Sleep in adults with Autism Spectrum Disorder: a systematic review and meta-analysis of subjective and objective studies (original) (raw)
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Sleep in children with autism spectrum disorders
Current Treatment Options in Neurology, 2008
The amount of research conducted on sleep in children and adolescents has increased dramatically over the past decade due to the recognition that many children have significant sleep problems leading to daytime dysfunction. Approximately one third of typically developing children have sleep difficulties at some point, and a similar percentage of adolescents have impaired or insufficient sleep leading to daytime impairments. Sleep problems are known to occur at even greater rates in children with special needs, such as those with developmental disabilities, psychiatric conditions, and medical illnesses. The recognition that interventions can improve sleep and may result in better daytime functioning has fueled a growing interest in more fully characterizing the sleep problems in children with special needs. This article presents a discussion of the sleep problems experienced by children with one particular group of developmental disorders-the autism spectrum disorders. Neurobiologic: abnormalities in GABA or melatonin Behavioral: inadequate sleep hygiene, sleep-onset association type, limit-setting type Coexisting neurologic disorder (eg, epilepsy) Coexisting medical disorder (eg, gastrointestinal reflux disease) Coexisting psychiatric disorder (eg, anxiety) Medications (eg, corticosteroids, bronchodilators) Obstructive sleep apnea Parasomnias (non-REM arousal disorders, REM sleep behavior disorder, rhythmic movement disorder) Periodic limb movements of sleep GABA-aminobutyric acid; REM-rapid eye movement.
Nature and Science of Sleep
Over forty percent of autistic children experience poor sleep quality, and social interaction difficulties are a core characteristic of autism. However, the relationship between sleep quality and social functioning and behavior remains poorly understood. This systematic review examined the evidence concerning the impact of sleep quality on the social functioning and behavior problems in autistic children and adolescents. It also identified key related factors and evaluated how this issue has been researched to date. Seven key journals were hand-searched and five databases were systematically searched, using keywords. Titles and abstracts of 4123 items were screened against eligibility criteria by two researchers. Relevant studies were retained if they were peer-reviewed empirical papers, published in English between 2000 and 2021. Then, the full text of 97 papers was screened and if they met the eligibility criteria, their reference lists were hand-searched. Forty-six studies were included in the final review. Data were systematically extracted and two authors critically appraised the strengths and weaknesses of studies using Critical Appraisal Skills Programme tools. Key themes were identified, because a meta-analysis was not possible due to the studies' heterogeneity. The review identified that sleep quality and social functioning are associated with one another and there is a small amount of evidence that a bidirectional causal relationship may exist. Evidence suggests that several nights of suboptimal sleep duration and a lack of deep continuous sleep negatively impact externalizing and internalizing behavior. Sleep quality is also reduced by anxiety and sensory sensitivity. However, longitudinal studies with larger samples are needed to establish causality. Future research needs to examine confounding factors and to develop consensus regarding best-practice processes for the objective measurement of sleep with autistic children. Additional research also needs to further examine the consequences of poor sleep quality on internalizing behavior, and the impact of socio-cultural practices.
Sleep in Autism Spectrum Disorders
Current Sleep Medicine Reports, 2015
Autism spectrum disorders (ASD) are common neurodevelopmental conditions, affecting 1 in 68 children. Sleep disturbance, particularly insomnia, is very common in children diagnosed with ASD, with evidence supporting overlapping neurobiological and genetic underpinnings. Disturbed sleep exacerbates core and related ASD symptoms and has a substantial negative impact on the entire family. Treatment of sleep disturbance holds promise for ameliorating many of the challenging behavioral symptoms that children with ASD and their families face. Behavioral and pharmacological studies indicate promising approaches to treating sleep disturbances in this population. Awareness of treatment options is particularly important as parents and clinicians may believe that sleep disturbance is part of autism and refractory to therapy. In addition, autism symptoms refractory to treatment with conventional psychiatric medications may improve when sleep is addressed. Additional evidence-based studies are needed, including those that address the underlying biology of this condition.
THERAPEUTIC APPROACHES TO SLEEP DISORDERS IN CHILDREN WITH AUTISM SPECTRUM DISORDER: AN INTEGRATIVE REVIEW (Atena Editora), 2023
Sleep disturbances are a significant issue that affects the quality of life of children with autism spectrum disorders (ASD). These sleep difficulties can have a negative impact on the cognitive, behavioral and emotional development of these children. In this article, we performed an integrative review to compile and analyze treatment approaches for sleep disorders in children with ASD. We used a systematic search strategy in scientific databases, including PubMed and Scopus, using the terms "sleep disorders", "child", "autistic spectrum disorder" and "therapy". We selected studies that addressed therapeutic interventions to improve sleep quality in children with ASD. The selected studies point to several treatment approaches, including pharmacological interventions, behavioral therapies and multidisciplinary approaches. Pharmacological treatments included the use of melatonin as an adjunctive treatment in children with ASD and severe insomnia. Behavioral therapies included routine-based interventions, cognitive-behavioral therapy, and behavior modification therapy. Additionally, some research has explored the relationship between co-sleeping and sleep disturbances in children with ASD. The integrative review suggests that there are several treatment approaches for sleep disorders in children with ASD, with varying results in terms of effectiveness. Pharmacological approaches, such as the use of melatonin, have been investigated, as well as behavioral interventions aimed at improving the sleep routine and the sleeping environment. Multidisciplinary interventions have also shown promising results. However, it is important to emphasize the need for more research to assess the long-term efficacy and safety of these approaches.
Sleep problems in children with autism spectrum problems: a longitudinal population-based study
2011
This study examined the prevalence and chronicity of sleep problems in children who manifest problems believed to be typical of Autism Spectrum Disorders (ASD). Using data from a longitudinal total population study, symptoms of ASD, insomnia and potential explanatory factors were assessed at ages 7-9 and 11-13. Children were included in a group defined as having Autism Spectrum Problems (ASP) if they scored above a strict threshold on the Autism Spectrum Screening Questionnaire (ASSQ). Twenty-eight (0.8%) of 3700 children fulfilled the selected criteria for ASP at both waves, and the prevalence of chronic insomnia was more than ten times
Research in Autism Spectrum Disorders, 2018
Background: An estimated 40-80% of children with ASD have sleep problems, including bedtime behavior problems, difficulty falling asleep and staying asleep, decreased sleep time, and daytime sleepiness. This study aimed to examine the relationship between sleep problems and characteristics of children with ASD in a large, nationwide sample. Methods: This secondary analysis of children 4-to 18-years explored 11 sleep problems using the Simons Simplex Collection Sleep Interview (SSCSI). The SSCSI includes nighttime problems, daytime problems, and sleep duration problems subscales. Chi square, Kruskal-Wallis and Mann-Whitney U tests were performed to detect differences between age groups, sexes, and sleep problem groups (none/minimal, mild, moderate/severe). Odds ratios for variables associated with sleep problems were assessed using baseline and adjacent category logistic regression. Twoway interaction effects were included in regression models, and stratified analyses were performed for age groups. Results: Approximately 41% of children were categorized as having mild or moderate/severe sleep problems. The most commonly reported SSCSI items were in the nighttime problems subscale; difficulty falling asleep was the most frequently reported item. Mean sleep duration was approximately 9 h, although more than one-quarter slept less than the hours recommended for their age. Increased odds of sleep problems were most frequently associated with gastrointestinal distress (GID) and non-verbal IQ (NVIQ), followed by male sex and age. ADOS severity score is likely not associated with sleep problems in this sample. Conclusions: This study advances our understanding of sleep in ASD by showing that GID, NVIQ, sex, and age increased the odds of sleep problems in children with ASD. These results reinforce that healthcare professionals should screen for sleep problems in children with ASD and suggest future lines of inquiry. 1. Autism spectrum disorder Autism spectrum disorder (ASD) is a pervasive neurodevelopmental condition characterized by persistent difficulties in communication and social interaction, and restricted, repetitive behaviors, interests and activities. ASD is referred to as a "spectrum" because impairments may range from mild to severe, and may also include intellectual disability (American Psychiatric Association, 2013). The Autism and Developmental Disabilities Monitoring Network estimated that, in 2012, ASD affected 1 in 68 American children, and had a male-to-female ratio of 4.5:1 (Centers for Disease Control and Prevention, 2016).
A Sleep Intervention for Children with Autism Spectrum Disorder: A Pilot Study
The Open Journal of Occupational Therapy, 2017
Background: Parents of children who have Autism Spectrum Disorders (ASD) commonly report sleep problems, which typically exacerbate daytime behavior problems. This pilot study sought to identify the short-term effects on sleep, behavior challenges, attention, and quality of life of children with ASD following use of the iLs Dreampad ™ pillow, which delivers bone conducted music and environmental sounds. Aims were to demonstrate acceptability and feasibility, identify measures sensitive to change, and describe individual characteristics responsive to change. Method: Parent report questionnaires assessed sleep behavior, attention, autism-related behaviors, and quality of life from 15 participants before and during intervention. A Sleep Diary documented average sleep duration and average time to fall asleep during the preintervention phase and the last 2 weeks of the treatment phase. Results: Procedures were acceptable and feasible for families. All measures were sensitive to change. Children with ASD demonstrated significant change in sleep duration and time needed to fall asleep from pretest to intervention. Improvements were noted in autism-related behaviors, attention, and quality of life. Parent satisfaction was high. Conclusions: The iLs Dreampad ™ pillow may be one alternative intervention to pharmacological interventions for children with ASD who have sleep problems. Further study is warranted. Comments Conflict of Interest We confirm that this manuscript has been read and approved by all named authors and that there are no other persons who satisfied the criteria for authorship but are not listed. Partial research support was provided by Integrated Listening Systems to the first author who was not involved in recruitment, administration of the intervention or data collection for this study. All authors attest no conflict of interest.