Beth Malow

Vanderbilt University | Vander Bilt · Department of Neurology

Sleep disorders are very common across neurodevelopmental disorders and place a large burden on affected children, adolescents, and their families. Sleep disturbances seem to involve a complex interplay of genetic, neurobiological, and medical/environmental factors in neurodevelopmental disorders. In this review, we discuss animal models of sleep p...

Two proposed public policies, ending seasonal clock change with a transition to permanent Standard Time and moving middle school and high school start times later, are population-based initiatives to improve sleep health. Daylight Saving Time and early school start times are associated with reduced sleep duration and increased circadian misalignmen...

Autistic adults, as compared to non-autistic adults, have increased rates of nearly all medical and psychiatric conditions. Many of these conditions begin in childhood, although few longitudinal studies have been conducted to examine prevalence rates of these conditions from adolescence into early adulthood. In this study, we analyze the longitudin...

Children with autism spectrum disorder (ASD) report high rates of sleep problems. In 2012, the Autism Treatment Network/ Autism Intervention Research Network on Physical Health (ATN/AIR-P) Sleep Committee developed a pathway to address these concerns. Since its publication, ATN/AIR-P clinicians and parents have identified night wakings as a refract...

Background Although polygenic scores (PGS) for autism have been related to various psychiatric and medical conditions, most studies to date have been conducted in research ascertained populations. We aimed to identify the psychiatric and physical conditions associated with autism PGS in a health care setting. Methods We computed PGS for 12,383 unr...

Dear Editor, We appreciate the interest of Martin-Olalla and Mira in response to the Sleep Research Society (SRS) position statement supporting the abolition of the seasonal clock change and the adoption of permanent standard time (pST). Their criticism of two elements of the current practice of the seasonal clock change, namely the use of a 1-h in...

Background: Autistic adults have high rates of co-occurring health conditions, suicide, and premature mortality, yet often experience health care barriers and poor health outcomes. A better understanding of the health care needs and experiences of autistic adults is essential for improving the health care system and patient experience. Methods:...

Background Numerous genes are implicated in autism spectrum disorder (ASD). ASD encompasses a wide-range and severity of symptoms and co-occurring conditions; however, the details of how genetic variation contributes to phenotypic differences are unclear. This creates a challenge for translating genetic evidence into clinically useful knowledge. Sl...

The electronic health record (EHR) provides valuable data for understanding physical and mental health conditions in autism. We developed an approach to identify charts of autistic young adults, retrieved from our institution's de‐identified EHR database. Clinical notes within two cohorts were identified. Cohort 1 charts had at least one Internatio...

Purpose of Review To review the short- and long-term effects of daylight saving time (DST) on neurological and psychological disorders as well as neurocognitive and neuropsychological processes that affect societal functioning. Recent Findings Circadian disruption causes sleep duration and quality to worsen after the spring transition to DST and t...

Daylight saving time (DST) refers to the practice of advancing clock time by one hour each spring, with a return (setting back) to standard time (ST) each fall. Numerous sleep and circadian societies other than the Sleep Research Society have published statements in support of permanent ST, and permanent ST has also received support from multiple m...

Background Sleep problems are common in children with autism spectrum disorder (autism). There is sparse research to date to examine whether insomnia in people with autism is related to autism genetics or insomnia genetics. Moreover, there is a lack of research examining whether circadian-rhythm related genes share potential pathways with autism....

This research evaluated the feasibility of actigraphy to measure sleep and physical activity in children (ages 2-8 years) with autism spectrum disorder (ASD). We also explored associations between sleep and physical activity. Validated screening measures established eligibility. Questionnaires, diaries, and 5 days and 5 nights of actigraphy monitor...

Published self-determination programs do not adequately address the needs of autistic adults. We designed a multi-component self-determination program, grounded in the neurodiversity paradigm, to help autistic adults achieve goals to improve their quality of life. The first phase involved 5 days of psychoeducation, practice, and social events; the...

Objective/background Sleep problems are common in people on the autism spectrum. This study reviews one detailed approach to querying the electronic health record (EHR) in a large tertiary care center. Patients/methods We developed methods for identifying people on the autism spectrum and defined their sleep problems using the key words, “sleep” o...

Background Adults on the autism spectrum are at high risk for co-occurring conditions and poor health outcomes, yet they often experience significant unmet healthcare needs. A better understanding of potential gaps and barriers is essential for improving the healthcare system. This mixed-methods study was conducted to better understand the healthca...

Objective Epilepsy prevalence is higher in children with Autism Spectrum Disorder (ASD) and is a contributor to morbidity and mortality. Little is known about the recurrence rate after the first nonfebrile seizure in this population, specifically in regard to seizure type and electroencephalogram (EEG) findings. Methods We reviewed pediatric medic...

Background Benzodiazepine hypnotics and the related nonbenzodiazepine hypnotics (z-drugs) are among the most frequently prescribed medications for older adults. Both can depress respiration, which could have fatal cardiorespiratory effects, particularly among patients with concurrent opioid use. Trazodone, frequently prescribed in low doses for ins...

Background Adequate sleep is important for proper neurodevelopment and positive health outcomes. Sleep disturbances are more prevalent in children with genetically determined neurodevelopmental syndromes compared to typically developing counterparts. We characterize sleep behavior in Rett (RTT), Angelman (AS) and Prader-Willi (PWS) syndromes in ord...

Introduction The use of online platforms for pediatric healthcare research is timely, given the current pandemic. These platforms facilitate trial efficiency integration including electronic consent, randomization, collection of patient/family survey data, delivery of an intervention, and basic data analysis. Methods We created an online digital p...

Background In autism, poor sleep begins in early childhood, varies in severity and is associated with behavioural difficulties. We examined relationships between sleep and behaviour in young children with autism and no, mild/typical or severe/atypical sleep problems to determine behavioural profiles that may differentiate sleep problem severity. M...

Background Sleep problems are common in children with autism spectrum disorder (ASD). Sleep education, effective in improving sleep in ASD, may be difficult to access. We determined if community-based pediatric therapists could successfully deliver sleep educational interventions to caregivers of children with ASD. Methods A seven-week feasibility...

Background: Adequate sleep is important for proper neurodevelopment and positive health outcomes. Sleep disturbances are more prevalent in children with genetically determined neurodevelopmental syndromes compared to typically developing counterparts. We characterize sleep behavior in Rett (RTT), Angelman (AS) and Prader-Willi (PWS) syndromes in or...

Background Although screening for sleep problems in children with ASD is recommended, primary care providers generally ask parents a single, high-level screening question about their child’s sleep. Can this capture whether a child has severe sleep problems? Method Parents of children with ASD ages 3–17 years recruited from a validated and verified...

The Per family of genes functions as a primary circadian rhythm maintenance in the brain. Mutations in PER2 are associated with familial advanced sleep‐phase syndrome 1 (FASPS1), and recently suggested in delayed sleep phase syndrome and idiopathic hypersomnia. The detection of PER2 variants in individuals with autism spectrum disorder (ASD) and wi...

There are multiple disorders of neurodevelopment that present with co-occurring sleep disturbances. Many of these neurodevelopmental disorders (NDD) include sleep disturbances in their diagnostic criteria. Neurobiological, genetic, and environmental factors overlap to cause different sleep disorders in individuals with NDD. Caregivers often present...

Human genetic studies have implicated more than a hundred genes in Autism Spectrum Disorder (ASD). Understanding how variation in implicated genes influence expression of co-occurring conditions and drug response can inform more effective, personalized approaches for treatment of individuals with ASD. Rapidly translating this information into the c...

Objective To assess the feasibility and acceptability of an educational sleep-promoting intervention (Sleep Coach Jr.) for school-aged children (ages 5–9) with type 1 diabetes (T1D) and their parents. Methods Parents and children (N = 39 dyads, mean child age = 8 years, 64% girls,) were randomized to either the Sleep Coach Jr. intervention, consis...

Compared to typically developing children, sleep disturbances are exceedingly prevalent in children with neurodevelopmental disorders. The diagnostic criteria for many neurodevelopmental disorders includes sleep problems. Sleep disturbance in this population is often multifactorial and caused by the interplay of genetic, neurobiological and environ...

Objective: Despite their complex health care needs, transition-aged youth diagnosed with autism spectrum disorder (TAY-ASD) receive few transition services and describe difficulty finding adult providers. A 12-week primary care provider (PCP) training was developed to improve the delivery of transition services for TAY-ASD [Extension for Community...

Background: Obstructive sleep apnea (OSA) is defined by frequent episodes of reduced or complete cessation of airflow during sleep and is linked to negative health outcomes. Understanding the genetic factors influencing expression of OSA may lead to new treatment strategies. Electronic health records (EHRs) can be leveraged to both validate previo...

Importance One major advantage of developing large, federally funded networks for clinical research in neurology is the ability to have a trial-ready network that can efficiently conduct scientifically rigorous projects to improve the health of people with neurologic disorders. Observations National Institute of Neurological Disorders and Stroke N...

Objective Actigraphy is a non-intrusive method of recording rest/activity cycles and a surrogate for sleep/wake activity. Standard actigraphy analysis is limited in ascribing discrete movement events to wake status during sleep. We applied a novel algorithm to overnight actigraphy data recorded simultaneously with video polysomnography-electroencep...

Background: Teens with type 1 diabetes (T1D) experience increased sleep disturbances, which have been linked to problems with adherence and glycemic control. As such, sleep represents a novel target to improve outcomes in teens. Objective: To evaluate the feasibility, acceptability and preliminary efficacy of a sleep-promoting intervention in te...

Objective: A recent 3-month double-blind placebo-controlled study demonstrated efficacy and safety of child-appropriate prolonged-release melatonin (PedPRM) for insomnia in children with autism spectrum disorder (ASD). Here, we report on the long-term effects of PedPRM treatment on sleep, growth, body mass index, and pubertal development. Method:...

Study objectives: We examined the performance of a simple algorithm to accurately distinguish cases of diagnosed obstructive sleep apnea (OSA) and noncases using the electronic health record (EHR) across six health systems in the United States. Methods: Retrospective analysis of EHR data was performed. The algorithm defined cases as individuals...

Daylight saving time (DST) begins on the second Sunday in March and ends on the first Sunday in November. During this period, clocks in most parts of the United States are set 1 hour ahead of standard time. First introduced in the United States in 1918 to mimic policies already being used in several European countries during World War I, DST was un...

Transition-age youth and young adults with autism spectrum disorder have complex healthcare needs, yet the current healthcare system is not equipped to adequately meet the needs of this growing population. Primary care providers lack training and confidence in caring for youth and young adults with autism spectrum disorder. The current study develo...

This study examined rates of and contributing factors to self-determination among young adults with autism spectrum disorder. Caregivers of young adults with autism spectrum disorder, 16–25 years, from five Autism Treatment Network sites completed surveys about their young adults’ transition experiences including the American Institutes for Researc...

Obstructive sleep apnea (OSA) is defined by frequent episodes of reduced or complete cessation of airflow during sleep and is linked to negative health outcomes. Understanding the genetic factors influencing expression of OSA may lead to new treatment strategies. Electronic health records can be leveraged to both validate previously reported OSA-as...

A randomized, 13-weeks, placebo-controlled double-blind study in 125 subjects aged 2–17.5 years with Autism Spectrum Disorder or Smith-Magenis syndrome and insomnia demonstrated efficacy and safety of easily-swallowed prolonged-release melatonin mini-tablets (PedPRM; 2–5 mg) in improving sleep duration and onset. Treatment effects on child behavior...

Background: Insomnia and low iron stores are common in children with autism spectrum disorders, and low iron stores have been associated with sleep disturbance. Methods: We performed a randomized placebo-controlled trial of oral ferrous sulfate to treat insomnia in children with autism spectrum disorders and low normal ferritin levels. Twenty pa...

The chronicity of sleep disturbance and its relation to co-occurring symptoms in children with autism spectrum disorder (ASD) are not well understood. The current study examined longitudinal relations among sleep and co-occurring symptoms in a large well-characterized sample of 437 children with ASD assessed at baseline and follow-up (M = 3.8 years...

Introduction Sleep problems, especially insomnia, are highly prevalent in adults with autism. Those not in employment, education, or training (NEET) may be at particular risk for insomnia given their limited structured activities. Additionally, adults with autism face stigma. Stigma and stereotyped threat (signals impacting physical and psychologic...

Introduction Obstructive sleep apnea (OSA) contributes to a myriad of behavioral, neuropsychological, and cognitive problems. Children with neurodevelopmental disorders (NDD), already vulnerable to these problems, are even more at risk if they have coexisting OSA. In those children with OSA refractory to surgical treatments, improving positive airw...

Introduction Sleep education to address insomnia in children with autism spectrum disorder (ASD) and their parents can be effective but often inaccessible. In conjunction with a quasi-experimental pilot study, we assessed parent reaction to and satisfaction with a multi-week sleep education program delivered by community providers trained and suppo...

Introduction Treatment of obstructive sleep apnea (OSA) improves patient symptoms and decreases the risk for various comorbid conditions. However, OSA diagnosis is complicated by multiple criteria for scoring of obstructive hypopneas. Increasingly, more stringent Medicare criteria (AHI4%) are being adopted, potentially decreasing the number of pati...

Introduction Insomnia is common in children with autism spectrum disorder (ASD). Due to time constraints, pediatricians may impart only limited information to parents on sleep education. Building the capacity of community therapists to provide sleep education within the context of their ongoing care is practical and time-effective for families. We...

Objectif Une étude randomisée et contrôlée (ERC) récente a démontré l’efficacité à 3 mois d’une nouvelle forme pédiatrique de mélatonine à libération prolongée (PedPRM ; 2/5 mg) vs. Placébo chez l’enfant et adolescent avec troubles du spectre de l’autisme (TSA) atteint d’insomnie chronique. L’objectif de notre étude était d’évaluer l’efficacité et...

Background Sleep difficulties in children with autism spectrum disorders (ASD) have been well-established. Aims To develop a model to predict sleep problems in children with ASD. Methods and procedures A sample of children in the Autism Speaks-Autism Treatment Network (ATN) registry without parent-reported sleep problems at baseline and with slee...

Autism spectrum disorders (ASD) are neurodevelopmental conditions that are influenced by genetic factors and encompass a wide-range and severity of symptoms. The details of how genetic variation contributes to variable symptomatology are unclear, creating a major challenge for translating vast amounts of data into clinically-useful information. To...

Purpose: The purpose of this study is to identify barriers, facilitators, and consequences of obtaining sufficient sleep in adolescents with type 1 diabetes. Methods: Semistructured interviews were conducted with 25 adolescents (52% female, mean age = 15.6 years) and 25 caregivers. Interviews were transcribed and coded using Atlas.ti. A thematic...

Behavioral sleep education has shown promise in young children with autism spectrum disorder (ASD), but has received much less study in adolescents with ASD. A pilot study of a brief sleep intervention was delivered to 18 adolescents, ages 11–18 years, and their parents. This sleep education, delivered in a two-session format, was associated with i...

Objective: A recent double-blind randomized placebo-controlled study demonstrated 3-month efficacy and safety of a novel pediatric-appropriate prolonged-release melatonin (PedPRM) for insomnia in children and adolescents with autism spectrum disorder (ASD) and neurogenetic disorders (NGD) with/without attention-deficit/hyperactivity disorder comor...

Objectives: Constipation and insomnia are not consistently identified and treated in children with autism spectrum disorder (ASD) despite their high prevalence and deleterious impact in this population. To standardize care, a constipation practice pathway and an insomnia practice pathway were previously developed by Autism Treatment Network clinic...

Sleep problems are common in children with autism spectrum disorder (ASD) and adversely impact daytime functioning. Although no questionnaires have been developed to assess sleep in children with ASD, the 33-item Children’s Sleep Habits Questionnaire (CSHQ) is widely used in this population. We examined the factor structure of the CSHQ in 2872 chil...

Introduction A simple algorithm to accurately distinguish cases and controls using the electronic health record (EHR) is crucial for large-scale analyses leveraging available clinical biorepositories. Combining this algorithm with de-identified genomic data linked to EHRs offers the opportunity to leverage existing resources to decipher heterogenei...

Introduction Sleep disturbances in pediatric patients have been discussed heavily in published literature, but limited attention has been given specifically to obstructive sleep apnea (OSA) in those with autism spectrum disorder (ASD). Our objective is to investigate the association between OSA and ASD in this patient population. Methods Children...

Background/aims: Pseudohypoparathyroidism (PHP) is a rare, genetic disorder. Patients with PHP may have increased prevalence of obstructive sleep apnea (OSA) but this has not been prospectively studied. Methods: We enrolled children aged 6-18 years with PHP and matched controls. Evaluation included physical examination, medical history, and poly...

Objective To describe adolescents’ sleep on school and weekend nights using multiple methods, and to examine the links between sleep variability, quality and duration with diabetes indicators. Methods Adolescents with type 1 diabetes (N=65, mean age=15.0, 52.3% female, mean HbA1c=8.9% or 74 mmol/mol) wore an actigraph and kept daily diaries record...

Study objective: Excessive daytime sleepiness, the hallmark of narcolepsy, predisposes patients to serious performance decrements in multiple areas of function. Psychosocial dysfunction has been demonstrated in adults and children with narcolepsy. Several factors could influence psychosocial functioning in children. The objective of this study was...

A large body of literature supports the need to delay high school starting times to improve student health and well-being by allowing students an opportunity to get sufficient and appropriately timed sleep. However, a dearth of uniform and standardized tools has hampered efforts to collect data on adolescent sleep and related health behaviors that...

Autism spectrum disorder (ASD) is a neurodevelopmental disorder that has increased in prevalence over the last several decades. A significant proportion of children with ASD have comorbid sleep disorders. The interplay between ASD and sleep is multifactorial and bidirectional. There is evidence for physiological differences in ASD that contribute t...

Introduction Chronic lymphocytic inflammation with pontine perivascular enhancement responsive to steroids (CLIPPERS) is an inflammatory central nervous system (CNS) disorder with particular involvement of the pons. Diagnostic criteria include a range of clinical symptoms related to the underlying brainstem pathology, visible with magnetic resonanc...

We studied 28 adolescents/young adults with autism spectrum disorders (ASD) and 13 age/sex matched individuals of typical development (TD). Structured sleep histories, validated questionnaires, actigraphy (4 weeks), and salivary cortisol and melatonin (4 days each) were collected. Compared to those with TD, adolescents/young adults with ASD had lon...

Introduction An increased incidence of narcolepsy in children and adolescents has been reported after the 2009 H1N1 pandemic in Europe and China. In addition, some studies have indicated different clinical characteristics in recent cases. However, no data have been reported from the United States. Methods The Pediatric Working Group of the Sleep R...

Introduction Behavioral sleep education for children with sleep disturbance is currently provided largely within academic medical centers, which often include long waiting lists for this service. Our study aims to determine the feasibility of providing sleep education training to parents of children with autism spectrum disorders in diverse communi...

Introduction Insomnia is common in individuals with autism spectrum disorder (ASD) and there is substantial overlap among genetic mechanisms regulating sleep and influencing ASD risk. As studies have observed that sufficient sleep is essential for normal neurodevelopment, the need for effective treatments of insomnia in individuals with ASD is prof...

Evidence-based clinical practice guidelines and policy statements from the AAP! Clinical practice guidelines have long provided physicians with an evidence-based decision-making tool for managing common pediatric conditions. Policies issued and endorsed by the American Academy of Pediatrics (AAP) represent the AAP position on child health care issu...

Sleep disturbance, particularly insomnia, is common in children with autism spectrum disorders (ASD). Furthermore, disturbed sleep affects core symptoms and other related comorbidities. Understanding the causes and consequences of sleep disturbances in children with ASD is an important step toward mitigating these symptoms. To better understand the...

We are performing whole-genome sequencing of families with autism spectrum disorder (ASD) to build a resource (MSSNG) for subcategorizing the phenotypes and underlying genetic factors involved. Here we report sequencing of 5,205 samples from families with ASD, accompanied by clinical information, creating a database accessible on a cloud platform a...

Research evidence increasingly points to the large impact of sleep disturbances on public health. Many aspects of sleep are heritable and genes influencing traits such as timing, EEG characteristics, sleep duration, and response to sleep loss have been identified. Notably, large-scale genome-wide analyses have implicated numerous genes with small e...

Behavioral sleep education for children with sleep disturbance is currently provided largely within academic medical centers, which often include long waiting lists for this service. Our study aims to determine the feasibility of providing sleep education training to parents of children with ASD in a community setting with a diverse patient populat...

We examined the association of two types of restricted and repetitive behaviors, repetitive sensory motor (RSM) and insistence on sameness (IS), with sleep problems in children with autism spectrum disorder (ASD). Participants included 532 children (aged 2–17) who participated in the Autism Speaks Autism Treatment Network research registry. Confirm...

Members of the American Academy of Sleep Medicine developed consensus recommendations for the amount of sleep needed to promote optimal health in children and adolescents using a modified RAND Appropriateness Method. After review of 864 published articles, the following sleep durations are recommended: Infants 4 months to 12 months should sleep 12...

Vanderbilt Kennedy Center Science Day Presentation (September, 2016)

Sleep disturbance affects 50-80% of children with autism spectrum disorder (ASD). Behavioral sleep education for children with sleep disturbance is currently provided largely within academic medical centers, which often include long waiting lists for this service. Our study aims to determine the feasibility of providing sleep education training to...

This multi-method study, including actigraphy, sleep diaries, and questionnaires, indicated significant sleep disturbances in young children with type 1 diabetes (age 3-5) and insufficient sleep duration in children and their parents. Results provide initial support for sleep as a potential target to improve both diabetes outcomes and parental dist...

PurposeAutonomic dysfunction has been reported in autism spectrum disorders (ASD). Less is known about autonomic function during sleep in ASD. The objective of this study is to provide insight into the autonomic cardiovascular control during different sleep stages in ASD. We hypothesized that patients with ASD have lower vagal and higher sympatheti...