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Sleep Problems, Circadian Rhythms, and Their Relation to Behavioral Difficulties in Children and Adolescents with

Elena Martinez-Cayuelas1,2, Teresa Gavela-Pérez3, María Rodrigo-Moreno3

  • 1Department of Pediatrics, Instituto de Investigaciones Sanitarias-Fundación Jiménez Díaz, Universidad Autónoma de Madrid, Madrid, Spain. elena.martinezc@quironsalud.es.

Journal of Autism and Developmental Disorders
|March 4, 2023
PubMed

Insights

Children with autism spectrum disorder (ASD) experiencing sleep problems often show increased behavioral issues. Early melatonin release may offer a protective effect against some of these symptoms.

Area of Science:

  • Neuroscience
  • Developmental Psychology
  • Sleep Medicine

Background:

  • Sleep disturbances are common in children with autism spectrum disorder (ASD).
  • Understanding the relationship between sleep patterns, circadian rhythms, and behavioral symptoms in ASD is crucial.
  • Objective and subjective measures are needed to comprehensively assess sleep and behavior in this population.

Purpose of the Study:

  • To compare sleep patterns and associated behaviors in children with ASD versus typically developing children.
  • To investigate the relationship between objective circadian rhythm markers, like dim light melatonin onset (DLMO), and behavioral outcomes in ASD.
  • To identify specific sleep issues in ASD and their impact on the child and family.

Main Methods:

  • Cross-sectional study comparing 45 children with ASD and 24 typically developing controls, matched for age, sex, and BMI.
  • Objective sleep and circadian data collected via ambulatory circadian monitoring and saliva samples for DLMO.
  • Parent-completed questionnaires included the Child Behavior Checklist (CBCL), Repetitive Behavior Scale-Revised (RBS-R), and General Health Questionnaire (GHQ28).

Main Results:

  • Children with ASD who were poor sleepers scored higher on the CBCL and RBS-R.
  • Sleep fragmentation correlated with somatic complaints, self-injury, and greater family impact.
  • Sleep onset difficulties were linked to withdrawal, anxiety, and depression.
  • Advanced DLMO was associated with fewer somatic complaints, less anxiety/depression, and fewer social problems, suggesting a protective role.

Conclusions:

  • Sleep problems in children with ASD are significantly associated with a range of behavioral and emotional difficulties.
  • Sleep fragmentation and onset difficulties represent key areas of concern impacting daily functioning and family life.
  • An advanced DLMO may confer a protective effect against certain behavioral and emotional challenges in children with ASD.

Keywords:
ActigraphyAutism spectrum disorderBehaviorMelatoninQuestionnairesSleep

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