Sleep is associated with problem behaviors in children and adolescents with Autism Spectrum Disorders

doi:10.1016/j.rasd.2011.01.010

Research in Autism Spectrum Disorders

Volume 5, Issue 3, July–September 2011, Pages 1223-1229

https://doi.org/10.1016/j.rasd.2011.01.010 Get rights and content

Abstract

Multiple sleep problems have been reported in children with Autism Spectrum Disorder (ASD). The association of poor sleep with problematic daytime behaviors has been shown in small studies of younger children. We assessed the relationship between sleep and behavior in 1784 children, ages 2–18, with confirmed diagnosis of ASD participating in the Autism Treatment Network. Sleep problems were identified using the Children's Sleep Habits Questionnaire (CSHQ). The Parental Concerns Questionnaire (PCQ) was used to evaluate behavioral concerns and to define good or poor sleepers. Poor sleepers had a higher percentage of behavioral problems on all PCQ scales than good sleepers. Over three-fourths had problems with attention span and social interactions. Further delineation of this phenotype will help guide future interventions.

Research highlights

▶ Sleep and associated problematic behaviors were studied in 1784 children and adolescents with ASD. ▶ Our research found an association of sleep and daytime behavior from childhood through adolescence. ▶ Children/adolescents who were reported to be poor sleepers had a higher percentage of behavioral problems than good sleepers.

Section snippets

Participants

The study population was 1784 children participating in the Autism Treatment Network (ATN) whose parents completed the Children's Sleep Habits Questionnaire (CSHQ) and the Parental Concerns Questionnaire (PCQ) at their first visit. The ATN is a registry collecting data on children with ASD across 14 sites in the United States and Canada. All children/adolescents have a clinical diagnosis of ASD (American Psychiatric Association, 2000) At least 90% of the children/adolescents enrolled in the

Participants

Children ranged in age from 3 to 18 years with a mean age (standard deviation) of 6.7 (3.5) years. The population was 84.5% male, race and ethnicity were by self-report with 85% Caucasian and 8.5% Black. Parents of 1200 (67%) children reported their child to be a good sleeper, and 584 (33%) reported their child as a poor sleeper.

Developmental and behavioral problems associated with good and poor sleepers

Developmental and behavioral problems, as reported by the parents on the PCQ, were prevalent. In this cohort over 60% of the children had problems with language use and

Discussion

In this study, we examined a large and well-characterized cohort of children with ASD for the relationship between sleep problems and problem daytime behavior. Our findings support previous studies showing an association of sleep and daytime behavior (Goldman et al., 2009, Malow et al., 2006, Mayes and Calhoun, 2009, Patzold et al., 1998, Schreck et al., 2004) with a much larger population and expand the field of knowledge to include an older age group, ADOS confirmed diagnoses of ASD, and

Acknowledgements

Financial support: This research was conducted as part of the Autism Treatment Network (ATN), a program of Autism Speaks. Further support came from a cooperative agreement (UA3 MC 11054) from the U.S. Department of Health and Human Services, Health Resources and Services Administration, Maternal and Child Health Research Program, to the Massachusetts General Hospital. The views expressed in this publication do not necessarily reflect the views of Autism Speaks, Inc. The authors acknowledge the

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Citation Excerpt :
A study on 1193 children with autism found that children with sleep problems had more internalizing and externalizing behavior problems and worse adaptive skill development than children with autism without sleep problems (Sikora, Johnson, Clemons, & Katz, 2012). In another study of 2714 children with autism, core symptoms of autism, including social impairment and restricted/repetitive behaviors, were associated with short sleep duration (Suzanne E. Goldman et al., 2011). Clinical and animal studies have shown that sleep problems during development are associated with long-lasting developmental consequences that can affect learning, memory and mood regulation (Watson & Buzsáki, 2015).
Sleep problems are common in children with autism spectrum disorder (autism). There is sparse research to date to examine whether insomnia in people with autism is related to autism genetics or insomnia genetics. Moreover, there is a lack of research examining whether circadian-rhythm related genes share potential pathways with autism.
To address this research gap, we tested whether polygenic scores of insomnia or autism are related to risk of insomnia in people with autism, and whether the circadian genes are associated with insomnia in people with autism.
We tested these questions using the phenotypically and genotypically rich MSSNG dataset (N = 1049) as well as incorporating in the analyses data from the Vanderbilt University Biobank (BioVU) (N = 349). Outcomes and results: In our meta-analyzed sample, there was no evidence of associations between the polygenic scores (PGS) for insomnia and a clinical diagnosis of insomnia, or between the PGS of autism and insomnia. We also did not find evidence of a greater burden of rare and disruptive variation in the melatonin and circadian genes in individuals with autism and insomnia compared to individuals with autism without insomnia.
Overall, we did not find evidence for strong effects of genetic scores influencing sleep in people with autism, however, we cannot rule out the possibility that smaller genetic effects may play a role in sleep problems. Our study indicated the need for a larger collection of data on sleep problems and sleep quality among people with autism.

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Sleep is associated with problem behaviors in children and adolescents with Autism Spectrum Disorders

Abstract

Research highlights

Section snippets

Participants

Participants

Developmental and behavioral problems associated with good and poor sleepers

Discussion

Acknowledgements

Journal of the American Academy of Child and Adolescent Psychiatry

Research in Autism Spectrum Disorders

Pediatric Neurology

Sleep Medicine

Sleep Medicine Reviews

Research in Developmental Disabilities

Research in Developmental Disabilities

The international classifications of sleep disorders

Diagnostic and Statistical Manual of Mental Disorders

Decreasing self-injurious behavior associated with awakening in a child with autism and developmental delays. [Article]

Behavioral Interventions

Sleep disturbance and its relation to DSM-IV psychiatric symptoms in preschool-age children with pervasive developmental disorder and community controls

Journal of Child Neurology

Age-related differences in restricted repetitive behaviors in Autism Spectrum Disorders

Journal of Autism and Developmental Disorders

Spectrum of sleep problems in children with autism—an epidemiological analysis

Sleep

Defining the sleep phenotype in children with autism

Developmental Neuropsychology

Sleep problems, sleepiness and daytime behavior in preschool-age children. [Article]

Journal of Child Psychology and Psychiatry

Model-based estimation of relative risks and other epidemiologic measures in studies of common outcomes and in case–control studies

American Journal of Epidemiology