Function-Based Behavioral Interventions for Sleep Problems in Children and Adolescents with Autism: Summary of 41 Clinical Cases

McLay, Laurie; Blampied, Neville M.; Deurs, Jenna van; Hunter, Jolene; Knight, Jacqui; Hastie, Brent; Carnett, Amarie; Woodford, Emma; Gibbs, Rosina; Lang, Russell

doi:10.1007/s10803-020-04548-7

Cited by 48 publications

(27 citation statements)

References 58 publications

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“…Patients with ASD associated with intellectual disability often have a pre-existing sleep disorder. [ 1 – 4 , 18 – 20 ] It has been suggested that insomnia symptoms of sleep problems, such as increased sleep onset latency, increased wake after sleep onset episodes, and reduced total sleep time, are commonly experienced with ASD. [ 14 , 15 ] Therefore, we consider that daily medication with these drugs for maintenance of mental condition might have a major influence on sleep quality.…”

Section: Discussionmentioning

confidence: 99%

“…It has been reported that, patients with autism spectrum disorders, with existing circadian rhythm disorder rapidly deteriorate due to acute sleep disorder during the perioperative period after general anesthesia. [ 1 – 5 ] Furthermore, when sleep disorders occur after the administration of general anesthesia in the elderly with mildly deteriorated brain function, not only does acute postoperative delirium develop within a few days of the operation but also subacute postoperative operation occurs within a few weeks. The risk of cognitive impairment has also been pointed out.…”

Section: Introductionmentioning

confidence: 99%

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Study on the preventive effect of ramelteon on the onset of sleep disorder after general anesthesia in patients with autism spectrum disorder

Ayuse¹,

Ozaki-Honda

Kurata

et al. 2020

Medicine

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Background: The persistent loss of consciousness caused by general anesthesia without the existence of repeated 90-minute cycles of non-REM and REM sleep might significantly disturb and suppress the cycle of normal physiological sleep in postoperative periods after general anesthesia. Patients with autism spectrum disorders (ASD) with existing circadian rhythm disorder are reported to rapidly deteriorate due to acute sleep disorder during the perioperative period after general anesthesia. A melatonin receptor agonist, ramelteon (Rozerem), which is a sleep cycle regulator, is used as a therapeutic drug for patients with sleep disorders, but there are no studies on the prevention of postoperative sleep disorder after general anesthesia. In this study, we investigate whether prophylactic administration of a sleep-inducing substance, a melatonin receptor agonist, is effective against sleep disorder after general anesthesia in patients with ASD. Methods/design: This study is intended for patients with ASD aged 12 years and above who undergo treatment at Nagasaki University Hospital, Isahaya General Hospital Dentistry, and Sasebo City General Medical Center Dentistry and undergo dental treatment under general anesthesia. A melatonin receptor agonist (Rozerem) will be taken 7 days prior and 7 days postsurgery in patients diagnosed with insomnia. A randomized comparison will be made between 2 groups: an experimental group that is additionally administered Rozerem and a control group. The primary endpoint is the incidence of NREM-REM sleep disorders that occur within 3 to 5 days after general anesthesia. The secondary endpoint is the incidence of circadian rhythm sleep disorders (rate of occurrence of sleep-retardation syndrome with drowsiness and strong fatigue). Discussion: Postoperative sleep disorders after general anesthesia has been reported in patients with ASD; however, effective preventive pharmacological treatments have not been established. A sleep cycle regulator, ramelteon (Rozerem), is used as a therapeutic drug for patients with sleep disorders by decreasing the difficulty of falling asleep in insomnia. If sleep disorder can be prevented after the administration of general anesthesia in patients with ASD, we can support social participation while maintaining their quality of life. Trial registration: The study was registered with the jRCT1071200030.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Study on the preventive effect of ramelteon on the onset of sleep disorder after general anesthesia in patients with autism spectrum disorder

Ayuse¹,

Ozaki-Honda

Kurata

et al. 2020

Medicine

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“…The study was designed to benefit the autism community through the improvement of insomnia, defined as difficulty initiating or maintaining sleep. Sleep education, including attention to daytime habits, evening routines, the timing of sleep, and parent interactions with their children, has shown benefit in improving sleep, child behavior, and family functioning [23][24][25][26][27][28], and practice guidelines have emphasized its use as the first-line treatment [29,30]. Delivery of sleep education to reach as many families as possible (including those without easy access to practitioners) can be facilitated through apps and other online methods [31].…”

Section: Current Studymentioning

confidence: 99%

A REDCap-based model for online interventional research: Parent sleep education in autism

Malow

Galion

et al. 2021

J. Clin. Trans. Sci.

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“…The most frequently reported sleep difficulties are associated with sleep onset and maintenance and include sleep onset delay (SOD), frequent and prolonged night wakings (NWs), poor sleep efficiency, and reduced total sleep time (Cortesi et al, 2010;Johnson et al, 2018;Singh & Zimmerman, 2015). These problems are often accompanied by bedtime resistance, daytime sleepiness, disruptive behaviors (e.g., calling out to parents and caregivers [hereafter referred to as parents], screaming or crying, playing with toys or objects), and unwanted co-sleeping (Cortesi et al, 2010;Kirkpatrick et al, 2019;McLay et al, 2021a;Richdale & Schreck, 2009). Sleep problems in such children do not tend to remit without treatment, often persisting throughout adolescence (Goldman et al, 2012;Mazurek et al, 2019;Sivertsen et al, 2012).…”

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confidence: 99%

“…Extant research suggests that stereotypy (e.g., repetitive vocalizations or motor movements) can accompany sleep problems (e.g., SOD, NWs) in children on the autism spectrum (Hunter et al, 2021;Jin et al, 2013;Malow et al, 2006;McLay et al, 2019;Richdale & Schreck, 2009;Weiskop et al, 2005). For example, in a recent case analysis by McLay et al (2021a) of 41 children and adolescents on the autism spectrum with sleep problems, 27% of participants exhibited stereotypy in the sleep context. Stereotypic behaviors in children on the autism spectrum are heterogeneous, but can broadly be classified as either motor stereotypy, consisting of motor movements (e.g., hand-flapping, body-rocking), repetitive manipulation of objects (RMO; e.g., mouthing or spinning objects), or vocal stereotypy, involving non-contextual vocalizations (i.e., without a clear communicative purpose, e.g., recurring words or non-word sounds; Ahearn et al, 2007;Akers et al, 2020;Cunningham & Schreibman, 2008;DiGennaro Reed et al, 2012;Wang et al, 2020).…”

mentioning

confidence: 99%

Parent Perceptions of Sleep-Related Stereotypy Within Sleep Problems in Children on the Autism Spectrum: Implications for Behavioral Treatment

Hunter

McLay

France

et al. 2022

Adv Neurodev Disord

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Objectives Sleep problems in children on the autism spectrum may be affected by core diagnostic characteristics, including stereotypy (restricted and repetitive behaviors). Little is known about the nature of sleep-related stereotypy and its role within sleep disturbance. This study aimed to improve our understanding of the types of sleep-related stereotypy, its potential role within sleep difficulties, and how parents manage night-time stereotypy, in children on the autism spectrum. Methods This qualitative study used thematic analysis to analyze clinical assessment reports obtained from 21 parents of children on the autism spectrum referred for behavioral sleep intervention. Five themes, including the types of stereotypy, timing within sleep problems, stereotypy as sleep-interfering, stereotypy as sleep-conducive, and parent-responses, were identified. A clinical case study illustrates the potential role of vocal stereotypy within night wakings, through functional assessment and treatment of sleep problems in a child on the autism spectrum. Results Stereotypy included vocal and motor behaviors and repetitive manipulation of objects. Parents perceived stereotypy as both problematic and as beneficial to sleep, which may differentially affect behavioral treatment. Parent responses to stereotypy were varied and included co-sleeping. The case study highlights the complexity of the sleep and stereotypy relationship and the difficulty in treating automatically maintained behavior in the sleep context. Conclusion The function that stereotypy serves in relation to sleep disturbance is unclear and may differ across and within children. It is important we seek to better understand the specific ways that stereotypy may affect sleep, and vice versa, to improve clinical management of sleep problems in children on the autism spectrum.

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Function-Based Behavioral Interventions for Sleep Problems in Children and Adolescents with Autism: Summary of 41 Clinical Cases

Cited by 48 publications

References 58 publications

Study on the preventive effect of ramelteon on the onset of sleep disorder after general anesthesia in patients with autism spectrum disorder

Study on the preventive effect of ramelteon on the onset of sleep disorder after general anesthesia in patients with autism spectrum disorder

A REDCap-based model for online interventional research: Parent sleep education in autism

Parent Perceptions of Sleep-Related Stereotypy Within Sleep Problems in Children on the Autism Spectrum: Implications for Behavioral Treatment

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