Sleep Mediates the Association Between Emotion Dysregulation and Repetitive Behaviors in Autistic Children

Emotion dysregulation (ED) is recognized as a transdiagnostic risk factor for psychopathology, influencing both autistic and non-autistic populations. Among autistic children, ED has been linked to the occurrence of restricted and repetitive behaviors (RRBs), a core feature of autism spectrum disorder. However, the mechanisms underlying this relationship remain poorly understood. Given that sleep problems are common in autistic children and play a critical role in shaping emotional and behavioral functioning, this study investigates whether sleep difficulties mediate the link between ED and RRBs, offering new insights into their interconnected dynamics in ASD.

The study included 90 autistic children aged 6-12 years (71 males and 19 females). A mediation model was tested, examining ED as the predictor, sleep disturbances as the mediator, and children's RRBs-total RRBs, low-order RRBs, and high-order RRBs-as criteria.

The results revealed a significant indirect effect of ED on children's RRBs via sleep disturbances. Specifically, we identified the role of sleep as a mediator for the relationship between ED and low-order RRBs.

Our finding indicates that difficulties in emotion regulation may amplify sleep disturbances, thus triggering or intensifying RRBs, especially those related with repetitive physical movements, such as motor stereotypes and self-harming repetitive actions. The mediation effect of sleep highlights its potential as a target for interventions to reduce both ED and RRBs in autistic children. Improving sleep quality could address emotional and behavioral symptoms simultaneously, underscoring the need for integrated therapeutic approaches that prioritize sleep in comprehensive autism care.