Sleep problems in children with autism spectrum disorder: a multicenter survey

Abstract

Background High prevalence of sleep problems have been reported in children with Autism Spectrum Disorder (ASD). This study aims to investigate the sleep conditions of ASD children in China, and explore the relationship between the common sleep problems and core symptoms and developmental levels. Methods Using a cross-sectional design, we included 2 to 7-year-old children from 13 cities in China: 1310 with ASD and 1158 with typically-developing (TD) children. The neurodevelopmental level was evaluated with the revised Children Neuropsychological and Behavior Scale (CNBS-R2016). ASD were diagnosed with DSM-5 and Child Autism Rating Scale (CARS). the Social Responsiveness Scale (SRS), the Autism Behavior Checklist (ABC) and the communication warning behavior sub-scale in CNBS-R2016 valued autism behaviors. The children’ s sleep habits questionnaire (CSHQ) assessed sleep conditions. Results The prevalence of sleep disorders in ASD children was significantly higher than that in TD (67.4% vs. 51%, p < 0.01), and among them the four dimensions with the highest prevalence of sleep problems were bedtime resistance (25.6%), sleep anxiety (22.7%), sleep onset delay (17.9%) and daytime sleepiness (14.7%). ASD children with sleep onset delay or sleep anxiety had higher ABC, SRS scores and higher scores on communication warning behavior with sleep anxiety, with daytime sleepiness had higher ABC, SRS and CARS scores, and with bedtime resistance had higher SRS total scores. Differences in the neurodevelopmental level were not significant. Conclusion Children with ASD have a higher prevalence of sleep problems. Bedtime resistance, anxiety, sleep onset delay and daytime sleepiness may be related to the core symptoms, but not be related to the developmental level in ASD children. In the clinic, sleep assessment should be included in the routine of ASD visits, and during the intervention, sleep hygiene education is as important as the treatment of biological factors. Trial registration The study was approved by the ethics committee of the Children’s Hospital of Chongqing Medical University, Approval Number: (2018) IRB (STUDY) NO. 121, and registered in the Chinese Clinical Trial Registry (Registration number: ChiCTR2000031194).

A Placebo-Controlled Trial of Cannabinoid Treatment for Disruptive Behavior in Children and Adolescents with Autism Spectrum Disorder: Effects on Sleep Parameters as Measured by the CSHQ

“…Consistent with previous studies [ 39 , 74 ], we also found that the severity of sleep disturbances, as indicated by the CSHQ total score at the baseline, correlated with a younger age and with the severity of the autistic core symptoms. Most of the participants in our cohort had severe autistic symptoms (78.7% had a comparison score of 8–10 in the ADOS-2).…”

“…Most of the participants in our cohort had severe autistic symptoms (78.7% had a comparison score of 8–10 in the ADOS-2). This might explain the higher rate of participants (86%) who screened positive for sleep disturbances, compared to a rate of approximately 70% that was reported in a US registry study [ 74 ] and in a Chinese multicenter survey [ 39 ].…”

“…Children’s Sleep Habits Questionnaire (CSHQ) [ 34 ]. This parent-rated questionnaire has been used and validated in multiple studies of ASD [ 35 , 36 , 37 , 38 , 39 ]. It comprises 33 scored questions, and additional items intended to provide other relevant information on sleep behavior.…”

Sleep Disturbances in Children Affected by Autism Spectrum Disorder

“…Research on animals and on typically developing children demonstrated that sleep deprivation may lead to impairments of adequate synaptic development and brain maturation ( 24 , 25 ); therefore, some authors have speculated that sleep dysfunction in children with ASD could actively cause disorders in synaptic function, potentially creating a maladaptive feed-forward loop of sleep disruption and neural anomalies ( 24 , 25 ). Furthermore, less sleeping time and worse quality of sleep may affect adaptive behavior (e.g., hygiene, eating, toileting…), cognition, attention, memory, learning ( 26 – 30 ) and executive functioning ( 31 ), and increase internalizing and externalizing problems, as depression, anxiety, self-injury, oppositional behavior, irritability, physical aggression ( 24 , 32 – 35 ). Sleep problems may also exacerbate the core symptom severity of ASD: poor sleepers were reported to show more restricted and stereotyped behaviors, more severe social skills deficits ( 2 , 26 , 36 – 40 ) and communication problems ( 41 ).…”

“…Furthermore, less sleeping time and worse quality of sleep may affect adaptive behavior (e.g., hygiene, eating, toileting…), cognition, attention, memory, learning ( 26 – 30 ) and executive functioning ( 31 ), and increase internalizing and externalizing problems, as depression, anxiety, self-injury, oppositional behavior, irritability, physical aggression ( 24 , 32 – 35 ). Sleep problems may also exacerbate the core symptom severity of ASD: poor sleepers were reported to show more restricted and stereotyped behaviors, more severe social skills deficits ( 2 , 26 , 36 – 40 ) and communication problems ( 41 ). However, it is still unclear what daytime implications of sleep disorder are and the direction of their relationship.…”