Clinical and behavioral attributes leading to sleep disorders in children on the autism spectrum

Abstract

Sleep disorders are a common comorbid condition in children diagnosed with autism spectrum disorder ("autism"). However, the relationship between the clinical features of autism and sleep disorders remains unclear. A better understanding of the inherent autism-related characteristics linked to comorbid sleep disorders would improve comprehensive assessment and management. This study examined the relationship between sociodemographics, autism symptoms, sleep problems, cognitive status, behavioral attributes, and sensory profiles. Using data from 1268 participants who took part in the Australian Autism Biobank, sleep-related measurements using the Child Sleep Habits Questionnaire (CSHQ) were compared between autistic children aged 2 to 17 (N = 969), their siblings (N = 188), and unrelated children without an autism diagnosis (N = 111). The known relationship between sleep problems and autism was further explored by including scores from the Autism Diagnostic Observation Schedule-2, Mullen Scales of Early Learning, Vineland Adaptive Behavioral Scale-II and the Short Sensory Profile-2; which were included in analyses for autistic participants who had a completed CSHQ. Multiple regression models were used to identify clinical/behavioral variables associated with CSHQ subscales. The autism group had a significantly higher total CSHQ score than the sibling and comparison groups (p < 0.001), indicating worse sleep quality. Within the autism group, lower adaptive behaviors (i.e., VABS-II) and sensory issues (i.e., SSP-2 subclass scores) were positively associated with the severity of sleep problems (i.e., the CSHQ subclass scores) (p < 0.001). The significant functional impact of poor sleep on autistic children warrants an assessment of sleep as a critical part of a holistic approach to supporting autistic children and their families. Lay SummaryAutistic children generally have co-occurring conditions. Sleep disorders impact approximately 50%-80% of autistic children. The impact on the quality of life for both the children and their families can be significant. This study compares sleep problems in autistic children and adolescents with their siblings and children without a diagnosis of autism, and investigates the relationship between specific autistic traits, daily life behaviors and sleep problems. The findings highlight the importance of a holistic assessment for autistic children and matching appropriate sleep intervention and supports where indicated.

Impact of sleep disorders on behavioral issues in preschoolers with autism spectrum disorder

“…To sum up, sleep problems are among the most frequently represented comorbid symptoms in children with ASD as early as preschool age. A wide number of literature reviews demonstrate that sleep disruption is link to emotional and behavioral issues in ASD, thus influencing children’s health, cognition, executive functions and consequently school performance besides having an important impact on the quality of life of families ( 3 , 16 , 21 , 74 , 75 ). Despite this, they are often not properly identified and treated in clinical practice ( 8 , 21 ), as treatment guidelines to help parents manage challenging behaviors in children with ASD frequently fail to include sleep at all or only briefly address the topic.…”

Gastrointestinal Disorders and Food Selectivity: Relationship with Sleep and Challenging Behavior in Children with Autism Spectrum Disorder

“…Autism Spectrum Disorder (ASD) is a neurodevelopmental disorder characterized by persistent social communication difficulties, restricted interests, repetitive activities, and sensory abnormalities [1]. These core behavioral features can be associated with many co-occurring medical conditions such as anxiety disorders [2,3], sleep abnormalities [4,5], and gastrointestinal dysfunction, including gastrointestinal (GI) symptoms [6,7] and feeding disorders [8]. Comorbidities can vary in incidence and severity, contributing to the heterogeneity of clinical manifestations in children with ASD [9].…”