Sleep problems in autism spectrum disorders: prevalence, nature, & possible biopsychosocial aetiologies.
ABSTRACT As considerably more people are diagnosed with an autism spectrum disorder (ASD), interest in the associated behaviours, including sleep problems has increased. This has resulted in a subsequent increase in the research related to the sleep problems occurring in people with an ASD. This article summarizes and evaluates the current literature related to a) the higher prevalence of a sleep problem compared to typically developing children, b) the specific types of sleep problems for people with an ASD, and c) the possible aetiology of sleep problems in the ASDs within a biopsychosocial framework. It is concluded that recent studies confirm that the majority of this population are likely to experience sleep difficulties, with settling issues in children with an ASD the most commonly reported. However, exploration of the types of sleep difficulties and associated aetiological factors in the ASDs is still in its infancy.
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ABSTRACT: Background: The literature has been highly informative regarding actigraphy and its validity in pediatric research. However, minimal literature exists on how to perform actigraphy, especially in special populations including children with autism spectrum disorders. Objectives: We determined whether providing comprehensive actigraphy training to parents increased the nights of actigraphy data that could be scored in a clinical trial. The training program covers the proper use of actigraphs in the home and recording on the sleep diary. Methods: We compared two studies in children with autism spectrum disorders, both containing a behavioral sleep intervention in which actigraphy was the major outcome variable. The single site trial (Study 1) consisted of 20 children ages 4-10 years (80% male) whose parents received sleep education in a group setting at Vanderbilt University. The multisite trial (Study 2) consisted of 80 children ages 3-10 years (80% male) whose parents received either group or individual education at Vanderbilt University, University of Colorado Denver, or University of Toronto. Study 1 provided a basic level of actigraphy training while Study 2 provided more comprehensive actigraphy training using a variety of educational tools. Educational tools developed and implemented in Study 2 included presentation of actigraphy data to the parents, use of a quiz testing the parents' knowledge of actigraphy procedures, and a practice session in which the parents recorded data on sleep diaries and demonstrated proper use of an actigraphy watch, including the event marker. Feedback was given to the parents on their use of the watch. One week of actigraphy was performed at baseline and post-intervention in both trials, and scored by a single analyst. The proportion of scorable nights of actigraphy was compared between Study 1 and Study 2 using Mann-Whitney U test. Results: Scorable nights of actigraphy were higher in Study 2 than Study 1 at baseline (P = 0.04) and post-intervention (p = 0.002). The mean proportion of scorable nights (standard deviation) in the baseline and post-intervention phases was 0.91 (0.20) and 0.90 (0.17) for Study 2 compared to 0.73 (0.35) and 0.58 (0.39) for Study 1. One-way analysis of variance showed no difference in scorable nights between the three research sites in Study 2 [F= 0.93; p = 0.4]. Conclusions: Comprehensive training resulted in an increase in scorable nights of actigraphy. Our results support the use of educational tools to enhance actigraphy data collection in research studies involving children with autism spectrum disorders.2014 International Meeting for Autism Research; 05/2014
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ABSTRACT: Children with autism spectrum disorders (ASD), including autistic disorder, frequently suffer from comorbid sleep problems. An altered melatonin rhythm is considered to underlie the impairment in sleep onset and maintenance in ASD. We report three cases with autistic disorder in whom nocturnal symptoms improved with ramelteon, a selective melatonin receptor agonist. Insomnia and behavior, assessed using the Clinical Global Impression-Improvement Scale, improved in two cases with 2 mg ramelteon and in the third case with 8 mg ramelteon. Our findings demonstrate that ramelteon is effective not only for insomnia, but for behavioral problems as well, in patients with autistic disorder.05/2014; 2014:561071. DOI:10.1155/2014/561071
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ABSTRACT: The present study explores behavioral and sleep outcomes in preschool-age siblings of children with autism spectrum disorders (ASD). This study focuses on behavior problems that are common in children with ASD, such as emotional reactivity, anxiety, inattention, aggression, and sleep problems. Infant siblings were recruited from families with at least one older child with ASD (high-risk group, n = 104) or families with no history of ASD (low-risk group, n = 76). As part of a longitudinal prospective study, children completed the Mullen Scales of Early Learning and the Autism Diagnostic Observation Schedule, and parents completed the Child Behavior Checklist (CBCL) and the Social Communication Questionnaire at 36 months of age. This study focuses on developmental concerns outside of ASD; therefore, only siblings who did not develop an ASD were included in analyses. Negative binomial regression analyses revealed that children in the high-risk group were more likely to have elevated behavior problems on the CBCL Anxious/Depressed and Aggression subscales. To explore sleep problems as a correlate of these behavior problems, a second series of models was specified. For both groups of children, sleep problems were associated with elevated behavior problems in each of the areas assessed (reactivity, anxiety, somatic complaints, withdrawal, attention, and aggression). These findings support close monitoring of children with a family history of ASD for both behavioral and sleep issues. Autism Res 2013, ●●: ●●-●●. © 2013 International Society for Autism Research, Wiley Periodicals, Inc.Autism Research 06/2013; 6(3). DOI:10.1002/aur.1278 · 4.53 Impact Factor