Evaluation of the Relationship of Sleep Disturbances to Severity and Common Behaviors in Autism Spectrum Disorder.

ABSTRACT

Background: Autism spectrum disorder (ASD) is one of the most puzzling disorders of childhood. Recent research of comorbidities that accompany ASD and are commonly attributed to the diagnosis, indicate that they may contribute to the severity of behavioral symptoms of the disorder.Disturbed sleep in all children can decrease cognition, decrease focus, increase performance problems, and alter mood and behavior. Children with ASD experience an increased sensitivity to disturbed sleep that may increase the severity of the disorder. Disturbed sleep patterns, such as increased sleep latency, nighttime waking and early arousal, have been identified in up to 80% of children with ASD. This study explored the relationship of disturbed sleep and the severity of the core ASD symptoms. Methods: Actigraphy and an accompanying sleep diary captured disturbed sleep patterns in 24 children, ages 6-12, with ASD. Participants wore a GT3X actigraphy monitor for 7 nights to collect data on patterns of disturbed sleep. Parents completed a sleep diary and the Autism Spectrum Rating Scale (ASRS) questionnaire.A descriptive analysis was used to report the characteristics of nighttime sleep and sleep efficiency as well as sleep disturbances. Pearson's r determined the relationships between the number of sleep disturbances and the severity of ASD behavioral scores and diagnostic severity (determined by the ASRS). Results: Of the 24 study participants, almost 92% had one or more sleep disturbances. A positive correlation was present between the number of sleep disturbances and the severity of delays in social and communication symptoms. A moderate effect size was found between the number of sleep disturbances and unusual behaviors in ASD suggests a possible, unanticipated, inverse relationship. Conclusions: Exploring the relationship of disturbed sleep to behavior and symptom severity in children with ASD can provide an understanding of how poor sleep influences ASD symptoms. This study identified distinct differences in ASD symptom severity between and within individual participants and found unique, and unexpected, symptom patterns. This finding supports the need, in research and treatment, to identify comorbidities and symptoms that contribute to individual behavioral profiles and phenotypes of the disorder.