Sleep and stereotypy in children with autism: effectiveness of function-based behavioral treatment

Analysis of brain functional connectivity in children with autism spectrum disorder and sleep disorders: a fNIRS observational study

Introduction

Autism spectrum disorder (ASD) is often associated with sleep disorders, although the neurophysiological reasons behind these issues are poorly understood. In this cross-sectional study, functional near-infrared spectroscopy (fNIRS) was used to compare differences in brain functional connectivity (FC) in children with ASD and sleep disorders and those with ASD that was not complicated by sleep disorders.

Methods

A total of 88 children (4-9 years old, either sex) were included in the study. The children were divided into three groups: those with ASD and sleep disorders (ASD with sleep disorder group; n = 29), those with ASD and no sleep disorders (ASD without sleep disorder group; n = 29), and those with typical development (TD group; n = 30). All children with ASD met the diagnostic criteria for the "Diagnostic and Statistical Manual of Mental Disorders-5 (DSM-V)." The ASD group with sleep disorders showed typical sleep disorder symptoms, with a total score of ≥41 on the Children's Sleep Habits Questionnaire. All children were assessed using the Autism Diagnostic Observation Scale, the Vineland Adaptive Behavior Scale, third edition, the Social Response Scale, and the Children's Sleep Habits Questionnaire. The fNIRS detection was conducted in a quiet environment.

Results

The fNIRS data revealed that under resting-state conditions, the supramarginal gyrus [SMG:Cohen's f = 0.981(L)f = 0.467(R)], inferior frontal gyrus [IFG:Cohen's f = 0.415(L)f = 0.443(R)], frontopolar area [FPA:Cohen's f = 0.620(L)f = 0.634(R)], dorsolateral prefrontal cortex [DLPFC:Cohen's f = 0.593(L)f = 0.547(R)], and visual association cortex [VAC:Cohen's f = 0.500(L)f = 0.524(R)] of the brain showed lower activity in ASD with sleep disorder group compared with the TD group (p < 0.01). The FC values for the SMG [Cohen's f = 0.981(L)f = 0.467(R)], RFPA (Cohen's f = 0.634), DLPFC [Cohen's f = 0.593(L)f = 0.547(R)], and VAC [Cohen's f = 0.500(L)f = 0.524(R)] were also lower in the ASD with sleep disorder group than the ASD without sleep disorder group (p < 0.01). The FC values of the LIFG showed a mild negative correlation with social affect scale scores (r = -0.34, p = 0.07), while FC values in the RDLPFC were negatively correlated with restricted repetitive behavior (RRB) (r = -0.41, p = 0.03). The Children's Sleep Habits Questionnaire scores showed a positive correlation with FC values in the RIFG region of the brain (r = 0.37, p = 0.05).

Conclusion

The results indicate that FC in the resting brain of children with ASD complicated with sleep disorders was weaker than that of children with ASD without sleep disorders. Both groups showed weaker FC compared with the TD group. However, due to the limited sample size, the generalizability of the findings requires further validation in multicenter, large-sample studies.

Possible Sleep Bruxism in Children and Adolescents with Autism Spectrum Disorder: Association with Parental Stress and Sleep Disorders

PURPOSE

To investigate associations between possible sleep bruxism (PSB) and sleep disorders in children/adolescents with autism spectrum disorder (ASD) as well as parental perceived stress.

METHODS

A cross-sectional study was conducted involving children/adolescents with ASD five to 19 years of age and their parents at a public institution that supports disabled people in the city of João Pessoa in Northeast Brazil. The parents answered a form addressing sociodemographic characteristics and medical data (schooling, income, age, sex, support level and use of medications). PSB was recorded based on the reports of the parents. Parental stress was investigated using the Perceived Stress Scale (PSS-10). Sleep disorders in the children/adolescents were investigated using the Sleep Disturbance Scale for Children (SDSC). Data analysis involved descriptive, bivariate and Poisson regression analyses (95% CI; p < 0.05).

RESULTS

Fifty children/adolescents with ASD participated in the study. Boys accounted for 84.0% of the sample (n = 42). PSB in the children/adolescents was reported by 28.0% of the parents. The mean parental PSS-10 score was 20.3 ± 8.5 and the mean SDSC score was 48.8 ± 17.5. The adjusted Poisson model revealed associations between PSB and higher levels of perceived stress of the parents (PR = 1.05; 95% CI: 1.01-1.09), sleep breathing disorders (PR = 1.14; 95%CI: 1.05-1.24) and sleep-wake transition disorders (PR = 1.16; 95%CI: 1.00-1.36; p = 0.044).

CONCLUSION

The occurrence of PSB in children and adolescents with ASD was associated with higher levels of parental stress, higher scores for sleep breathing disorders and sleep-wake transition disorders.

High definition transcranial direct current stimulation of the Cz improves social dysfunction in children with autism spectrum disorder: A randomized, sham, controlled study

The purpose of this study was to determine the effect of the Cz of high-definition 5-channel tDCS (HD-tDCS) on social function in 4-12 years-old children with autism spectrum disorder (ASD). This study was a randomized, double-blind, pseudo-controlled trial in which 45 ASD children were recruited and divided into three groups with sex, age, and rehabilitation treatment as control variables. Each group of 15 children with ASD was randomly administered active HD-tDCS with the Cz as the central anode, active HD-tDCS with the left dorsolateral prefrontal cortex (F3) as the central anode, and sham HD-tDCS with the Cz as the central anode with 14 daily sessions in 3 weeks. The Social Responsiveness Scale Chinese Version (SRS-Chinese Version) was compared 1 week after stimulation with values recorded 1 week prior to stimulation. At the end of treatment, both the anodal Cz and anodal left DLFPC tDCS decreased the measures of SRS-Chinese Version. The total score of SRS-Chinese Version decreased by 13.08%, social cognition decreased by 18.33%, and social communication decreased by 10.79%, which were significantly improved over the Cz central anode active stimulation group, especially in children with young age, and middle and low function. There was no significant change in the total score and subscale score of SRS-Chinese Version over the Cz central anode sham stimulation group. In the F3 central anode active stimulation group, the total score of SRS-Chinese Version decreased by 13%, autistic behavior decreased by 19.39%, and social communication decreased by 14.39%, which were all significantly improved. However, there was no significant difference in effect between the Cz and left DLPFC stimulation conditions. HD-tDCS of the Cz central anode may be an effective treatment for social dysfunction in children with ASD.

Genetic and neural mechanisms of sleep disorders in children with autism spectrum disorder: a review

Background

The incidence of sleep disorders in children with autism spectrum disorder (ASD) is very high. Sleep disorders can exacerbate the development of ASD and impose a heavy burden on families and society. The pathological mechanism of sleep disorders in autism is complex, but gene mutations and neural abnormalities may be involved.

Methods

In this review, we examined literature addressing the genetic and neural mechanisms of sleep disorders in children with ASD. The databases PubMed and Scopus were searched for eligible studies published between 2013 and 2023.

Results

Prolonged awakenings of children with ASD may be caused by the following processes. Mutations in the MECP2, VGAT and SLC6A1 genes can decrease GABA inhibition on neurons in the locus coeruleus, leading to hyperactivity of noradrenergic neurons and prolonged awakenings in children with ASD. Mutations in the HRH1, HRH2, and HRH3 genes heighten the expression of histamine receptors in the posterior hypothalamus, potentially intensifying histamine's ability to promote arousal. Mutations in the KCNQ3 and PCDH10 genes cause atypical modulation of amygdala impact on orexinergic neurons, potentially causing hyperexcitability of the hypothalamic orexin system. Mutations in the AHI1, ARHGEF10, UBE3A, and SLC6A3 genes affect dopamine synthesis, catabolism, and reuptake processes, which can elevate dopamine concentrations in the midbrain. Secondly, non-rapid eye movement sleep disorder is closely related to the lack of butyric acid, iron deficiency and dysfunction of the thalamic reticular nucleus induced by PTCHD1 gene alterations. Thirdly, mutations in the HTR2A, SLC6A4, MAOA, MAOB, TPH2, VMATs, SHANK3, and CADPS2 genes induce structural and functional abnormalities of the dorsal raphe nucleus (DRN) and amygdala, which may disturb REM sleep. In addition, the decrease in melatonin levels caused by ASMT, MTNR1A, and MTNR1B gene mutations, along with functional abnormalities of basal forebrain cholinergic neurons, may lead to abnormal sleep-wake rhythm transitions.

Conclusion

Our review revealed that the functional and structural abnormalities of sleep-wake related neural circuits induced by gene mutations are strongly correlated with sleep disorders in children with ASD. Exploring the neural mechanisms of sleep disorders and the underlying genetic pathology in children with ASD is significant for further studies of therapy.

The trilateral interactions between mammalian target of rapamycin (mTOR) signaling, the circadian clock, and psychiatric disorders: an emerging model

Circadian (~24 h) rhythms in physiology and behavior are evolutionarily conserved and found in almost all living organisms. The rhythms are endogenously driven by daily oscillatory activities of so-called "clock genes/proteins", which are widely distributed throughout the mammalian brain. Mammalian (mechanistic) target of rapamycin (mTOR) signaling is a fundamental intracellular signal transduction cascade that controls important neuronal processes including neurodevelopment, synaptic plasticity, metabolism, and aging. Dysregulation of the mTOR pathway is associated with psychiatric disorders including autism spectrum disorders (ASD) and mood disorders (MD), in which patients often exhibit disrupted daily physiological rhythms and abnormal circadian gene expression in the brain. Recent work has found that the activities of mTOR signaling are temporally controlled by the circadian clock and exhibit robust circadian oscillations in multiple systems. In the meantime, mTOR signaling regulates fundamental properties of the central and peripheral circadian clocks, including period length, entrainment, and synchronization. Whereas the underlying mechanisms remain to be fully elucidated, increasing clinical and preclinical evidence support significant crosstalk between mTOR signaling, the circadian clock, and psychiatric disorders. Here, we review recent progress in understanding the trilateral interactions and propose an "interaction triangle" model between mTOR signaling, the circadian clock, and psychiatric disorders (focusing on ASD and MD).

Cognitive, Behavioral, and Sensory Profile of Pallister–Killian Syndrome: A Prospective Study of 22 Individuals

Background: Developmental delay and intellectual disability are two pivotal elements of the phenotype of Pallister–Killian Syndrome (PKS). Our study aims to define the cognitive, adaptive, behavioral, and sensory profile of these patients and to evaluate possible correlations between the different aspects investigated and with the main clinical and demographic variables. Methods: Individuals of any age with genetically confirmed PKS were recruited. Those ≤ 42 months were administered the Bayley Scales of Infant and Toddler Development Third Edition (Bayley-III), and those > 42 months the Vineland Adaptive Behavior Scales—Second Edition (Vineland-II). Stereotyped behaviors (Stereotypy Severity Scale, SSS) and aggressive behaviors (Behavior Problems Inventory—Short Version, BPIs) were assessed in all subjects > 1 year; sensory profile (Child Sensory Profile 2, C-SP2) in all aged 2–18 years. Results: Twenty-two subjects were enrolled (11 F/11 M; age 9 months to 28 years). All subjects ≤ 42 months had psychomotor developmental delay. Of the subjects > 42 months, 15 had low IQ deviation, and 1 in the normal range. Stereotypies were frequent (median SSS-total score 25/68). Lower Vineland-II values corresponded to greater intensity and frequency of stereotypies (p = 0.004 and p = 0.003), and self-injurious behaviors (p = 0.002 and p = 0.002). Patients with severe low vision had greater interference of stereotypies (p = 0.027), and frequency and severity of aggressive behaviors (p = 0.026; p = 0.032). The C-SP2, while not homogeneous across subjects, showed prevalence of low registration and sensory seeking profiles and hypersensitivity to tactile and auditory stimuli. Lower Vineland-II scores correlated with higher Registration scores (p = 0.041), while stereotypies were more frequent and severe in case of high auditory sensitivity (p = 0.019; p = 0.007). Finally, greater sleep impairment correlated with stereotypies and self-injurious behaviors, and lower Vineland-II scores. Conclusions: The present study provides a further step in the investigation of the etiopathogenesis of the syndrome. Furthermore, these aspects could guide rehabilitation therapy through the identification of targeted protocols.