Sleep and Cognition in Children with Fetal Alcohol Spectrum Disorders (FASD) and Children with Autism Spectrum Disorders (ASD)

Abstract

Children with Fetal Alcohol Spectrum Disorders (FASD) and Autism Spectrum Disorders (ASD) experience significantly higher rates of sleep disturbances than their typically developing peers. However, little is known about the association between sleep and the cognitive phenotype in these clinical populations. Structural damage affecting cortical and subcortical connectivity occurs as a result of prenatal alcohol exposure in children with FASD, whilst it is believed an abundance of short-range connectivity explains the phenotypic manifestations of childhood ASD. These underlying neural structural and connectivity differences manifest as cognitive patterns, with some shared and some unique characteristics between FASD and ASD. This is the first study to examine sleep and its association with cognition in individuals with FASD, and to compare sleep in individuals with FASD and ASD. We assessed children aged 6–12 years with a diagnosis of FASD (n = 29), ASD (n = 21), and Typically Developing (TD) children (n = 46) using actigraphy (CamNTech Actiwatch 8), digit span tests of working memory (Weschler Intelligence Scale), tests of nonverbal mental age (MA; Ravens Standard Progressive Matrices), receptive vocabulary (British Picture Vocabulary Scale), and a choice reaction time (CRT) task. Children with FASD and ASD presented with significantly shorter total sleep duration, lower sleep efficiency, and more nocturnal wakings than their TD peers. Sleep was significantly associated with scores on the cognitive tests in all three groups. Our findings support the growing body of work asserting that sleep is significant to cognitive functioning in these neurodevelopmental conditions; however, more research is needed to determine cause and effect.

Nightmares in Children with Foetal Alcohol Spectrum Disorders, Autism Spectrum Disorders, and Their Typically Developing Peers

“…Perhaps due to the small number of participants who reported nightmares such data were not found, or this may be due to the ceiling effect of high nightmare frequency and high parasomnia scores. Within previous analyses of the larger dataset [ 43 , 44 ], parasomnias were significantly associated with executive functioning and behavioural outcomes in the TD and FASD group, but less so in the ASD group. Night wakings however were associated with somatic complaints and attention in the TD group, which is comparable to the present analysis.…”

“…Around 80% of children with FASD are in the care of adults other than the biological parent, which contributes to attachment, attentional, and other pervasive neurodevelopmental problems [ 41 ]. Sleep problems are prevalent in children with FASD and are thought to have a bidirectional association with neuropsychological outcomes, such as sensory sensitivity [ 42 ], anxiety [ 43 ], and cognition [ 44 ]. Caregiver reports reveal that children with FASD present with significantly more sleep problems than TD children [ 45 ].…”

Nightmares in Children with FASD, ASD and Their Typically Developing Peers

“…It is reasonable to assume a relationship between anxiety and nightmare frequency given the involvement of pre-sleep emotions on the occurrence of nightmares, as well as the role of emotional continuity and threat simulation [18,23,59]. Anxiety is consistently associated with sleep problems both in children with ASD [28] and FASD [44]. In addition, nightmares are conceptualised as anxiety based phenomenon [61].…”

“…Around 80% of children with FASD are in the care of adults other than the biological parent, which contributes to attachment and attentional and other pervasive neurodevelopmental problems [41]. Sleep problems are prevalent in children with FASD and are thought to have a bidirectional association with neuropsychological outcomes such as sensory sensitivity [42], anxiety [43] and cognition [44]. Caregiver reports reveal that children with FASD present with significantly more sleep problems than TD children [45].…”

How Sleep Affects Daytime Functioning: The Latest Insights from Different Patient and Age Groups

“…Kölbel et al show that different sleep disorders are prevalent in children and young adults suffering from sickle cell anemia (4–23 years of age), causing daytime sleepiness [ 13 ]. By comparing groups of 6-to-12-year olds with, and without, autism or fetal alcohol syndrome, Mughal et al show that in all participants, cognitive performance was related to sleep quality, and that particularly those children with autism or fetal alcohol syndrome suffered from multiple sleep problems [ 14 ].…”