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Martinez-Cayuelas E, Moreno-Vinués B, Pérez-Sebastián I, Gavela-Pérez T, Del Rio-Camacho G, Garcés C, Soriano-Guillén L. Sleep problems and circadian rhythm functioning in autistic children, autism with co-occurring attention deficit hyperactivity disorder, and typically developing children: A comparative study. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2024:13623613241254594. [PMID: 38813763 DOI: 10.1177/13623613241254594] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2024]
Abstract
LAY ABSTRACT Sleep problems are common in autism spectrum disorder (ASD) and different factors can contribute to its occurrence in this population. Misalignment of the biological clock (our circadian system) has been described as one possible explanation. While there is a body of research on sleep problems, relatively less is known about circadian functioning and the specific population of autistic children with co-occurring attention deficit hyperactivity disorder (ADHD). Using an ambulatory circadian monitoring (ACM) system, which resembles a common watch, we gathered sleep parameters and the different rhythms obtained from measuring motor activity, light exposure and distal temperature in 87 autistic children and adolescents, 27 of whom were diagnosed with co-occurring ADHD, and 30 neurotypical children and adolescents as a comparison group. Autistic children and, especially, those with co-occurring ADHD showed greater motor activity during sleep which would be worth studying in future projects which could better define this restless sleep. Of note, we observed an atypical pattern of wrist temperature, with higher values in neurotypical children, followed by autistic children and, ultimately, those with co-occurring ADHD. Temperature is one of the most valuable factors evaluated here as it is closely connected to sleep-wakefulness and the hormone melatonin. Its special pattern during day and nighttime would support the hypothesis of an atypical secretion of melatonin in autistic individuals which would also link with the higher presence of sleep problems in this neurodevelopmental condition.
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Weissenkampen JD, Ghorai A, Fasolino M, Gehringer B, Rajan M, Dow HC, Sebro R, Rader DJ, Keenan BT, Almasy L, Brodkin ES, Bucan M. Sleep and Activity Patterns in Autism Spectrum Disorder. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2024:2024.05.02.592263. [PMID: 38766266 PMCID: PMC11100584 DOI: 10.1101/2024.05.02.592263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2024]
Abstract
Background Autism spectrum disorder (ASD) is a highly heritable and heterogeneous neurodevelopmental disorder characterized by impaired social interactions, repetitive behaviors, and a wide range of comorbidities. Between 44-83% of autistic individuals report sleep disturbances, which may share an underlying neurodevelopmental basis with ASD. Methods We recruited 382 ASD individuals and 223 of their family members to obtain quantitative ASD-related traits and wearable device-based accelerometer data spanning three consecutive weeks. An unbiased approach identifying traits associated with ASD was achieved by applying the elastic net machine learning algorithm with five-fold cross-validation on 6,878 days of data. The relationship between sleep and physical activity traits was examined through linear mixed-effects regressions using each night of data. Results This analysis yielded 59 out of 242 actimetry measures associated with ASD status in the training set, which were validated in a test set (AUC: 0.777). For several of these traits (e.g. total light physical activity), the day-to-day variability, in addition to the mean, was associated with ASD. Individuals with ASD were found to have a stronger correlation between physical activity and sleep, where less physical activity decreased their sleep more significantly than that of their non-ASD relatives. Conclusions The average duration of sleep/physical activity and the variation in the average duration of sleep/physical activity strongly predict ASD status. Physical activity measures were correlated with sleep quality, traits, and regularity, with ASD individuals having stronger correlations. Interventional studies are warranted to investigate whether improvements in both sleep and increased physical activity may improve the core symptoms of ASD.
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Martinez-Cayuelas E, Gavela-Pérez T, Rodrigo-Moreno M, Losada-Del Pozo R, Moreno-Vinues B, Garces C, Soriano-Guillén L. Sleep Problems, Circadian Rhythms, and Their Relation to Behavioral Difficulties in Children and Adolescents with Autism Spectrum Disorder. J Autism Dev Disord 2024; 54:1712-1726. [PMID: 36869970 PMCID: PMC9984759 DOI: 10.1007/s10803-023-05934-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/13/2023] [Indexed: 03/05/2023]
Abstract
This was an exploratory cross-sectional study comparing 45 children with ASD to 24 typically developing drug-naïve controls, group-matched on age, sex, and body mass index. Objective data was obtained using the following: an ambulatory circadian monitoring device; saliva samples to determine dim light melatonin onset (DLMO): and three parent-completed measures: the Child Behavior Checklist (CBCL); the Repetitive Behavior Scale-Revised (RBS-R); and the General Health Questionnaire (GHQ28). The CBCL and RBS-R scales showed the highest scores amongst poor sleepers with ASD. Sleep fragmentation was associated with somatic complaints and self-injury, leading to a higher impact on family life. Sleep onset difficulties were associated with withdrawal, anxiety, and depression. Those with phase advanced DLMO had lower scores for "somatic complaints"; "anxious/depressed" state; and "social problems", suggesting that this phenomenon has a protective role.
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Affiliation(s)
- Elena Martinez-Cayuelas
- Department of Pediatrics, Instituto de Investigaciones Sanitarias-Fundación Jiménez Díaz, Universidad Autónoma de Madrid, Madrid, Spain
- Hospital Universitario Fundación Jiménez Díaz, Avenida Reyes Católicos n2, 28040 Madrid, Spain
| | - Teresa Gavela-Pérez
- Department of Pediatrics, Instituto de Investigaciones Sanitarias-Fundación Jiménez Díaz, Universidad Autónoma de Madrid, Madrid, Spain
| | - María Rodrigo-Moreno
- Department of Pediatrics, Instituto de Investigaciones Sanitarias-Fundación Jiménez Díaz, Universidad Autónoma de Madrid, Madrid, Spain
| | - Rebeca Losada-Del Pozo
- Department of Pediatrics, Instituto de Investigaciones Sanitarias-Fundación Jiménez Díaz, Universidad Autónoma de Madrid, Madrid, Spain
| | - Beatriz Moreno-Vinues
- Department of Pediatrics, Instituto de Investigaciones Sanitarias-Fundación Jiménez Díaz, Universidad Autónoma de Madrid, Madrid, Spain
| | - Carmen Garces
- Lipid Laboratory, Instituto de Investigaciones Sanitarias-Fundación Jiménez Díaz, Universidad Autónoma de Madrid, Madrid, Spain
| | - Leandro Soriano-Guillén
- Department of Pediatrics, Instituto de Investigaciones Sanitarias-Fundación Jiménez Díaz, Universidad Autónoma de Madrid, Madrid, Spain
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Inkelis SM, Soja J, Mattson SN, Chambers CD, Bhattacharjee R, Thomas JD. Characteristics of sleep in children with heavy prenatal alcohol exposure. ALCOHOL, CLINICAL & EXPERIMENTAL RESEARCH 2024; 48:928-943. [PMID: 38523054 PMCID: PMC11073897 DOI: 10.1111/acer.15303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/05/2023] [Revised: 02/16/2024] [Accepted: 03/03/2024] [Indexed: 03/26/2024]
Abstract
BACKGROUND Sleep plays an important role in neurodevelopment. However, the effects of prenatal alcohol exposure on sleep quality have been understudied, despite reports of sleep disturbance in infants prenatally exposed to alcohol and elevated levels of sleep problems reported by caregivers of children with fetal alcohol spectrum disorders. The current study characterizes sleep in children with prenatal alcohol exposure using both objective (actigraphy) and subjective (questionnaires, sleep diaries) methods. METHODS Participants aged 6-10 years, with and without prenatal alcohol exposure, were included in the study (alcohol-exposed [AE]: n = 35; control [CON]: n = 39). Objective sleep was measured via 24-h actigraphy for 2 weeks. Parents completed sleep diaries and sleep questionnaires (Children's Sleep Habits Questionnaire, Pediatric Sleep Questionnaire). Multivariate analysis of variance was used to characterize the sleep profile (objective, subjective) and examine group differences. RESULTS There were no group differences on actigraphy metrics averaged across 2 weeks. However, the AE group showed significantly greater intraindividual variability on most actigraphy measures, particularly total sleep time, percent sleep, wake after sleep onset, and number of wake bouts. Parents reported significantly more sleep problems in the AE group than in the CON group, primarily driven by night wakings, parasomnias (e.g., sleepwalking), snoring, and daytime sleepiness. These effects were more severe in children >8.5 years of age. CONCLUSIONS Despite similar 2-week average sleep outcomes, children with prenatal alcohol exposure showed greater intraindividual sleep variability and parents reported more sleep problems related to sleep behavior and snoring. These difficulties with sleep may be related to other cognitive and behavioral outcomes. Importantly, sleep is a modifiable behavior, and interventions that focus on variability in sleep, particularly in sleep duration, can impact the quality of life in children with prenatal alcohol exposure and their families.
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Affiliation(s)
- Sarah M Inkelis
- Department of Neurology, University of California San Francisco, San Francisco, California, USA
| | - Jacqueline Soja
- Department of Psychology, Center for Behavioral Teratology, San Diego State University, San Diego, California, USA
| | - Sarah N Mattson
- Department of Psychology, Center for Behavioral Teratology, San Diego State University, San Diego, California, USA
| | - Christina D Chambers
- Department of Pediatrics, University of California San Diego, San Diego, California, USA
| | - Rakesh Bhattacharjee
- Department of Pediatrics, University of California San Diego, San Diego, California, USA
| | - Jennifer D Thomas
- Department of Psychology, Center for Behavioral Teratology, San Diego State University, San Diego, California, USA
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Wang X, Ling Z, Luo T, Zhou Q, Zhao G, Li B, Xia K, Li J. Severity of Autism Spectrum Disorder Symptoms Associated with de novo Variants and Pregnancy-Induced Hypertension. J Autism Dev Disord 2024; 54:749-764. [PMID: 36445517 DOI: 10.1007/s10803-022-05824-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/10/2022] [Indexed: 11/30/2022]
Abstract
Genetic factors, particularly, de novo variants (DNV), and an environment factor, exposure to pregnancy-induced hypertension (PIH), were reported to be associated with risk of autism spectrum disorder (ASD); however, how they jointly affect the severity of ASD symptom is unclear. We assessed the severity of core ASD symptoms affected by functional de novo variants or PIH. We selected phenotype data from Simon's Simplex Collection database, used genotypes from previous studies, and created linear regression models. We found that ASD patients carrying DNV with PIH exposure had increased adaptive and cognitive ability, decreased social problems, and enhanced repetitive behaviors; however, there was no difference in patients without DNV between those with or without PIH exposure. In addition, the DNV genes carried by patients exposed to PIH were enriched in ubiquitin-dependent proteolytic processes, highlighting how candidate genes in pathways and environments interact. The results indicate the joint contribution of DNV and PIH to ASD.
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Affiliation(s)
- Xiaomeng Wang
- Department of Geriatrics, Xiangya Hospital, Central South University, Changsha, 41008, Hunan, China
- Centre for Medical Genetics, Hunan Key Laboratory of Medical Genetics, School of Life Sciences, Central South University, Changsha, 41008, Hunan, China
| | - Zhengbao Ling
- Centre for Medical Genetics, Hunan Key Laboratory of Medical Genetics, School of Life Sciences, Central South University, Changsha, 41008, Hunan, China
| | - Tengfei Luo
- Centre for Medical Genetics, Hunan Key Laboratory of Medical Genetics, School of Life Sciences, Central South University, Changsha, 41008, Hunan, China
| | - Qiao Zhou
- Department of Geriatrics, Xiangya Hospital, Central South University, Changsha, 41008, Hunan, China
- Bioinformatics Center, National Clinical Research Centre for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Guihu Zhao
- Department of Geriatrics, Xiangya Hospital, Central South University, Changsha, 41008, Hunan, China
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, Hunan, China
- Bioinformatics Center, National Clinical Research Centre for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Bin Li
- Department of Geriatrics, Xiangya Hospital, Central South University, Changsha, 41008, Hunan, China
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, Hunan, China
- Bioinformatics Center, National Clinical Research Centre for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Kun Xia
- Centre for Medical Genetics, Hunan Key Laboratory of Medical Genetics, School of Life Sciences, Central South University, Changsha, 41008, Hunan, China.
- University of South China, Hengyang, Hunan, China.
| | - Jinchen Li
- Department of Geriatrics, Xiangya Hospital, Central South University, Changsha, 41008, Hunan, China.
- Centre for Medical Genetics, Hunan Key Laboratory of Medical Genetics, School of Life Sciences, Central South University, Changsha, 41008, Hunan, China.
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, Hunan, China.
- Bioinformatics Center, National Clinical Research Centre for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan, China.
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Hai Y, Kou W, Gu Z, Zhang C, Zou Q, Wang F, Yao H, Wei P. Obstructive sleep apnea affects the psychological and behavioural development of children-a case-control study. J Sleep Res 2024; 33:e13924. [PMID: 37194421 DOI: 10.1111/jsr.13924] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Revised: 04/20/2023] [Accepted: 04/24/2023] [Indexed: 05/18/2023]
Abstract
This study aims to investigate the effects of obstructive sleep apnea on paediatric psychological and behavioural abnormalities. A total of 1086 paediatric patients with obstructive sleep apnea and 728 sample snoring controls were enrolled in the study. Patients with obstructive sleep apnea underwent bilateral tonsillectomy plus adenoidectomy or adenoidectomy alone. Repeated Autism Behaviour Checklist, Spence Children's Anxiety Scale, and Children's Depression Inventory were performed to assess the autism symptoms, anxiety level and depressive symptoms before and after surgery. The score of Autism Behaviour Checklist in preschool children with obstructive sleep apnea was higher than that in control. In school children with obstructive sleep apnea, the score of Spence Children's Anxiety Scale was also higher. School children with obstructive sleep apnea with depressive symptoms were significantly higher than that in control. The scores of Autism Behaviour Checklist, Spence Children's Anxiety Scale, and Children's Depression Inventory in the obstructive sleep apnea group after surgery were significantly lower than that before surgery. Our study showed that the score of Spence Children's Anxiety Scale and Children's Depression Inventory had a close correlation with the illness course and hypoxia duration. The Spence Children's Anxiety Scale and Children's Depression Inventory scores are also closely associated with the Autism Behaviour Checklist score. These results suggest that obstructive sleep apnea may have a significant impact on autism symptoms, anxiety levels and depressive symptoms in children. We found that the longer the duration of the obstructive sleep apnea course and hypoxia, the greater the impact on anxiety level and depressive symptoms. The suspected autism symptoms, anxiety level and depressive symptoms in children with obstructive sleep apnea were also significantly correlated. Thus, early detection and timely treatment may often reverse the psychological and behavioural abnormalities caused by obstructive sleep apnea.
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Affiliation(s)
- Yang Hai
- Department of Otolaryngology, Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Translational Medical Research in Cognitive Development and Learning and Memory Disorders, Chongqing, China
- Department of Otolaryngology, Chongqing Youyou Baobei Women and Children's Hospital, Chongqing, China
| | - Wei Kou
- Department of Otolaryngology, Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Translational Medical Research in Cognitive Development and Learning and Memory Disorders, Chongqing, China
| | - Zheng Gu
- Department of Otolaryngology, Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Translational Medical Research in Cognitive Development and Learning and Memory Disorders, Chongqing, China
| | - Cheng Zhang
- Department of Otolaryngology, Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Translational Medical Research in Cognitive Development and Learning and Memory Disorders, Chongqing, China
| | - Qiyuan Zou
- Department of Otolaryngology, Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Translational Medical Research in Cognitive Development and Learning and Memory Disorders, Chongqing, China
| | - Fan Wang
- Department of Otolaryngology, Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Translational Medical Research in Cognitive Development and Learning and Memory Disorders, Chongqing, China
| | - Hongbing Yao
- Department of Otolaryngology, Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Translational Medical Research in Cognitive Development and Learning and Memory Disorders, Chongqing, China
| | - Ping Wei
- Department of Otolaryngology, Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Translational Medical Research in Cognitive Development and Learning and Memory Disorders, Chongqing, China
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Aghakhani S, Carre N, Mostovoy K, Shafer R, Baeza-Hernandez K, Entenberg G, Testerman A, Bunge EL. Qualitative analysis of mental health conversational agents messages about autism spectrum disorder: a call for action. Front Digit Health 2023; 5:1251016. [PMID: 38116099 PMCID: PMC10728644 DOI: 10.3389/fdgth.2023.1251016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Accepted: 11/20/2023] [Indexed: 12/21/2023] Open
Abstract
Background Conversational agents (CA's) have shown promise in increasing accessibility to mental health resources. This study aimed to identify common themes of messages sent to a mental health CA (Wysa) related to ASD by general users and users that identify as having ASD. Methods This study utilized retrospective data. Two thematic analyses were conducted, one focusing on user messages including the keywords (e.g., ASD, autism, Asperger), and the second one with messages from users who self-identified as having ASD. Results For the sample of general users, the most frequent themes were "others having ASD," "ASD diagnosis," and "seeking help." For the users that self-identified as having ASD (n = 277), the most frequent themes were "ASD diagnosis or symptoms," "negative reaction from others," and "positive comments." There were 3,725 emotion words mentioned by users who self-identified as having ASD. The majority had negative valence (80.3%), and few were positive (14.8%) or ambivalent (4.9%). Conclusion Users shared their experiences and emotions surrounding ASD with a mental health CA. Users asked about the ASD diagnosis, sought help, and reported negative reactions from others. CA's have the potential to become a source of support for those interested in ASD and/or identify as having ASD.
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Affiliation(s)
- S. Aghakhani
- Department of Psychology, Palo Alto University, Palo Alto, CA, United States
| | - N. Carre
- Department of Psychology, Palo Alto University, Palo Alto, CA, United States
| | - K. Mostovoy
- Department of Psychology, Palo Alto University, Palo Alto, CA, United States
| | - R. Shafer
- Department of Psychology, Palo Alto University, Palo Alto, CA, United States
| | - K. Baeza-Hernandez
- Department of Psychology, Palo Alto University, Palo Alto, CA, United States
| | | | - A. Testerman
- Department of Psychology, Palo Alto University, Palo Alto, CA, United States
| | - E. L. Bunge
- Department of Psychology, Palo Alto University, Palo Alto, CA, United States
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Raman N, Ringold SM, Jayashankar A, Butera CD, Kilroy E, Harrison L, Cermak SA, Aziz-Zadeh L. Relationships between Affect Recognition, Empathy, Alexithymia, and Co-Occurring Conditions in Autism. Brain Sci 2023; 13:1161. [PMID: 37626517 PMCID: PMC10452701 DOI: 10.3390/brainsci13081161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2023] [Revised: 07/31/2023] [Accepted: 08/01/2023] [Indexed: 08/27/2023] Open
Abstract
Prior studies show differences in empathy and affect-recognition ability between those with autism spectrum disorder (ASD) and typically developing (TD) individuals. Autistic individuals also exhibit increased behavioral, gastrointestinal, and sleep issues. In the current study, we explored the differences in empathy and affect recognition between the ASD and TD groups; and we investigated their associations with conditions co-occurring in ASD. A total of 54 TD and 56 ASD children (8-17 years) were included. As compared to the TD group, the ASD group showed lower scores for affect recognition and perspective taking (PT) and higher scores for personal distress (PD). Interestingly, results from hierarchical linear regressions suggested that disparities in the PD and PT between the groups were primarily attributable to attenuated levels of alexithymia, rather than being mediated by the presence of an autism diagnosis. Differences in affect-recognition ability, however, were mediated by both an autism diagnosis and alexithymia. We also found significant correlations between empathy and affect recognition and measures of related conditions common in ASD. Alexithymia, hence, contributes to difficulties in empathy while both alexithymia and autism are associated with affect-recognition ability in ASD. Additionally, the association between affect recognition and empathic ability with co-occurring conditions in ASD needs to be considered during assessments and interventions.
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Affiliation(s)
- Nandita Raman
- Division of Occupational Science and Occupational Therapy, University of Southern California, Los Angeles, CA 90089, USA; (N.R.); (S.M.R.); (A.J.); (C.D.B.); (E.K.); (L.H.); (S.A.C.)
- Brain and Creativity Institute, Dornsife College of Letters, Arts and Sciences, University of Southern California, Los Angeles, CA 90089, USA
| | - Sofronia M. Ringold
- Division of Occupational Science and Occupational Therapy, University of Southern California, Los Angeles, CA 90089, USA; (N.R.); (S.M.R.); (A.J.); (C.D.B.); (E.K.); (L.H.); (S.A.C.)
- Brain and Creativity Institute, Dornsife College of Letters, Arts and Sciences, University of Southern California, Los Angeles, CA 90089, USA
| | - Aditya Jayashankar
- Division of Occupational Science and Occupational Therapy, University of Southern California, Los Angeles, CA 90089, USA; (N.R.); (S.M.R.); (A.J.); (C.D.B.); (E.K.); (L.H.); (S.A.C.)
- Brain and Creativity Institute, Dornsife College of Letters, Arts and Sciences, University of Southern California, Los Angeles, CA 90089, USA
| | - Christiana D. Butera
- Division of Occupational Science and Occupational Therapy, University of Southern California, Los Angeles, CA 90089, USA; (N.R.); (S.M.R.); (A.J.); (C.D.B.); (E.K.); (L.H.); (S.A.C.)
- Brain and Creativity Institute, Dornsife College of Letters, Arts and Sciences, University of Southern California, Los Angeles, CA 90089, USA
| | - Emily Kilroy
- Division of Occupational Science and Occupational Therapy, University of Southern California, Los Angeles, CA 90089, USA; (N.R.); (S.M.R.); (A.J.); (C.D.B.); (E.K.); (L.H.); (S.A.C.)
- Brain and Creativity Institute, Dornsife College of Letters, Arts and Sciences, University of Southern California, Los Angeles, CA 90089, USA
| | - Laura Harrison
- Division of Occupational Science and Occupational Therapy, University of Southern California, Los Angeles, CA 90089, USA; (N.R.); (S.M.R.); (A.J.); (C.D.B.); (E.K.); (L.H.); (S.A.C.)
- Brain and Creativity Institute, Dornsife College of Letters, Arts and Sciences, University of Southern California, Los Angeles, CA 90089, USA
| | - Sharon A. Cermak
- Division of Occupational Science and Occupational Therapy, University of Southern California, Los Angeles, CA 90089, USA; (N.R.); (S.M.R.); (A.J.); (C.D.B.); (E.K.); (L.H.); (S.A.C.)
- Department of Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles, CA 90033, USA
| | - Lisa Aziz-Zadeh
- Division of Occupational Science and Occupational Therapy, University of Southern California, Los Angeles, CA 90089, USA; (N.R.); (S.M.R.); (A.J.); (C.D.B.); (E.K.); (L.H.); (S.A.C.)
- Brain and Creativity Institute, Dornsife College of Letters, Arts and Sciences, University of Southern California, Los Angeles, CA 90089, USA
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Iwamoto BK, Neece CL, Nair A, Rockwood NJ, Fenning RM, Krantz ML, Van Dyk TR. Exploring Bidirectional Relationships: Child Sleep Duration, Child Behavior Problems, and Parenting Stress in Families of Children with Autism Spectrum Disorder. RESEARCH IN AUTISM SPECTRUM DISORDERS 2023; 106:102197. [PMID: 37484880 PMCID: PMC10358315 DOI: 10.1016/j.rasd.2023.102197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/25/2023]
Abstract
Background Youth with Autism Spectrum Disorder (ASD) are at-risk for sleep and behavior problems, and their parents are at-risk for high stress. Child sleep duration, behavior problems, and parenting stress are interrelated; however, directionality of these associations is unclear and research including youth with ASD is lacking. Using a day-to-day, within-person design, this study explores the directionality of these relationships in families of children with ASD. Method Twenty-six children (ages 3-5, 73.1% male, 65.4% Hispanic/Latino) with ASD and their mothers participated in a 14-day study. Child sleep duration (parent-report and actigraphy), behavior problems, and parenting stress were measured daily. Constructs were decomposed into their within- and between-person components and analyzed with random intercept cross-lagged panel models. Results While between-person relationships were directionally expected in that shorter sleep, more behavior problems, and greater parenting stress were associated, within-person relationships were complicated. Better-than-average child behavior was associated with less next-day parenting stress, yet more parenting stress than average was associated with better next-day child behavior. As expected, longer-than-average child sleep was associated with less next-day parenting stress, while greater child behavior problems were associated with less sleep that night. Conclusions Understanding the directionality of associations between child and parent factors allows for the optimization of interventions to improve the quality of life for families of children with ASD. Interventions that target child behavior and/or help parents manage stress while maintaining effective parenting strategies for sleep and behavior may be useful.
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Affiliation(s)
- Brooke K. Iwamoto
- Department of Psychology, Loma Linda University; 11130 Anderson Street, Loma Linda, CA 92354, United States
| | - Cameron L. Neece
- Department of Psychology, Loma Linda University; 11130 Anderson Street, Loma Linda, CA 92354, United States
| | - Aarti Nair
- Department of Psychology, Loma Linda University; 11130 Anderson Street, Loma Linda, CA 92354, United States
| | - Nicholas J. Rockwood
- Division of Interdisciplinary Studies, Loma Linda University; 11065 Campus Street, Loma Linda, CA 92350, United States
| | - Rachel M. Fenning
- Department of Psychological Science and The Claremont Autism Center, Claremont McKenna College; 850 Columbia Avenue, Claremont, CA 91711, United States
| | - Megan L. Krantz
- Department of Psychology, Loma Linda University; 11130 Anderson Street, Loma Linda, CA 92354, United States
| | - Tori R. Van Dyk
- Department of Psychology, Loma Linda University; 11130 Anderson Street, Loma Linda, CA 92354, United States
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Yamada T, Watanabe T, Sasaki Y. Are sleep disturbances a cause or consequence of autism spectrum disorder? Psychiatry Clin Neurosci 2023; 77:377-385. [PMID: 36949621 PMCID: PMC10871071 DOI: 10.1111/pcn.13550] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Revised: 03/10/2023] [Accepted: 03/17/2023] [Indexed: 03/24/2023]
Abstract
Autism spectrum disorder (ASD) is a neurodevelopmental disorder characterized by core symptoms such as atypical social communication, stereotyped behaviors, and restricted interests. One of the comorbid symptoms of individuals with ASD is sleep disturbance. There are two major hypotheses regarding the neural mechanism underlying ASD, i.e., the excitation/inhibition (E/I) imbalance and the altered neuroplasticity hypotheses. However, the pathology of ASD remains unclear due to inconsistent research results. This paper argues that sleep is a confounding factor, thus, must be considered when examining the pathology of ASD because sleep plays an important role in modulating the E/I balance and neuroplasticity in the human brain. Investigation of the E/I balance and neuroplasticity during sleep might enhance our understanding of the neural mechanisms of ASD. It may also lead to the development of neurobiologically informed interventions to supplement existing psychosocial therapies.
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Affiliation(s)
- Takashi Yamada
- Department of Cognitive, Linguistic, and Psychological Sciences, Brown University, Providence, 02912, USA
| | - Takeo Watanabe
- Department of Cognitive, Linguistic, and Psychological Sciences, Brown University, Providence, 02912, USA
| | - Yuka Sasaki
- Department of Cognitive, Linguistic, and Psychological Sciences, Brown University, Providence, 02912, USA
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11
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Martinez-Cayuelas E, Merino-Andreu M, Losada-Del Pozo R, Gavela-Pérez T, Garcés C, Soriano-Guillén L. Response to Melatonin Treatment in Children With Autism spectrum Disorder and Relationship to Sleep Parameters and Melatonin Levels. J Child Neurol 2023:8830738231173606. [PMID: 37192744 DOI: 10.1177/08830738231173606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/18/2023]
Abstract
Melatonin is one of the most used pharmacologic treatments for sleep problems in autism spectrum disorder, though its relationship with circadian and sleep parameters is still not well stablished. A naturalistic study was conducted in children with autism spectrum disorder, previously drug-naïve, before and after treatment with immediate-release melatonin. Circadian rhythms and sleep parameters were studied using an ambulatory circadian-monitoring device, and saliva samples were collected enabling determination of dim light melatonin onset. Twenty-six children with autism spectrum disorder (age 10.50 ± 2.91) were included. Immediate-release melatonin modified circadian rhythm as indicated by wrist skin temperature, showing an increase at night. A positive correlation was found between time of peak melatonin and sleep efficiency improvement values. Sleep-onset latency and efficiency improved with immediate-release melatonin. Immediate-release melatonin could be an effective treatment to improve sleep onset and restore a typical pattern of wrist temperature, which appears to be lost in autism spectrum disorder.
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Affiliation(s)
- Elena Martinez-Cayuelas
- Department of Pediatrics, Instituto de Investigación Sanitaria- Fundación Jiménez Díaz. Universidad Autónoma de Madrid, Madrid, Spain
| | - Milagros Merino-Andreu
- Neurophisiology, Sleep Unit, Hospital Universitario La Paz, Paseo de la Castellana, 261. 28046, Madrid, Spain
| | - Rebeca Losada-Del Pozo
- Department of Pediatrics, Instituto de Investigación Sanitaria- Fundación Jiménez Díaz. Universidad Autónoma de Madrid, Madrid, Spain
| | - Teresa Gavela-Pérez
- Department of Pediatrics, Instituto de Investigación Sanitaria- Fundación Jiménez Díaz. Universidad Autónoma de Madrid, Madrid, Spain
| | - Carmen Garcés
- Lipid Laboratory, Instituto de Investigación Sanitaria-Fundación Jiménez Díaz. Universidad Autónoma de Madrid, Madrid, Spain
| | - Leandro Soriano-Guillén
- Department of Pediatrics, Instituto de Investigación Sanitaria- Fundación Jiménez Díaz. Universidad Autónoma de Madrid, Madrid, Spain
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12
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Henderson LM, St Clair M, Knowland V, van Rijn E, Walker S, Gaskell MG. Stronger Associations Between Sleep and Mental Health in Adults with Autism: A UK Biobank Study. J Autism Dev Disord 2023; 53:1543-1559. [PMID: 34860312 PMCID: PMC10066094 DOI: 10.1007/s10803-021-05382-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/22/2021] [Indexed: 12/26/2022]
Abstract
This study examined sleep and its cognitive and affective correlates in adults with and without autism spectrum disorder (ASD), utilizing UK Biobank data. There were no group differences in subjective sleep duration [n = 220 ASD; n = 2200 general population (GP)]. Accelerometer measures of sleep duration or nighttime activity did not differ by group, but sleep efficiency was marginally lower in ASD (n = 83 ASD; n = 824 GP). Sleep efficiency was associated with wellbeing and mental health, and pathways between accelerometer sleep measures and wellbeing and mental health were significantly stronger for adults with ASD (who also reported substantially poorer wellbeing and > 5 × likelihood of experiencing mental distress). These findings highlight the need to monitor sleep to maintain good mental health in adult ASD.
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Affiliation(s)
- Lisa M Henderson
- Department of Psychology, University of York, York, YO10 5DD, UK.
| | - M St Clair
- Department of Psychology, University of Bath, Bath, UK
| | - V Knowland
- Department of Speech and Language Sciences, University of Newcastle, Newcastle, Australia
| | - E van Rijn
- Department of Psychology, University of York, York, YO10 5DD, UK
| | - S Walker
- Department of Psychology, University of York, York, YO10 5DD, UK
| | - M G Gaskell
- Department of Psychology, University of York, York, YO10 5DD, UK
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13
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Nic Ghiolla Phadraig A, Smyth S. Sleep mediates the relationship between having an autistic child and poor family functioning. Sleep Med 2023; 101:190-196. [PMID: 36402004 DOI: 10.1016/j.sleep.2022.10.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Revised: 10/13/2022] [Accepted: 10/16/2022] [Indexed: 11/09/2022]
Abstract
Sleep is an important biological necessity, a lack of which can have many cognitive, psychological, social, and physical impacts. Children with autism are known to present with sleep difficulties more frequently than their typically developing peers but despite this, there is relatively little research looking at the impact of sleep on the family. To investigate the effect of sleep on families of autistic and typically developing (TD) children, we conducted a study of sleep disturbances among children, sleep quality of their parents in association with their family function. In our study, 239 parents of autistic children and 227 parents of TD children participated. These parents completed a survey about their child's sleep disturbances, their own sleep quality, and their family function, along with a series of demographic questions. Analyses indicated that autistic children experience more sleep difficulties than TD peers, that children's sleep disturbances are associated with parental sleep quality and that parents of autistic children report decreased sleep quality compared to parents of TD children. Parental sleep quality, and child sleep quality were both found to partially mediate the relationship between autism diagnosis and family function.
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Affiliation(s)
| | - Sinéad Smyth
- School of Psychology, Dublin City University, Ireland.
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14
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Antikainen E, Njoum H, Kudelka J, Branco D, Rehman RZU, Macrae V, Davies K, Hildesheim H, Emmert K, Reilmann R, Janneke van der Woude C, Maetzler W, Ng WF, O’Donnell P, Van Gassen G, Baribaud F, Pandis I, Manyakov NV, van Gils M, Ahmaniemi T, Chatterjee M. Assessing fatigue and sleep in chronic diseases using physiological signals from wearables: A pilot study. Front Physiol 2022; 13:968185. [PMID: 36452041 PMCID: PMC9702812 DOI: 10.3389/fphys.2022.968185] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Accepted: 10/31/2022] [Indexed: 08/07/2023] Open
Abstract
Problems with fatigue and sleep are highly prevalent in patients with chronic diseases and often rated among the most disabling symptoms, impairing their activities of daily living and the health-related quality of life (HRQoL). Currently, they are evaluated primarily via Patient Reported Outcomes (PROs), which can suffer from recall biases and have limited sensitivity to temporal variations. Objective measurements from wearable sensors allow to reliably quantify disease state, changes in the HRQoL, and evaluate therapeutic outcomes. This work investigates the feasibility of capturing continuous physiological signals from an electrocardiography-based wearable device for remote monitoring of fatigue and sleep and quantifies the relationship of objective digital measures to self-reported fatigue and sleep disturbances. 136 individuals were followed for a total of 1,297 recording days in a longitudinal multi-site study conducted in free-living settings and registered with the German Clinical Trial Registry (DRKS00021693). Participants comprised healthy individuals (N = 39) and patients with neurodegenerative disorders (NDD, N = 31) and immune mediated inflammatory diseases (IMID, N = 66). Objective physiological measures correlated with fatigue and sleep PROs, while demonstrating reasonable signal quality. Furthermore, analysis of heart rate recovery estimated during activities of daily living showed significant differences between healthy and patient groups. This work underscores the promise and sensitivity of novel digital measures from multimodal sensor time-series to differentiate chronic patients from healthy individuals and monitor their HRQoL. The presented work provides clinicians with realistic insights of continuous at home patient monitoring and its practical value in quantitative assessment of fatigue and sleep, an area of unmet need.
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Affiliation(s)
- Emmi Antikainen
- VTT Technical Research Centre of Finland Ltd., Tampere, Finland
| | | | - Jennifer Kudelka
- Department of Neurology, University Hospital Schleswig-Holstein, Kiel University, Kiel, Germany
| | - Diogo Branco
- LASIGE, Faculdade de Ciências, Universidade de Lisboa, Lisbon, Portugal
| | - Rana Zia Ur Rehman
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle Upon Tyne, United Kingdom
| | - Victoria Macrae
- NIHR Newcastle Biomedical Research Centre and NIHR Newcastle Clinical Research Facility, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle Upon Tyne, United Kingdom
| | - Kristen Davies
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle Upon Tyne, United Kingdom
| | - Hanna Hildesheim
- Department of Neurology, University Hospital Schleswig-Holstein, Kiel University, Kiel, Germany
| | - Kirsten Emmert
- Department of Neurology, University Hospital Schleswig-Holstein, Kiel University, Kiel, Germany
| | - Ralf Reilmann
- George-Huntington-Institute, University of Münster, Münster, Germany
- Department of Clinical Radiology, University of Münster, Münster, Germany
- Department of Neurodegenerative Diseases and Hertie Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany
| | | | - Walter Maetzler
- Department of Neurology, University Hospital Schleswig-Holstein, Kiel University, Kiel, Germany
| | - Wan-Fai Ng
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle Upon Tyne, United Kingdom
- NIHR Newcastle Biomedical Research Centre and NIHR Newcastle Clinical Research Facility, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle Upon Tyne, United Kingdom
| | - Patricio O’Donnell
- Department of Psychiatry, Harvard Medical School, McLean Hospital, Belmont, MA, United States
| | | | | | | | | | - Mark van Gils
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Teemu Ahmaniemi
- VTT Technical Research Centre of Finland Ltd., Tampere, Finland
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15
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Schnapp A, Harel M, Cayam-Rand D, Cassuto H, Polyansky L, Aran A. A Placebo-Controlled Trial of Cannabinoid Treatment for Disruptive Behavior in Children and Adolescents with Autism Spectrum Disorder: Effects on Sleep Parameters as Measured by the CSHQ. Biomedicines 2022; 10:biomedicines10071685. [PMID: 35884990 PMCID: PMC9312464 DOI: 10.3390/biomedicines10071685] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Revised: 07/08/2022] [Accepted: 07/12/2022] [Indexed: 12/18/2022] Open
Abstract
Autism spectrum disorder (ASD) is often associated with debilitating sleep disturbances. While anecdotal evidence suggests the positive effect of cannabinoids, randomized studies are lacking. Here, we report the effects of cannabinoid treatment on the sleep of 150 children and adolescents with ASD, as part of a double-blind, placebo-controlled study that assessed the impact of cannabinoid treatment on behavior (NCT02956226). Participants were randomly assigned to one of the following three treatments: (1) whole-plant cannabis extract, containing cannabidiol (CBD) and Δ9-Tetrahydrocannabinol (THC) in a 20:1 ratio, (2) purified CBD and THC extract in the same ratio, and (3) an oral placebo. After 12 weeks of treatment (Period 1) and a 4-week washout period, participants crossed over to a predetermined, second 12-week treatment (Period 2). Sleep disturbances were assessed using the Children’s Sleep-Habit Questionnaire (CSHQ). We found that the CBD-rich cannabinoid treatment was not superior to the placebo treatment in all aspects of sleep measured by the CSHQ, including bedtime resistance, sleep-onset delay, and sleep duration. Notably, regardless of the treatment (cannabinoids or placebo), improvements in the CSHQ total score were associated with improvements in the autistic core symptoms, as indicated by the Social Responsiveness Scale total scores (Period 1: r = 0.266, p = 0.008; Period 2: r = 0.309, p = 0.004). While this study failed to demonstrate that sleep improvements were higher with cannabinoids than they were with the placebo treatment, further studies are required.
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Affiliation(s)
- Aviad Schnapp
- Department of Pediatrics, Hadassah Medical Center, Jerusalem 91120, Israel;
| | - Moria Harel
- Neuropediatric Unit, Shaare Zedek Medical Center, Jerusalem 9103102, Israel; (M.H.); (D.C.-R.); (L.P.)
| | - Dalit Cayam-Rand
- Neuropediatric Unit, Shaare Zedek Medical Center, Jerusalem 9103102, Israel; (M.H.); (D.C.-R.); (L.P.)
| | - Hanoch Cassuto
- Child Development Centers, Leumit Health Services, Jerusalem 9439221, Israel;
| | - Lola Polyansky
- Neuropediatric Unit, Shaare Zedek Medical Center, Jerusalem 9103102, Israel; (M.H.); (D.C.-R.); (L.P.)
| | - Adi Aran
- Neuropediatric Unit, Shaare Zedek Medical Center, Jerusalem 9103102, Israel; (M.H.); (D.C.-R.); (L.P.)
- Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem 9112102, Israel
- Correspondence:
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16
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Chen L, Ma X, Chatterjee M, Kortelainen JM, Ahmaniemi T, Maetzler W, Wang P, Zhang D. Fatigue and Sleep Assessment using Digital Sleep Trackers: Insights from a Multi-Device Pilot Study. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2022; 2022:1133-1136. [PMID: 36086529 DOI: 10.1109/embc48229.2022.9870923] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
For the patient community with neurodegenerative disorders (NDD) and immune-mediated inflammatory diseases (IMID), fatigue and sleep disturbances stand out as two of the most common and disabling symptoms, which mightily impair patient's quality of life. Traditional questionnaire-oriented approaches to reflect such symptoms suffer from recall bias and poor sensitivity to change. By virtue of multiple sensing modalities at home, IDEA-FAST project aims to identify novel digital endpoints of fatigue and sleep disturbances, that are objective, reliable and sensitive to change. This article presents and discusses results from a pilot study of IDEA-FAST to evaluate the feasibility of capturing sleep and fatigue measures from three sleep trackers. Data collected from 143 participants (age range: 21-82) across 6 disease groups and healthy cohort for a period of 9 months, were investigated using our proposed sensor analytical pipeline. The overall performance reveals that the median coverage rate of sleep trackers ranged from 48.3% to 76.9%. Furthermore, the digital measures obtained from each device, indicated a higher association with sleep related patient reported outcomes (PROs) than fatigue related ones, when taking all participants into account.
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17
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Masi A, Moni MA, Azim SI, Choi B, Heussler H, Lin PI, Diaz AM, Eapen V. Clinical and behavioral attributes leading to sleep disorders in children on the autism spectrum. Autism Res 2022; 15:1274-1287. [PMID: 35596587 DOI: 10.1002/aur.2745] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Accepted: 04/16/2022] [Indexed: 11/07/2022]
Abstract
Sleep disorders are a common comorbid condition in children diagnosed with autism spectrum disorder ("autism"). However, the relationship between the clinical features of autism and sleep disorders remains unclear. A better understanding of the inherent autism-related characteristics linked to comorbid sleep disorders would improve comprehensive assessment and management. This study examined the relationship between sociodemographics, autism symptoms, sleep problems, cognitive status, behavioral attributes, and sensory profiles. Using data from 1268 participants who took part in the Australian Autism Biobank, sleep-related measurements using the Child Sleep Habits Questionnaire (CSHQ) were compared between autistic children aged 2 to 17 (N = 969), their siblings (N = 188), and unrelated children without an autism diagnosis (N = 111). The known relationship between sleep problems and autism was further explored by including scores from the Autism Diagnostic Observation Schedule-2, Mullen Scales of Early Learning, Vineland Adaptive Behavioral Scale-II and the Short Sensory Profile-2; which were included in analyses for autistic participants who had a completed CSHQ. Multiple regression models were used to identify clinical/behavioral variables associated with CSHQ subscales. The autism group had a significantly higher total CSHQ score than the sibling and comparison groups (p < 0.001), indicating worse sleep quality. Within the autism group, lower adaptive behaviors (i.e., VABS-II) and sensory issues (i.e., SSP-2 subclass scores) were positively associated with the severity of sleep problems (i.e., the CSHQ subclass scores) (p < 0.001). The significant functional impact of poor sleep on autistic children warrants an assessment of sleep as a critical part of a holistic approach to supporting autistic children and their families. LAY SUMMARY: Autistic children generally have co-occurring conditions. Sleep disorders impact approximately 50%-80% of autistic children. The impact on the quality of life for both the children and their families can be significant. This study compares sleep problems in autistic children and adolescents with their siblings and children without a diagnosis of autism, and investigates the relationship between specific autistic traits, daily life behaviors and sleep problems. The findings highlight the importance of a holistic assessment for autistic children and matching appropriate sleep intervention and supports where indicated.
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Affiliation(s)
- Anne Masi
- School of Psychiatry, Faculty of Medicine, UNSW Sydney, Kensington, New South Wales, Australia
| | - Mohammod Ali Moni
- School of Psychiatry, Faculty of Medicine, UNSW Sydney, Kensington, New South Wales, Australia
| | - Syeda Ishra Azim
- School of Psychiatry, Faculty of Medicine, UNSW Sydney, Kensington, New South Wales, Australia
| | - Byungkuk Choi
- School of Psychiatry, Faculty of Medicine, UNSW Sydney, Kensington, New South Wales, Australia
| | - Helen Heussler
- Centre for Children's Health Research, University of Queensland, South Brisbane, Queensland, Australia.,Child Development, Child and Youth Community Health Services, Queensland Children's Hospital, South Brisbane, Queensland, Australia
| | - Ping-I Lin
- School of Psychiatry, Faculty of Medicine, UNSW Sydney, Kensington, New South Wales, Australia.,Mental Health Research Unit, South Western Sydney Local Health District, Liverpool, New South Wales, Australia.,Ingham Institute, Liverpool Hospital, Liverpool, New South Wales, Australia
| | - Antonio Mendoza Diaz
- School of Psychiatry, Faculty of Medicine, UNSW Sydney, Kensington, New South Wales, Australia.,Academic Unit of Child Psychiatry, South Western Sydney Local Health District, Liverpool, New South Wales, Australia
| | - Valsamma Eapen
- School of Psychiatry, Faculty of Medicine, UNSW Sydney, Kensington, New South Wales, Australia.,Ingham Institute, Liverpool Hospital, Liverpool, New South Wales, Australia.,Academic Unit of Child Psychiatry, South Western Sydney Local Health District, Liverpool, New South Wales, Australia
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18
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Di Martino RMC, Cavalli A, Bottegoni G. Dopamine D3 receptor ligands: a patent review (2014-2020). Expert Opin Ther Pat 2022; 32:605-627. [PMID: 35235753 DOI: 10.1080/13543776.2022.2049240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
INTRODUCTION Compelling evidence identified D3 dopamine receptor (D3R) as a suitable target for therapeutic intervention on CNS-associated disorders, cancer and other conditions. Several efforts have been made toward developing potent and selective ligands for modulating signalling pathways operated by these GPCRs. The rational design of D3R ligands endowed with a pharmacologically relevant profile has traditionally not encountered much support from computational methods due to a very limited knowledge of the receptor structure and of its conformational dynamics. We believe that recent progress in structural biology will change this state of affairs in the next decade. AREAS COVERED This review provides an overview of the recent (2014-2020) patent literature on novel classes of D3R ligands developed within the framework of CNS-related diseases, cancer and additional conditions. When possible, an in-depth description of both in vitro and in vivo generated data is presented. New therapeutic applications of known molecules with activity at D3R are discussed. EXPERT OPINION Building on current knowledge, future D3R-focused drug discovery campaigns will be propelled by a combination of unprecedented availability of structural information with advanced computational and analytical methods. The design of D3R ligands with the sought activity, efficacy and selectivity profile will become increasingly more streamlined.
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Affiliation(s)
| | - Andrea Cavalli
- Computational and Chemical Biology, Istituto Italiano di Tecnologia, via Morego 30, 16163, Genoa, Italy.,Department of Pharmacy and Biotechnology, Alma Mater Studiorum-Bologna University, via Belmeloro 6, 40126, Bologna, Italy
| | - Giovanni Bottegoni
- Department of Biomolecular Sciences, Urbino University "Carlo Bo", Piazza Rinascimento 6, 61029, Urbino, Italy.,Institute of Clinical Sciences, University of Birmingham, Edgbaston, B15 2TT, Birmingham, UK
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19
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Martínez-Cayuelas E, Rodríguez-Morilla B, Soriano-Guillén L, Merino-Andreu M, Moreno-Vinués B, Gavela-Pérez T. Sleep Problems and Circadian Functioning in Children and Adolescents With Autism Spectrum Disorder. Pediatr Neurol 2022; 126:57-64. [PMID: 34740134 DOI: 10.1016/j.pediatrneurol.2021.09.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Revised: 07/30/2021] [Accepted: 09/12/2021] [Indexed: 01/02/2023]
Abstract
BACKGROUND Sleep problems are a prevalent comorbidity in autism spectrum disorder (ASD) with a multifactorial basis in which circadian misalignment has been described. METHODS A cross-sectional study was conducted including 52 children and adolescents with ASD (9.85 ± 3.07) and 27 children and adolescent controls with normal intellectual functioning (8.81 ± 2.14). They were matched for age, sex, and body mass index, and all were drug-naïve. An ambulatory circadian monitoring device was used to record temperature and motor, body position, sleep, and light intensity. RESULTS Individuals with ASD presented longer sleep-onset latency, lower sleep efficiency, and decreased total sleep time and tended to be more sedentary and have less exposure to light. They also showed lower amplitude, low interdaily stability, and a different pattern of wrist temperature across the day, with a midpoint of sleep that did not concur with sleep midpoint indicated by the rest of circadian parameters. CONCLUSIONS The sleep problems observed in this sample resemble those reported previously, with the exception of nocturnal awakenings which did not show differences. The ambulatory circadian monitoring device enabled measurement of circadian parameters such as temperature which, until now, were scarcely described in children with ASD and could be used to better understand sleep and circadian system in ASD.
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Affiliation(s)
- Elena Martínez-Cayuelas
- Department of Pediatrics, IIS-Fundación Jiménez Díaz, Universidad Autónoma de Madrid, Madrid, Spain.
| | | | - Leandro Soriano-Guillén
- Department of Pediatrics, IIS-Fundación Jiménez Díaz, Universidad Autónoma de Madrid, Madrid, Spain
| | | | - Beatriz Moreno-Vinués
- Department of Pediatrics, IIS-Fundación Jiménez Díaz, Universidad Autónoma de Madrid, Madrid, Spain
| | - Teresa Gavela-Pérez
- Department of Pediatrics, IIS-Fundación Jiménez Díaz, Universidad Autónoma de Madrid, Madrid, Spain
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20
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Kaliukhovich DA, Manyakov NV, Bangerter A, Pandina G. Context Modulates Attention to Faces in Dynamic Social Scenes in Children and Adults with Autism Spectrum Disorder. J Autism Dev Disord 2021; 52:4219-4232. [PMID: 34623583 PMCID: PMC9508054 DOI: 10.1007/s10803-021-05279-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/04/2021] [Indexed: 11/28/2022]
Abstract
Individuals with autism spectrum disorder (ASD) have been found to view social scenes differently compared to typically developing (TD) peers, but results can vary depending on context and age. We used eye-tracking in children and adults (age 6-63) to assess allocation of visual attention in a dynamic social orientation paradigm previously used only in younger children. The ASD group (n = 94) looked less at the actor's face compared to TD (n = 38) when they were engaged in activity (mean percentage of looking time, ASD = 30.7% vs TD = 34.9%; Cohen's d = 0.56; p value < 0.03) or looking at a moving toy (24.5% vs 33.2%; d = 0.65; p value < 0.001). Findings indicate that there are qualitative differences in allocation of visual attention to social stimuli across ages in ASD.ClinicalTrials.gov identifier: NCT02668991.
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Affiliation(s)
| | | | | | - Gahan Pandina
- Janssen Research & Development, LLC, Titusville, NJ, USA
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21
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Halliwell N, Podvey M, Smith JD, Harris K, Sylvester L, DeGrace BW. Experience of Sleep for Families of Young Adults With Autism Spectrum Disorder. Am J Occup Ther 2021; 75:12672. [PMID: 34780630 DOI: 10.5014/ajot.2021.043364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
IMPORTANCE Children with autism spectrum disorder (ASD) may experience sleep difficulties that worsen into adulthood and negatively influence both child and family, yet the experience is not well understood. Understanding the family's experience can inform occupational therapy providers, future research, and practice guidelines. OBJECTIVE To examine experiences surrounding sleep for families raising a young adult with ASD (YA-ASD). DESIGN Qualitative study in the phenomenological tradition of Moustakas (1994). Experienced researchers analyzed transcripts from in-depth, in-person interviews to triangulate data, distill themes, and construct the essence of family experience. Trustworthiness was established through member checking, audit trails, and epoché diaries that were maintained throughout data analyses. SETTING Community setting (large city in the northeastern United States). PARTICIPANTS People who self-identified as living in a family arrangement that included a YA-ASD age 15-21 yr, able to verbally participate in English. Families with children diagnosed with developmental disabilities other than ASD were excluded. RESULTS Six eligible families identified through volunteer sampling participated. The participants' sociodemographic diversity was limited across household income, education level, and ethnicity. All YA-ASD in this study were limited verbally and unable to contribute. Analyses of interview transcripts revealed five themes that form the essence of the families' experience surrounding sleep. CONCLUSIONS AND RELEVANCE Sleep issues for YA-ASD continue into adulthood and affect the entire family because of continuous co-occupation; occupational therapy support is therefore important for families of YA-ASD. The lack of effective evidence-based interventions supporting the YA-ASD population also reveals an area for growth. What This Article Adds: The results indicate the importance of addressing sleep for YA-ASD and their families in occupational therapy practice because of its considerable impact on family life.
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Affiliation(s)
- Nicole Halliwell
- Nicole Halliwell, DSc, OTR/L, is Assistant Professor, Department of Occupational Therapy, Monmouth University, West Long Branch, NJ, and Occupational Therapist, Kid Clan Therapy Center, Clifton, NJ. At the time of this study, Halliwell was Doctoral Student, Rehabilitation Sciences Program, College of Allied Health, University of Oklahoma Health Sciences Center, Oklahoma City, and Occupational Therapist, The Phoenix Center, Nutley, NJ;
| | - Mara Podvey
- Mara Podvey, PhD, OTR, PMH-C, FAOTA, is Associate Professor, Department of Occupational Therapy, School of Health and Medical Sciences, Seton Hall University Interprofessional Health Sciences Campus, Nutley, NJ
| | - Julie D Smith
- Julie D. Smith, DSc, OTR/L, is Occupational Therapist, SoonerStart Early Intervention, Family Health Services, Oklahoma State Department of Health, Oklahoma City. At the time of this study, Smith was Doctoral Student, Rehabilitation Sciences Program, College of Allied Health, University of Oklahoma Health Sciences Center, Oklahoma City
| | - Katelyn Harris
- Katelyn Harris, MOT, OTR/L, is Occupational Therapist, KidsCare Home Health, Denver, CO. At time of this study, Harris was Master's Student, Department of Rehabilitation Science, College of Allied Health, University of Oklahoma Health Sciences Center, Oklahoma City
| | - Lorraine Sylvester
- Lorraine Sylvester, PhD, PT, is Professor Emeritus, Department of Rehabilitation Sciences, College of Allied Health, University of Oklahoma Health Sciences Center, Oklahoma City
| | - Beth W DeGrace
- Beth W. DeGrace, PhD, OTR/L, FAOTA, is Associate Professor, Department of Rehabilitation Sciences, College of Allied Health, University of Oklahoma Health Sciences Center, Oklahoma City
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22
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Fennell LCP, Johnson SA. Examination of professional biases about autism: how can we do better? Clin Neuropsychol 2021; 36:1094-1115. [PMID: 34369298 DOI: 10.1080/13854046.2021.1958922] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
This paper lends a critical eye to six common assumptions/biases about autism that may influence neuropsychologists in their clinical work. These biases are based on research as well as the historical roots of the study of autism. Our goal is to encourage curiosity and reflection on these biases in order to improve neuropsychological service delivery for people on the autism spectrum. Methods: We argue that psychologists should strive to understand the function of behaviours observed with autism in order to offer helpful supports. We explore the assertions that autism is not a dichotomous or linear construct and that the use of high and low functioning descriptors are not useful nor appreciated by the autism community. We discuss the widely held beliefs that individuals on the autism spectrum lack theory of mind, empathy and social motivation. Importantly, people on the autism spectrum are telling us that the dialogue about them around theory of mind and empathy is a human rights issue. Finally, we discuss the role of standardized testing. Conclusions: Through an exploration of research literature, the writings of scholars and advocates on the autism spectrum, and personal, clinical and research experience we encourage our profession to take a leadership role in examining biases and changing the clinical and research landscape so that it better reflects respectful discourse for individuals on the autism spectrum. This is critical to reduce the stigma that continues to be associated with autism and has a negative affect on mental health and quality of life.
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Affiliation(s)
- Louise C P Fennell
- Department of Psychology, University of Victoria, Victoria, Canada.,Private Practice of Psychologist Louise Fennell, Victoria, Canada
| | - Shannon A Johnson
- Department of Psychology and Neuroscience, Dalhousie University, Halifax, Canada
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23
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Black B. Sleep and Autism: An impactful and complex relationship that requires a personalized medicine approach. Sleep 2021; 44:6320054. [PMID: 34255079 DOI: 10.1093/sleep/zsab178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- Benjamin Black
- University of Missouri, Department of Child Health, Columbia, MO, United States of America
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24
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Complexity of Body Movements during Sleep in Children with Autism Spectrum Disorder. ENTROPY 2021; 23:e23040418. [PMID: 33807381 PMCID: PMC8066562 DOI: 10.3390/e23040418] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Revised: 03/30/2021] [Accepted: 03/30/2021] [Indexed: 12/15/2022]
Abstract
Recently, measuring the complexity of body movements during sleep has been proven as an objective biomarker of various psychiatric disorders. Although sleep problems are common in children with autism spectrum disorder (ASD) and might exacerbate ASD symptoms, their objectivity as a biomarker remains to be established. Therefore, details of body movement complexity during sleep as estimated by actigraphy were investigated in typically developing (TD) children and in children with ASD. Several complexity analyses were applied to raw and thresholded data of actigraphy from 17 TD children and 17 children with ASD. Determinism, irregularity and unpredictability, and long-range temporal correlation were examined respectively using the false nearest neighbor (FNN) algorithm, information-theoretic analyses, and detrended fluctuation analysis (DFA). Although the FNN algorithm did not reveal determinism in body movements, surrogate analyses identified the influence of nonlinear processes on the irregularity and long-range temporal correlation of body movements. Additionally, the irregularity and unpredictability of body movements measured by expanded sample entropy were significantly lower in ASD than in TD children up to two hours after sleep onset and at approximately six hours after sleep onset. This difference was found especially for the high-irregularity period. Through this study, we characterized details of the complexity of body movements during sleep and demonstrated the group difference of body movement complexity across TD children and children with ASD. Complexity analyses of body movements during sleep have provided valuable insights into sleep profiles. Body movement complexity might be useful as a biomarker for ASD.
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25
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Jamioł-Milc D, Bloch M, Liput M, Stachowska L, Skonieczna-Żydecka K. Tactile Processing and Quality of Sleep in Autism Spectrum Disorders. Brain Sci 2021; 11:brainsci11030362. [PMID: 33808992 PMCID: PMC8001965 DOI: 10.3390/brainsci11030362] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Revised: 03/03/2021] [Accepted: 03/10/2021] [Indexed: 12/17/2022] Open
Abstract
Individuals with autism spectrum disorders (ASDs) commonly experience problems with the processing of tactile stimuli and poor quality of sleep. The aim of the present study was to analyze whether tactile stimuli modulation (TSM) disorders might be linked to insomnia prevalence in ASD individuals. We hypothesized that sleep disorders in children with ASD may result from improper tactile under/over responsivity. The study included 27 children diagnosed with ASD, aged 6.8 (±2.9 years) with male dominance (n = 22, 81.5%). To evaluate the pattern of TSM we used a clinical interview with a parent, and guided and spontaneous observation of the patients. Sleep disorders were diagnosed using the Athens Insomnia Scale. Of all the children diagnosed with TSM, 20 patients (74.1%) had an over-responsivity pattern and 7 children (25.9%) had an under-responsivity pattern. Of the patients, 11 children (40.7%) met the diagnostic criteria for insomnia. The data indicated a statistical tendency for higher prevalence of insomnia in individuals diagnosed with tactile under-responsivity (p = 0.051). We concluded that under-responsivity toward tactile stimuli may be partly responsible for poor sleep quality in ASD. There is an urgent need to treat sleep and sensory disruptions which may intensify behavioral difficulties in ASD.
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Affiliation(s)
- Dominika Jamioł-Milc
- Department of Human Nutrition and Metabolomics, Pomeranian Medical University in Szczecin, 71-460 Szczecin, Poland
- Correspondence: ; Tel.: +48-91-441-48-06; Fax: +48-91-441-48-07
| | | | - Magdalena Liput
- Department of Pharmacognosy and Natural Medicines, Pomeranian Medical University in Szczecin, 70-111 Szczecin, Poland;
| | - Laura Stachowska
- Students Scientific Club at the Department of Human Nutrition and Metabolomics, Pomeranian Medical University in Szczecin, 71-460 Szczecin, Poland;
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26
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Kaliukhovich DA, Manyakov NV, Bangerter A, Ness S, Skalkin A, Boice M, Goodwin MS, Dawson G, Hendren R, Leventhal B, Shic F, Pandina G. Visual Preference for Biological Motion in Children and Adults with Autism Spectrum Disorder: An Eye-Tracking Study. J Autism Dev Disord 2021; 51:2369-2380. [PMID: 32951157 PMCID: PMC8189980 DOI: 10.1007/s10803-020-04707-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
Participants with autism spectrum disorder (ASD) (n = 121, mean [SD] age: 14.6 [8.0] years) and typically developing (TD) controls (n = 40, 16.4 [13.3] years) were presented with a series of videos representing biological motion on one side of a computer monitor screen and non-biological motion on the other, while their eye movements were recorded. As predicted, participants with ASD spent less overall time looking at presented stimuli than TD participants (P < 10-3) and showed less preference for biological motion (P < 10-5). Participants with ASD also had greater average latencies than TD participants of the first fixation on both biological (P < 0.01) and non-biological motion (P < 0.02). Findings suggest that individuals with ASD differ from TD individuals on multiple properties of eye movements and biological motion preference.
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Affiliation(s)
- Dzmitry A. Kaliukhovich
- grid.419619.20000 0004 0623 0341Janssen Pharmaceutica NV, Turnhoutseweg 30, 2340 Beerse, Belgium
| | - Nikolay V. Manyakov
- grid.419619.20000 0004 0623 0341Janssen Pharmaceutica NV, Turnhoutseweg 30, 2340 Beerse, Belgium
| | - Abigail Bangerter
- grid.497530.c0000 0004 0389 4927Janssen Research & Development, LLC, 1125 Trenton-Harbourton Road, Titusville, NJ 08560 USA
| | - Seth Ness
- grid.497530.c0000 0004 0389 4927Janssen Research & Development, LLC, 1125 Trenton-Harbourton Road, Titusville, NJ 08560 USA
| | - Andrew Skalkin
- grid.497530.c0000 0004 0389 4927Janssen Research & Development, LLC, 1125 Trenton-Harbourton Road, Titusville, NJ 08560 USA ,Present Address: DataGrok, Inc., 1800 JFK Blvd Suite 300, PMB 90078, Philadelphia, PA 19103 USA
| | - Matthew Boice
- grid.497530.c0000 0004 0389 4927Janssen Research & Development, LLC, 1125 Trenton-Harbourton Road, Titusville, NJ 08560 USA
| | - Matthew S. Goodwin
- grid.261112.70000 0001 2173 3359Department of Health Sciences, Bouvé College of Health Sciences, Northeastern University, 312E Robinson Hall, 360 Huntington Avenue, Boston, MA 02115 USA
| | - Geraldine Dawson
- grid.26009.3d0000 0004 1936 7961Duke Center for Autism and Brain Development, Duke University School of Medicine, 2608 Erwin Road, Suite 30, Durham, NC 27705 USA
| | - Robert Hendren
- grid.34477.330000000122986657Present Address: Center for Child Health, Behavior and Development, Seattle Children’s Research Institute, Department of Pediatrics, University of Washington School of Medicine, 2001 8th Ave Suite #400, Seattle, WA 98121 USA
| | - Bennett Leventhal
- grid.266102.10000 0001 2297 6811Benioff Children’s Hospital, University of California, San Francisco, 401 Parnassus Ave, Langley Porter, San Francisco, CA 94143-0984 USA
| | - Frederick Shic
- grid.34477.330000000122986657Present Address: Center for Child Health, Behavior and Development, Seattle Children’s Research Institute, Department of Pediatrics, University of Washington School of Medicine, 2001 8th Ave Suite #400, Seattle, WA 98121 USA ,grid.47100.320000000419368710Yale Child Study Center, Yale University School of Medicine, New Haven, USA
| | - Gahan Pandina
- grid.497530.c0000 0004 0389 4927Janssen Research & Development, LLC, 1125 Trenton-Harbourton Road, Titusville, NJ 08560 USA
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27
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Wallace K, Uchitel J, Prange L, Jasien J, Bonner M, D'Alli R, Maslow G, Mikati MA. Characterization of Severe and Extreme Behavioral Problems in Patients With Alternating Hemiplegia of Childhood. Pediatr Neurol 2020; 111:5-12. [PMID: 32951661 DOI: 10.1016/j.pediatrneurol.2020.06.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Revised: 06/14/2020] [Accepted: 06/20/2020] [Indexed: 12/21/2022]
Abstract
BACKGROUND Alternating hemiplegia of childhood often manifests severe or extreme behavioral problems, the nature of which remains to be fully characterized. METHODS We analyzed 39 consecutive patients with alternating hemiplegia of childhood for occurrence of behavioral problems and categorized those by severity: mild (not requiring intervention), moderate (requiring intervention but no risk), severe (minor risk to self, others, or both), and extreme (major risk). We then analyzed behavioral manifestations, concurrent morbidity, and medication responses in patients with severe or extreme symptoms. RESULTS Two patients had mild behavioral problems, five moderate, 10 severe, six extreme, and 16 none. Extreme cases exhibited disruptive behaviors escalating to assaults. Triggers, when present, included peer-provocation, low frustration tolerance, limits set by others, and sleep disruption. Reversible psychotic symptoms occurred in two patients: in one triggered by infection and trihexyphenidyl, and in another triggered by sertraline. Of the 16 patients with severe or extreme symptoms, 13 had concurrent neuropsychiatric diagnoses. Occurrence of severe or extreme symptoms did not correlate with age, puberty, severity of intellectual disability, or mutation status (P > 0.05). A multidisciplinary team including mental health professionals comanaged all patients with severe or extreme symptoms with either behavioral therapy, medications, or both. When considering medications prescribed to more than four patients, medicines that demonstrated efficacy or partial efficacy in more than 50% of patients were alpha-adrenergic agonists and selective-serotonin-reuptake-inhibitors. CONCLUSIONS Patients with alternating hemiplegia of childhood (41%) often experience severe or extreme behavioral problems and, rarely, medication-triggered psychotic symptoms. These observations are consistent with current understanding of underlying alternating hemiplegia of childhood brain pathophysiology. Increasing awareness of these behavioral problems facilitates alternating hemiplegia of childhood management and anticipatory guidance.
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Affiliation(s)
- Keri Wallace
- Division of Pediatric Neurology and Developmental Medicine, Duke Children's Health Center, Durham, North Carolina
| | - Julie Uchitel
- Division of Pediatric Neurology and Developmental Medicine, Duke Children's Health Center, Durham, North Carolina
| | - Lyndsey Prange
- Division of Pediatric Neurology and Developmental Medicine, Duke Children's Health Center, Durham, North Carolina
| | - Joan Jasien
- Division of Pediatric Neurology and Developmental Medicine, Duke Children's Health Center, Durham, North Carolina
| | - Melanie Bonner
- Department of Psychiatry and Behavioral Sciences, Duke University, Durham, North Carolina
| | - Richard D'Alli
- Division of Child Development and Behavioral Health, Department of Pediatrics, Duke University, Durham, North Carolina
| | - Gary Maslow
- Department of Psychiatry and Behavioral Sciences, Duke University, Durham, North Carolina; Department of Pediatrics, Duke University, Durham, North Carolina
| | - Mohamad A Mikati
- Division of Pediatric Neurology and Developmental Medicine, Duke Children's Health Center, Durham, North Carolina.
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28
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Yavuz-Kodat E, Reynaud E, Geoffray MM, Limousin N, Franco P, Bonnet-Brilhault F, Bourgin P, Schroder CM. Disturbances of Continuous Sleep and Circadian Rhythms Account for Behavioral Difficulties in Children with Autism Spectrum Disorder. J Clin Med 2020; 9:jcm9061978. [PMID: 32599848 PMCID: PMC7356341 DOI: 10.3390/jcm9061978] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Revised: 06/20/2020] [Accepted: 06/21/2020] [Indexed: 12/27/2022] Open
Abstract
Sleep disorders are among the most common comorbidities in children with Autism Spectrum Disorder (ASD), and subjectively defined sleep disturbances have been related to ASD symptom severity. However, no study has investigated the differential impact of objectively measured sleep and circadian rhythm disturbances on behavioral difficulties in this population. Fifty-two children with ASD aged 3-10 years underwent assessments of sleep and circadian rest-activity rhythms objectively with actigraphy and subjectively with the Children's Sleep Habits Questionnaire. Behavioral difficulties were assessed using the ABC-C. Group comparison analyses were used to compare sleep and circadian rhythm parameters of children with higher and lower behavioral difficulties and dominance analysis to rank predictors and address multicollinearity. Children with high irritability had a shorter continuous sleep period compared to those with lower irritability (-60 min, p = 0.04), as well as those with high stereotypic behaviors compared to children with less stereotypies (-75 min, p = 0.006). Objective circadian and sleep disturbances accounted together for, respectively, 17%, 18% and 36% of the variance in social withdrawal, irritability and stereotypic behaviors. The identification of both sleep and circadian rhythm disturbances as explanatory factors for behavioral difficulties warrants their inclusion in the existing behavioral management strategies for children with ASD.
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Affiliation(s)
- Enise Yavuz-Kodat
- Centre National de la Recherche Scientifique CNRS UPR 3212, Université de Strasbourg, Institut des Neurosciences Cellulaires et Intégratives, 8 allée du Général Rouvillois, 67000 Strasbourg, France; (E.Y.-K.); (P.B.); (C.M.S.)
| | - Eve Reynaud
- Centre National de la Recherche Scientifique CNRS UPR 3212, Université de Strasbourg, Institut des Neurosciences Cellulaires et Intégratives, 8 allée du Général Rouvillois, 67000 Strasbourg, France; (E.Y.-K.); (P.B.); (C.M.S.)
- Correspondence:
| | - Marie-Maude Geoffray
- Department of Child and Adolescent Neurodevelopmental Psychiatry, Le Vinatier Hospital, 95 Boulevard Pinel, 69678 Bron CEDEX, France;
- Health Services and Performance Research (HESPER), Claude Bernard University Lyon 1, 43 Boulevard du 11 Novembre 1918, 69622 Villeurbane CEDEX, France
| | - Nadège Limousin
- Department of Neurology and Clinical Neurophysiology, University Hospital Bretonneau, 2 Boulevard Tonnellé, 37044 Tours, France;
| | - Patricia Franco
- Pediatric Sleep, Hôpital Femme-Mère-Enfant, Hospices civils of Lyon, 59 Boulevard Pinel, 69500 Bron, France;
- Lyon Neuroscience Research Center U1028/UMR5292, Claude Bernard University Lyon 1, 43 Boulevard du 11 Novembre 1918, 69622 Villeurbane CEDEX, France
| | - Frédérique Bonnet-Brilhault
- UMR 1253, iBrain, Université de Tours, Inserm, CHRU de Tours, Centre Universitaire de Pédopsychiatrie, 2 Boulevard Tonnellé, 37044 Tours, France;
| | - Patrice Bourgin
- Centre National de la Recherche Scientifique CNRS UPR 3212, Université de Strasbourg, Institut des Neurosciences Cellulaires et Intégratives, 8 allée du Général Rouvillois, 67000 Strasbourg, France; (E.Y.-K.); (P.B.); (C.M.S.)
- Sleep Disorders Center, International Research Center for ChronoSomnology, Strasbourg University Hospitals, 1 place de l’Hôpital, 67000 Strasbourg, France
| | - Carmen M. Schroder
- Centre National de la Recherche Scientifique CNRS UPR 3212, Université de Strasbourg, Institut des Neurosciences Cellulaires et Intégratives, 8 allée du Général Rouvillois, 67000 Strasbourg, France; (E.Y.-K.); (P.B.); (C.M.S.)
- Sleep Disorders Center, International Research Center for ChronoSomnology, Strasbourg University Hospitals, 1 place de l’Hôpital, 67000 Strasbourg, France
- Department of Child and Adolescent Psychiatry, Strasbourg University Hospitals & University of Strasbourg Medical School, 67000 Strasbourg, France
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