Assessing a hyperarousal hypothesis of insomnia in adults with autism spectrum disorder

Baker, Emma K.; Richdale, Amanda L.; Hazi, Agnes; Prendergast, Luke A.

doi:10.1002/aur.2094

Cited by 30 publications

(27 citation statements)

References 66 publications

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“…Adults with ASD have dampened cortisol secretion and subjective somatic physiological arousal, associated with increased sleep onset latency, poorer sleep efficiency, and increased waking after sleep onset. This corroborates the hypothesis that dysregulation of the SNS-HPA is a key mechanism underlying phenotypic expression of ASD (Baker et al, 2019).…”

Section: Parent–infant Biobehavioral Synchrony Optimizes Reciprocity supporting

confidence: 90%

Pre-emptive Intervention for Autism Spectrum Disorder: Theoretical Foundations and Clinical Translation

Douglas

2019

Front. Integr. Neurosci.

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Autism spectrum disorders (ASD) are an emergent public health problem, placing significant burden upon the individual, family and health system. ASD are polygenetic spectrum disorders of neural connectome development, in which one or more feedback loops amplify small genetic, structural, or functional variations in the very early development of motor and sensory-motor pathways. These perturbations trigger a ‘butterfly effect’ of unpredictable cascades of structural and functional imbalances in the global neuronal workspace, resulting in atypical behaviors, social communication, and cognition long-term. The first 100 days post-term are critically neuroplastic and comprise an injury-sensitive developmental window, characterized by a neural biomarker, the persistence of the cortical subplate, and a behavioral biomarker, the crying diathesis. By the time potential diagnostic signs are identified, from 6 months of age, ASD neuropathy is already entrenched. The International Society for Autism Research Special Interest Group has called for pre-emptive intervention, based upon rigorous theoretical frames, and real world translation and evaluation. This paper responds to that call. It synthesizes heterogenous evidence concerning ASD etiologies from both psychosocial and biological research literatures with complexity science and evolutionary biology, to propose a theoretical framework for pre-emptive intervention. This paper hypothesizes that environmental factors resulting from a mismatch between environment of evolutionary adaptedness and culture initiate or perpetuate early motor and sensory-motor lesions, triggering a butterfly effect of multi-directional cascades of atypical developmental in the complex adaptive system of the parent and ASD-susceptible infant. Chronic sympathetic nervous system/hypothalamic-pituitary-adrenal axis hyperarousal and disrupted parent-infant biobehavioral synchrony are the key biologic and behavioral mechanisms perpetuating these atypical developmental cascades. A clinical translation of this evidence is proposed, for application antenatally and in the first 6 months of life, as pre-emptive intervention for ASD.

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Section: Parent–infant Biobehavioral Synchrony Optimizes Reciprocity supporting

confidence: 90%

Pre-emptive Intervention for Autism Spectrum Disorder: Theoretical Foundations and Clinical Translation

Douglas

2019

Front. Integr. Neurosci.

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“…Previous research has identified that the hyperarousal is associated with elevated levels of cortisol in insomnia patients (Vgontzas et al 2001;Rodenbeck et al 2002). Similar findings have been reported in the ASD population, whereby individuals with ASD experiencing sleep problem such as insomnia report elevated rates of cortisol compared with controls (Richdale & Prior 1992;Corbett et al 2008;Baker et al 2019). This elevation in cortisol provides support for a hyperarousal hypothesis of insomnia for individuals with ASD.…”

Section: Discussionmentioning

confidence: 58%

“…2008; Baker et al . 2019). This elevation in cortisol provides support for a hyperarousal hypothesis of insomnia for individuals with ASD.…”

Section: Discussionmentioning

confidence: 99%

Relationships among gastrointestinal symptoms, sleep problems, challenging behaviour, comorbid psychopathology and autism spectrum disorder symptoms in children and adolescents with 15q duplication syndrome

Leader

Forde

Naughton

et al. 2020

J intellect Disabil Res

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Background Comorbidity is the presence of at least two disorders in one person at one time. This study examined the frequency of gastrointestinal (GI) symptoms, sleep problems, comorbid psychopathology, challenging behaviour and autism spectrum disorder (ASD) symptoms in children and adolescents with duplication 15q syndrome (Dup15q), aged 3-17 years. This study also examined whether challenging behaviour in Dup15q is predicted by age, gender, presence of an intellectual disability, sleep problems, GI symptoms and comorbid psychopathology. Method Parental measures were completed by 101 parents of children and adolescents with Dup15q. Questionnaires were composed of the Children's Sleep Habits Questionnaire, Behavior Problems Inventory-Short Form, GI Symptom Inventory, Social Communication Questionnaire and the Child Behavior Checklist. Results Sleep problems (94%), GI symptoms (87%) and challenging behaviour (100%) were common comorbidities represented in the sample in this study. Significant relationships were found between challenging behaviour and the presence of co-occurring sleep problems, GI symptoms, comorbid psychopathology and ASD symptoms. Further analysis revealed that these comorbidities also predicted challenging behaviour. Conclusion This research demonstrated the importance of studying the relationships between GI symptoms, sleep problems, comorbid psychopathology, ASD symptoms and challenging behaviour in Dup15q and how these conditions can shape the Dup15q phenotype.

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“…Recent evidence also indicates a high rate of physical health issues in about 40%–60% of autistic adults including allergy, cardiovascular disease, obesity, neurological conditions, gastrointestinal disorders and sleep disorders (Croen et al, 2015; Jones et al, 2016). Autistic adults have more frequent sleeping difficulties than comparison groups (Limoges et al, 2005; Tani et al, 2003), and poor sleep is related to poor mental health (Baker et al, 2019; Tani et al, 2003) and pre-sleep arousal (Baker et al, 2019). Symptoms associated with insomnia and circadian sleep–wake disorders appear most common (Baker & Richdale, 2015, 2017; Hare et al, 2006).…”

mentioning

confidence: 99%

Cross-sectional and longitudinal predictors of quality of life in autistic individuals from adolescence to adulthood: The role of mental health and sleep quality

Lawson

Richdale

Haschek

et al. 2020

Autism

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Autistic adults experience a higher rate of physical and mental health conditions and lower rates of employment and post-secondary education participation than their non-autistic counterparts, which may affect negatively quality of life. Limited information exists on predictors of quality of life for autistic individuals, or how quality of life compares to non-autistic individuals. Our aims were to (a) examine and compare indicators of physical (e.g. sleep quality) and mental health (e.g. anxiety) on quality of life among a sample of 244 autistic and 165 non-autistic individuals aged 15–80 years and (b) examine factors contributing to quality of life 2 years later among the autistic sample ( n = 93). Participants were from two Australian longitudinal studies. The pattern of results for quality of life was similar across the autistic and non-autistic groups, with depression symptomatology, psychological well-being, sleep quality and autonomic symptoms all significantly predicting quality of life. In addition, among the autistic group, baseline quality of life had the greatest influence on quality of life 2 years later. These findings have implications for support services for autistic individuals, implying that in order to improve quality of life, mental health, particularly depression, needs addressing. Given known relationships between sleep and mental health, an intervention addressing these may have greatest clinical impact on quality of life among autistic individuals. Lay Abstract Research shows that autistic adults are at risk of a range of physical (e.g. sleep difficulties) and mental health (e.g. anxiety) conditions, as well as lower employment and post-secondary education participation; these all can affect one’s quality of life. However, we have little information about what affects quality of life for autistic individuals across the lifespan and whether this differs from non-autistic people. We determined what factors (e.g. mental or physical health challenges) affected quality of life in a large group of autistic individuals aged 15–80 years compared with similar age non-autistic individuals. We also examined what factors affected quality of life of the autistic group 2 years later. We found a similar pattern of results for the autistic and non-autistic groups; depression symptoms, psychological well-being, sleep quality and autonomic symptoms (e.g. sweating) were all significant predictors of quality of life. In addition, among the autistic group, baseline quality of life had the most influence on quality of life 2 years later. These results have implications for support services, as they highlight the relationship between mental health (especially depression) and quality of life. Given that sleep challenges (e.g. insomnia) are related to mental health, an intervention addressing both insomnia and mental health may be most useful in helping autistic individuals improve their quality of life.

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Assessing a hyperarousal hypothesis of insomnia in adults with autism spectrum disorder

Cited by 30 publications

References 66 publications

Pre-emptive Intervention for Autism Spectrum Disorder: Theoretical Foundations and Clinical Translation

Pre-emptive Intervention for Autism Spectrum Disorder: Theoretical Foundations and Clinical Translation

Relationships among gastrointestinal symptoms, sleep problems, challenging behaviour, comorbid psychopathology and autism spectrum disorder symptoms in children and adolescents with 15q duplication syndrome

Cross-sectional and longitudinal predictors of quality of life in autistic individuals from adolescence to adulthood: The role of mental health and sleep quality

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