of Medicine, 1161 21st Avenue South, Room A-0116, Nashville, TN, 37232, USA,
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41
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Tudor ME, Walsh CE, Mulder EC, Lerner MD. Pain as a predictor of sleep problems in youth with autism spectrum disorders. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2014; 19:292-300. [PMID: 24497628 DOI: 10.1177/1362361313518994] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Evidence suggests that pain interferes with sleep in youth with developmental disabilities. This study examined the relationship between pain and sleep problems in a sample of youth with parent-reported autism spectrum disorder (N = 62). Mothers reported on standardized measures of pain and sleep problems. Youth demonstrated atypically high levels of both observed pain and sleep problems. Pain predicted overall sleep disturbance and three specific sleep problems: sleep duration, parasomnias, and sleep-disordered breathing. These specific sleep problems were predicted by specific modalities of nonverbal pain communication (e.g. sleep duration problems were predicted by social communication of pain). Effects were consistent across probing of relevant moderators. These findings suggest that comprehensive assessment of both pain and sleep problems may provide important information for medical and behavioral treatment planning for youth with autism spectrum disorder.
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42
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Moss AHB, Gordon JE, O’Connell A. Impact of Sleepwise: An Intervention for Youth with Developmental Disabilities and Sleep Disturbance. J Autism Dev Disord 2014; 44:1695-707. [DOI: 10.1007/s10803-014-2040-y] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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43
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Matsuoka M, Nagamitsu S, Iwasaki M, Iemura A, Yamashita Y, Maeda M, Kitani S, Kakuma T, Uchimura N, Matsuishi T. High incidence of sleep problems in children with developmental disorders: results of a questionnaire survey in a Japanese elementary school. Brain Dev 2014; 36:35-44. [PMID: 23305729 DOI: 10.1016/j.braindev.2012.12.004] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2012] [Revised: 10/29/2012] [Accepted: 12/09/2012] [Indexed: 11/18/2022]
Abstract
OBJECTIVE The aim of the present school-based questionnaire was to analyze the sleep problems of children with developmental disorders, such as pervasive developmental disorder and attention deficit hyperactivity disorder. METHODS The sleep problems of 43 children with developmental disorders were compared with those of 372 healthy children (control group). All children attended one public elementary school in Kurume, Japan; thus, the study avoided the potential bias associated with hospital-based surveys (i.e. a high prevalence of sleep disturbance) and provided a more complete picture of the children's academic performance and family situation compared with a control group under identical conditions. Children's sleep problems were measured with the Japanese version of the Children's Sleep Habits Questionnaire (CSHQ). RESULTS Children with developmental disorders had significantly higher total CSHQ scores, as well as mean scores on the parasomnias and sleep breathing subscales, than children in the control group. The total CSHQ score, bedtime resistance, sleep onset delay, and daytime sleepiness worsened with increasing age in children with developmental disorders; in contrast, these parameters were unchanged or became better with age in the control group. In children with developmental disorders, there was a significant association between a higher total CSHQ score and lower academic performance, but no such association was found in the control group. For both groups, children's sleep problems affected their parents' quality of sleep. There were no significant differences in physical, lifestyle, and sleep environmental factors, or in sleep/wake patterns, between the two groups. CONCLUSIONS Children with developmental disorders have poor sleep quality, which may affect academic performance. It is important for physicians to be aware of age-related differences in sleep problems in children with developmental disorders. Further studies are needed to identify the association between sleep quality and school behavioral performance.
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Affiliation(s)
- Michiko Matsuoka
- Department of Pediatrics and Child Health, Kurume University School of Medicine, Fukuoka, Japan; Department of Neuropsychiatry, Kurume University School of Medicine, Fukuoka, Japan; Department of Neuropsychiatry, Kurume University Graduate School of Medicine, Fukuoka, Japan
| | - Shinichiro Nagamitsu
- Department of Pediatrics and Child Health, Kurume University School of Medicine, Fukuoka, Japan
| | - Mizue Iwasaki
- Department of Pediatrics and Child Health, Kurume University School of Medicine, Fukuoka, Japan
| | - Akiko Iemura
- Department of Pediatrics and Child Health, Kurume University School of Medicine, Fukuoka, Japan
| | - Yushiro Yamashita
- Department of Pediatrics and Child Health, Kurume University School of Medicine, Fukuoka, Japan
| | - Masaharu Maeda
- Department of Neuropsychiatry, Kurume University School of Medicine, Fukuoka, Japan
| | - Shingo Kitani
- Department of Biostatistics, Kurume University Graduate School of Medicine, Fukuoka, Japan
| | - Tatsuyuki Kakuma
- Biostatistics Center, Kurume University School of Medicine, Fukuoka, Japan
| | - Naohisa Uchimura
- Department of Neuropsychiatry, Kurume University School of Medicine, Fukuoka, Japan
| | - Toyojiro Matsuishi
- Department of Pediatrics and Child Health, Kurume University School of Medicine, Fukuoka, Japan.
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Goldman SE, Wang L, Fawkes DB. Concordance of Mother/Child Sleep Patterns Using Actigraphy: Preliminary Findings. ACTA ACUST UNITED AC 2014; 3. [PMID: 25325077 DOI: 10.4172/2325-9639.1000133] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Sleep problems are common in children with autism spectrum disorder (ASD) and are often associated with problem behaviors. Problematic sleep in the child may impact maternal sleep. We examined the association of sleep in mother-child dyads to child daytime behavior and maternal insomnia and daytime sleepiness in 11 children with ASD and 6 children of typical development (TD) using wrist actigraphs over 14 consecutive nights. Early morning wakenings were significantly associated with poorer daytime behavior as measured by the Child Behavior Checklist in both ASD and TD children. Additionally, associations were found between mother and child sleep and between the child's sleep and maternal daytime sleepiness. These results highlight the need to consider the potential interaction of maternal-child sleep in future studies.
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Affiliation(s)
- Suzanne E Goldman
- Neurology-Sleep Division, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Lily Wang
- Department of Biostatistics, Vanderbilt University School of Medicine, Nashville, Tennessee, USA
| | - Diane B Fawkes
- Neurology-Sleep Division, Vanderbilt University Medical Center, Nashville, Tennessee, USA
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45
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Relationship between children's sleep and mental health in mothers of children with and without autism. J Autism Dev Disord 2013; 43:956-63. [PMID: 22932769 DOI: 10.1007/s10803-012-1639-0] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
The study employed 90 children with autism spectrum disorders (ASDs) who were matched to 90 typically developing children on age, gender, and ethnicity. Using structural equation modeling, maternal sleep and maternal stress mediated the relationship between children's sleep and mothers' mental health for mothers of children with and without ASDs. Mothers of children with ASDs reported more problems related to children's sleep, their own sleep, greater stress, and poorer mental health; however, children's sleep and maternal sleep were more closely related to maternal stress for mothers of typically developing children. Implications of these findings and future directions for research are discussed.
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46
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Schlarb A, Brömer L, Brandhorst I, Wagner J, Milicevic V, Hautzinger M. Sleep problems among family members of a universal parent-training. SOMNOLOGIE 2013. [DOI: 10.1007/s11818-013-0615-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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47
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Giallo R, Wood CE, Jellett R, Porter R. Fatigue, wellbeing and parental self-efficacy in mothers of children with an autism spectrum disorder. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2011; 17:465-80. [PMID: 21788255 DOI: 10.1177/1362361311416830] [Citation(s) in RCA: 128] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Raising a child with an Autism Spectrum Disorder (ASD) presents significant challenges for parents that potentially have a impact on their health and wellbeing. The current study examined the extent to which parents experience fatigue and its relationship to other aspects of wellbeing and parenting. Fifty mothers of children with an ASD aged 2-5 years participated in the study. Compared with mothers of typically developing children, mothers of children with an ASD reported significantly higher fatigue, with overall scores in the moderate range. Factors associated with high levels of fatigue were poor maternal sleep quality, a high need for social support and poor quality of physical activity. Fatigue was also significantly related to other aspects of wellbeing, including stress, anxiety and depression, and lower parenting efficacy and satisfaction. The need for interventions to specifically target parental fatigue and its impact on families affected by ASDs both in the short and long term is clearly indicated.
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Abstract
Family systems are dynamic, with reciprocal interactions among family members. When children have sleep problems, they often awaken a parent, affecting parent sleep and subsequent parent daytime functioning. Child sleep patterns can also be disrupted by parent cognitions related to the child's sleep, as well as when parents are experiencing external stressors (eg, work or marital problems). This article focuses on sleep in a family context, reviewing the relationship between sleep among children and their parents from infancy to adolescence. Sleep in the family when a child has a chronic illness or development disorder is also reviewed.
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Affiliation(s)
- Lisa J. Meltzer
- Assistant Professor of Pediatrics, Division of Pediatric Behavioral Health, National Jewish Health, Denver, CO
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49
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SCHRECK KIMBERLYA, RICHDALE AMANDAL. Knowledge of childhood sleep: a possible variable in under or misdiagnosis of childhood sleep problems. J Sleep Res 2011; 20:589-97. [DOI: 10.1111/j.1365-2869.2011.00922.x] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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50
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Dietert RR, Dietert JM, Dewitt JC. Environmental risk factors for autism. EMERGING HEALTH THREATS JOURNAL 2011; 4:7111. [PMID: 24149029 PMCID: PMC3168222 DOI: 10.3402/ehtj.v4i0.7111] [Citation(s) in RCA: 74] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/03/2010] [Accepted: 10/11/2010] [Indexed: 01/29/2023]
Abstract
Autism is a devastating childhood condition that has emerged as an increasing social concern just as it has increased in prevalence in recent decades. Autism and the broader category of autism spectrum disorders are among the increasingly seen examples in which there is a fetal basis for later disease or disorder. Environmental, genetic, and epigenetic factors all play a role in determining the risk of autism and some of these effects appear to be transgenerational. Identification of the most critical windows of developmental vulnerability is paramount to understanding when and under what circumstances a child is at elevated risk for autism. No single environmental factor explains the increased prevalence of autism. While a handful of environmental risk factors have been suggested based on data from human studies and animal research, it is clear that many more, and perhaps the most significant risk factors, remain to be identified. The most promising risk factors identified to date fall within the categories of drugs, environmental chemicals, infectious agents, dietary factors, and other physical/psychological stressors. However, the rate at which environmental risk factors for autism have been identified via research and safety testing has not kept pace with the emerging health threat posed by this condition. For the way forward, it seems clear that additional focused research is needed. But more importantly, successful risk reduction strategies for autism will require more extensive and relevant developmental safety testing of drugs and chemicals.
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Affiliation(s)
- Rodney R Dietert
- Department of Microbiology and Immunology, Cornell University, Ithaca, NY, USA;
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