Rethinking bedtime resistance in children with autism: is restless legs syndrome to blame?

Kanney, Michelle L.; Durmer, Jeffrey S.; Trotti, Lynn Marie; Leu, Roberta M.

doi:10.5664/jcsm.8756

Cited by 24 publications

(7 citation statements)

References 40 publications

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“…Although the behavioral insomnia may present with bedtime resistance, delayed sleep onset, the possibility of periodic limb movement disorder or restless leg syndrome may be considered because some questions on sleep‐related movements were also included in the SWTD subscales. Many studies have shown an increased prevalence of sleep‐related movement disorders in children with neurodevelopmental disabilities (Carotenuto et al, 2013; Kanney et al, 2020; Konofal et al, 2010). Actigraphy is a useful tool to evaluate sleep disorders in children without adequate verbal expression (Cippa et al, 2013).…”

Section: Discussionmentioning

confidence: 99%

The clinical and sleep manifestations in children with FOXG1 syndrome

et al. 2023

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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 FOXG1 Research Foundation Patient 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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Section: Discussionmentioning

confidence: 99%

The clinical and sleep manifestations in children with FOXG1 syndrome

et al. 2023

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“…Rethinking bedtime resistance and exploring a possible diagnosis of RLS in children with autism ( 68 ) is only one of the conceivable applications of the Mind the Gap Logic Model. Many more scenarios are viable and would significantly aid disadvantaged IDD children in obtaining better and safer treatments within a 24-h circadian perspective, thus bolstering the recognition of sleep as a crucial and powerful modulator of behavior.…”

Section: Discussionmentioning

confidence: 99%

Behavioral sleep medicine—The need for harmonization of clinical best practice outcome measures in children and adolescents with intellectual or developmental disabilities and restless sleep

Silvestri

Ipsiroglu

2022

Front. Psychiatry

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In behavioral medicine, sleep disorders, insomnia in particular, may be considered comorbidities and precipitating factors to intellectual or developmental disabilities (IDD). Nevertheless, sleep alterations have often been neglected in favor of daytime features and symptoms, albeit simple behavioral nighttime observations may disclose hypermotor features that characterize restless sleep. The root of most hypermotor restlessness is linked to central iron deficiency. The latter is often exacerbated by vitamin D deficiency (VDD), which interferes with both dopaminergic and serotonergic mechanisms. In this way, an imbalance affecting daytime behavior and mood is created. Several sleep-related motor disorders such as bruxism, periodic and aperiodic leg movements, Restless Legs Syndrome (RLS), and Restless Sleep Disorder (RSD) are commonly seen in Attention Deficit Hyperactivity Disorder (ADHD) and Autism Spectrum Disorders (ASD). However, they are rarely diagnosed and often overlooked in affected children and adolescents. As a result, not only are these disorders not adequately addressed therapeutically, but their symptoms may be worsened by the side-effects of drugs used to contain disruptive daytime behavior, such as antipsychotics and antidepressants. In children with IDDs, obesity, inactivity and metabolic effects of antipsychotics often lead to Sleep Disordered Breathing (SDB), which is currently understood as an inflammatory state leading to “hyperactive” lethargy and further alterations of the hypoxic chain and vitamin D levels. Endorsing simple routine blood tests, including inflammatory markers such as C-reactive protein, ferritin, transferrin, and vitamin D levels, may favorably complement caregiver observations and ambulatory sleep recordings, leading to a sleep disorder diagnosis and consequent therapy. In fact, the treatment of SDB, RLS, and RSD has been copiously demonstrated to favorably impact vigilance, behavior, social competence, and academic skills in healthy and, to a greater extent, in IDD children. Thus, consulting and deliberating the root causes of functional and categorical diagnoses within a clinical framework may engender a more precise diagnosis and further benefit pediatric daytime and nighttime management of hyperactive behaviors.

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“…Weiskop et al (2005) reported that it was unable to be determined whether the night-time rocking was a form of automatically reinforced stereotypy or occurred whilst the child was asleep and was thus a form of parasomnia. Other sleep-related movement disorders are also relevant to autism, such as restless leg syndrome involving repetitive movement of the legs, or larger muscle groups (e.g., body-rocking) involving the legs, during the wake-sleep transition (Kanney et al, 2020;Veatch et al, 2015). Restless leg syndrome is often associated with periodic limb movements in sleep, involving repetitive movements of extremities during sleep (Veatch et al, 2015).…”

Section: Discussionmentioning

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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Rethinking bedtime resistance in children with autism: is restless legs syndrome to blame?

Cited by 24 publications

References 40 publications

The clinical and sleep manifestations in children with FOXG1 syndrome

The clinical and sleep manifestations in children with FOXG1 syndrome

Behavioral sleep medicine—The need for harmonization of clinical best practice outcome measures in children and adolescents with intellectual or developmental disabilities and restless sleep

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

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