The bidirectional association between sleep problems and autism spectrum disorder: a population-based cohort study

Area of Science:

• Child development
• Neurodevelopmental disorders
• Sleep medicine

Background:

• Sleep difficulties are common in children with autism spectrum disorder (ASD).
• The causal relationship between sleep problems and ASD is not well understood due to a lack of longitudinal studies.
• Clarifying this temporal association is crucial for understanding ASD's developmental trajectory.

Purpose of the Study:

• To determine if sleep problems precede and exacerbate autistic traits and ASD diagnoses.
• To investigate if sleep problems occur as a consequence of ASD.
• To elucidate the temporal dynamics of the relationship between sleep and ASD.

Main Methods:

• Utilized data from the Generation R Study, a large prospective birth cohort (n=5151).
• Collected repeated sleep measures from 1.5 to 9 years of age.
• Assessed autistic traits using the Pervasive Developmental Problems (PDP) score and Social Responsiveness Scale (SRS), with 81 children diagnosed with ASD.

Main Results:

• Early childhood sleep problems were linked to higher SRS scores, but this association did not hold when accounting for baseline PDP scores.
• Higher SRS scores and ASD diagnoses predicted increased sleep problems at later ages, even after adjusting for early sleep issues.
• A trajectory of worsening sleep problems was associated with an ASD diagnosis.

Conclusions:

• Sleep problems and ASD are not bidirectionally linked; sleep issues do not precede or worsen autistic behavior.
• Sleep problems co-occur with autistic traits in early childhood and tend to increase over time in children with ASD, unlike typically developing children.
• These findings suggest sleep problems are an integral component of the autism spectrum disorder construct.