Disturbances of Continuous Sleep and Circadian Rhythms Account for Behavioral Difficulties in Children with Autism Spectrum Disorder

Abstract

Sleep disorders are among the most common comorbidities in children with Autism Spectrum Disorder (ASD), and subjectively defined sleep disturbances have been related to ASD symptom severity. However, no study has investigated the differential impact of objectively measured sleep and circadian rhythm disturbances on behavioral difficulties in this population. Fifty-two children with ASD aged 3–10 years underwent assessments of sleep and circadian rest–activity rhythms objectively with actigraphy and subjectively with the Children’s Sleep Habits Questionnaire. Behavioral difficulties were assessed using the ABC-C. Group comparison analyses were used to compare sleep and circadian rhythm parameters of children with higher and lower behavioral difficulties and dominance analysis to rank predictors and address multicollinearity. Children with high irritability had a shorter continuous sleep period compared to those with lower irritability (−60 min, p = 0.04), as well as those with high stereotypic behaviors compared to children with less stereotypies (−75 min, p = 0.006). Objective circadian and sleep disturbances accounted together for, respectively, 17%, 18% and 36% of the variance in social withdrawal, irritability and stereotypic behaviors. The identification of both sleep and circadian rhythm disturbances as explanatory factors for behavioral difficulties warrants their inclusion in the existing behavioral management strategies for children with ASD.

Disrupted nocturnal melatonin in autism: Association with tumor necrosis factor and sleep disturbances

“…It is likely that the suppression of melatonin and associated changes in sleep, as well as immune regulation, has a significant influence on many aspects of ASD pathophysiology. 61 The data in the current study clearly indicate a role for increased TNF, but not IL-6, in the suppression of pineal melatonin and sleep disorders in ASD. Sleep-breathing dysfunction significantly increases nasal nitric oxide expiration 62 and is recognized to have an inflammatory basis.…”

“…Previous research indicates that delayed sleep onset, waking up during the night and early morning wakening are not uncommon in ASD, 12,60 which is given some support by the results of the present study. It is likely that the suppression of melatonin and associated changes in sleep, as well as immune regulation, has a significant influence on many aspects of ASD pathophysiology 61 …”

International Expert Opinions and Recommendations on the Use of Melatonin in the Treatment of Insomnia and Circadian Sleep Disturbances in Adult Neuropsychiatric Disorders

“…Although few studies ( 61 ) have investigated this topic in adult subjects, they suggest results are similar to those found compared to children. Studies have reported a high frequency of sleep disturbances and alterations of circadian sleep rhythmicity in adults with ASD such as difficulties in falling asleep, frequent and long nighttime awakenings, short sleep duration, delayed circadian phases, and evening preference such as evening chronotypes associated with ASD ( 62 ). Melatonin dysregulation, which includes delay in melatonin peak, reduction in amplitude, and alteration in genes encoding for enzymes responsible in melatonin synthesis have been hypothesized to play a role.…”

Practice Tools for Screening and Monitoring Insomnia in Children and Adolescents with Autism Spectrum Disorder

“…The following three tools -CSHQ -Children's Sleep Habits Questionnaire; CSDI-Composite sleep disturbance index; and SDSC -Sleep Disturbance Scale for Children, were evaluated for insomnia screening because they were the most widely used questionnaires adopted for children, had some psychometric validation in children with ASD, had clear cutoffs to distinguish insomnia and found appropriate for use by caregivers/ parents or patients (where applicable). Goldman et al, 2011;Hodge et al, 2012;Malow et al, 2006;Souders et al, 2009;Yavuz-Kodat et al, 2020). The CSHQ produces a total score based on 45 items, and individual subscale scores based on 33 items, with higher scores indicating more severe sleep disturbance.…”