The relationship between sleep and behavior in autism spectrum disorder (ASD): a review

Abstract

Although there is evidence that significant sleep problems are common in children with autism spectrum disorder (ASD) and that poor sleep exacerbates problematic daytime behavior, such relationships have received very little attention in both research and clinical practice. Treatment guidelines to help manage challenging behaviors in ASD fail to mention sleep at all, or they present a very limited account. Moreover, limited attention is given to children with low-functioning autism, those individuals who often experience the most severe sleep disruption and behavioral problems. This paper describes the nature of sleep difficulties in ASD and highlights the complexities of sleep disruption in individuals with low-functioning autism. It is proposed that profiling ASD children based on the nature of their sleep disruption might help to understand symptom and behavioral profiles (or vice versa) and therefore lead to better-targeted interventions. This paper concludes with a discussion of the limitations of current knowledge and proposes areas that are important for future research. Treating disordered sleep in ASD has great potential to improve daytime behavior and family functioning in this vulnerable population.

Irritability and Problem Behavior in Autism Spectrum Disorder: A Practice Pathway for Pediatric Primary Care

“…21 Sleep Problems: Sleep problems occur more frequently in patients with ASD than in typically developing patients and are strongly associated with daytime I/PB, among other problems. 22 Although more research is needed, many clinicians have anecdotal experience with improvement in I/PB after treatment of sleep problems. 22 Promotion of sleep hygiene in children with sleep problems should be prioritized.…”

“…22 Although more research is needed, many clinicians have anecdotal experience with improvement in I/PB after treatment of sleep problems. 22 Promotion of sleep hygiene in children with sleep problems should be prioritized. 23 The ATN has a useful packet to help parents improve their child's sleep habits (https:// www.…”

Sleep behaviour relates to language skills in children with and without communication disorders

“…Mannion & Leader (2014) reviewed these studies and reported a range of prevalence rates from 33% (Goldman et al, 2011) to 80.9% (Mannion, Leader & Healy, 2013). Sleep difficulties include time getting to sleep and night-waking, but at the clinical level sleep disorders are predominantly described as insomnia (Cohen et al, 2014) or as 'unspecified' (Malow et al, 2016). The review by Cohen and colleagues (2014) attempted to unpick some of the relationships between sleep and behaviour in children with ASD.…”

“…Only one paper included in Cohen et al (2014) reported on verbal skills (Taylor et al, 2012). One reason for this omission may be that not all children with ASD are felt to have linguistic difficulties (DSMV, 2015).…”

“…More studies in this area could be useful information, both clinically and theoretically. Cohen et al (2014) note that sleep is often absent from intervention strategies for families of children with autism (perhaps with the exception of medication, see Malow et al, 2016), and this is also true for families of children with DLD. If children with DLD are found to have sleep difficulties this opens a theoretical question about whether autistic children with additional linguistic impairment are the same subgroup as those with sleep disturbance.…”