Relationships between autistic traits, insufficient sleep, and real-world executive functions in children: a mediation analysis of a national epidemiological survey

Abstract

Background Although the literature documents low executive functions and sleep deficits in individuals with autism spectrum disorder or subclinical autistic traits, no study has simultaneously examined their relationships in the general child population. This study aimed to examine whether autistic traits impacted real-world executive functions through insufficient sleep in a nationally representative sample of children. Methods This was a national survey of 6832 primary and secondary school students, aged 8–14 years old, with equal sex distribution (3479 boys, 50.8%). Parents reported their child's nocturnal sleep duration and the need for sleep to maintain their daytime function and the Social Responsiveness Scale and the Behavior Rating Inventory of Executive Function (BRIEF) for their children's autistic traits and real-world executive functions, respectively. Results We found that autistic traits exerted indirect effects on real-world executive functions through sleep deficits, independent of sex, and age. Moreover, such an indirect effect was observed only from restricted and repetitive behaviors to executive functions through sleep deficits, but not in the other components of autistic traits (i.e. social communication and interaction). Conclusions Our novel findings underscore the importance of sleep and autistic traits in executive functions and suggest potential mechanisms that may underlie the observed correlational structure among autistic behaviors, sleep deficits, and low executive function performance.

Copy Number Variation at the 22q11.2 Locus Influences Prevalence, Severity, and Psychiatric Impact of Sleep Disturbance

“…While no SRS subscales were signi cantly associated with sleep at baseline, all SRS subscales except motivation was associated with sleep across timepoints. Our nding of a signi cant effect of sleep on BRIEF global composite is supported by a previous study reporting sleep de cits were associated with a worse global composite score on the BRIEF [9]. Contrary to expectations, the effect of sleep on BRIEF subscales did not reach signi cance at baseline.…”

“…In cross-sectional studies, sleep mediates the relationships between restrictive and repetitive behaviors and real-world executive function, [9] while in a study of boys with ASD, sleep disturbance was found to moderate the relationship between ASD symptom severity and problem behaviors [10]. Moreover, clinical trials of effective sleep interventions in children with neurodevelopmental disorders improved a range of behavioral and mood symptoms for at least six months post-treatment [11][12][13].…”

“…Autism Spectrum Measures. We chose to assess repetitive behaviors and social de cits because both of these domains are associated with sleep in studies of idiopathic ASD [9,12,13,[35][36][37]. The Repetitive Behavior Scale (RBS) [38] is a parent-report scale used to measure stereotyped, self-injurious, restrictive, need for sameness, compulsive, and ritualistic behaviors.…”

“…The Behavior Rating Inventory of Executive Function [41] (BRIEF) was used to measure parent-reported real-world executive function in participants aged 6-18. A previous study in a population-based cohort found associations between sleep, autistic traits, and the BRIEF [9], making it a measure of interest for the present study. The BRIEF consists of an overall global composite score and eight clinical subscales including: shifting, emotional, monitoring, inhibition, plan/organize, and organization/material.…”

Mismatch negativity and P3a in drug-naive adults with attention-deficit hyperactivity disorder

“…Items are rated as 1 (never), 2 (sometimes), and 3 (often). The BRIEF in Chinese has been used in epidemiological (Tsai, Chen, & Gau, 2019) and clinical (Goto et al 2017) research.…”