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The bidirectional association between sleep problems and autism spectrum disorder: a population-based cohort study
Maria E Verhoeff1,2, Laura M E Blanken1,2, Desana Kocevska1,2
11The Generation R Study Group, Erasmus Medical Center, Rotterdam, the Netherlands.
Insights
Sleep problems in children do not worsen autism spectrum disorder (ASD) traits. Instead, sleep difficulties co-occur with autistic traits and increase over time in children with ASD.
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.
Background:
Sleep difficulties are prevalent in children with autism spectrum disorder (ASD). The temporal nature of the association between sleep problems and ASD is unclear because longitudinal studies are lacking. Our aim is to clarify whether sleep problems precede and worsen autistic traits and ASD or occur as a consequence of the disorder.
Methods:
Repeated sleep measures were available at 1.5, 3, 6, and 9 years of age in 5151 children participating in the Generation R Study, a large prospective birth cohort in the Netherlands. Autistic traits were determined with the Pervasive Developmental Problems score (PDP) of the Child Behavior Checklist (CBCL) at 1.5 and 3 years and the Social Responsiveness Scale (SRS) at 6 years. This cohort included 81 children diagnosed with ASD.
Results:
Sleep problems in early childhood were prospectively associated with a higher SRS score, but not when correcting for baseline PDP score. By contrast, a higher SRS score and an ASD diagnosis were associated with more sleep problems at later ages, even when adjusting for baseline sleep problems. Likewise, a trajectory of increasing sleep problems was associated with ASD.
Conclusions:
Sleep problems and ASD are not bidirectionally associated. Sleep problems do not precede and worsen autistic behavior but rather co-occur with autistic traits in early childhood. Over time, children with ASD have an increase in sleep problems, whereas typically developing children have a decrease in sleep problems. Our findings suggest that sleep problems are part of the construct ASD.
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