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Tamir S, Dye TJ, Witt RM. Sleep and Circadian Disturbances in Children With Neurodevelopmental Disorders. Semin Pediatr Neurol 2023; 48:101090. [PMID: 38065637 DOI: 10.1016/j.spen.2023.101090] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Accepted: 09/28/2023] [Indexed: 12/18/2023]
Abstract
Sleep problems are highly prevalent in those with neurodevelopmental disorders (NDDs). We propose this is secondary to multiple factors that directly and indirectly negatively impact sleep and circadian processes in those with NDDs, which in turn, further perturbs development, resulting in a "developmental and sleep/circadian-related encephalopathy." In this review, we discuss select NDDs with known or suspected sleep and circadian phenotypes. We also highlight important considerations when evaluating and treating sleep and circadian disorders in these populations.
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Affiliation(s)
- Sharon Tamir
- University of Cincinnati College of Medicine, Cincinnati, OH; Division of Human Genetics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - Thomas J Dye
- Division of Child Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH; Division of Pulmonary Medicine and the Sleep Center, Cincinnati Children's Hospital Medical Center, Cincinnati, OH; Center for Circadian Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH; Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH
| | - Rochelle M Witt
- Division of Child Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH; Division of Pulmonary Medicine and the Sleep Center, Cincinnati Children's Hospital Medical Center, Cincinnati, OH; Center for Circadian Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH; Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH.
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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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da Silva JF, Honorato MM, Cremaschi RMDC, Coelho FMS. Efficacy and tolerance profile of risperidone use in people with autism spectrum disorder in a clinic in Santarém, Pará, Brazil. A retrospective study. J Neurosci Rural Pract 2023; 14:308-312. [PMID: 37181171 PMCID: PMC10174143 DOI: 10.25259/jnrp_53_2022] [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: 11/13/2022] [Accepted: 02/18/2023] [Indexed: 05/16/2023] Open
Abstract
Objectives This study aimed to obtain the profile of efficacy and tolerance of risperidone in the treatment of people with autism spectrum disorder. Materials and Methods This research was a cross-sectional and retrospective study. The medical records of 100 patients diagnosed with ASD according to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) were analyzed and measures of central tendency and correlation between variables such as gender, age at diagnosis, symptoms, daily dose, comorbidities, polytherapy, adverse drug effects, and outcome (improvement, worsening, and drug discontinuation) were calculated using Pearson's R test with a level of statistical significance P < 0.05. Results The male gender was the most affected, corresponding to 80% of the participants. The mean age at diagnosis was 6.88 ± 6.24 and the mean dose was 1.89 ± 1.68 mg/day. The use of risperidone for patients with aggressiveness, hyperactivity, insomnia, or self-harm improved in 76% of patients and adverse effects were reported in 27% of cases. The presence of self-harm implied lower chances of improvement (P = 0.05/r = -0.20). Adverse effects were strong predictors of discontinuation (P = 0.01/r = 0.39), and epileptic patients were more likely to have them (P = 0.02/r = 0.20). Male gender was associated with dosages lower than 2 mg/day (P = 0.05/r = 0.23). Conclusion Risperidone is a good option in the management of secondary symptoms of ASD, generally requiring low doses and presenting an acceptable profile of adverse effects. The age of diagnosis does not affect the drug's efficiency, but it can make the management of ASD difficult.
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Affiliation(s)
- João Ferreira da Silva
- Center of Biological and Health Sciences, State University of Pará, Santarém, São Paulo, Brazil
| | - Marcos Manoel Honorato
- Center of Biological and Health Sciences, State University of Pará, Santarém, São Paulo, Brazil
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Favole I, Davico C, Marcotulli D, Sodero R, Svevi B, Amianto F, Ricci FS, Arduino GM, Vitiello B. Sleep disturbances and emotional dysregulation in young children with autism spectrum, intellectual disability, or global developmental delay. Sleep Med 2023; 105:45-52. [PMID: 36963320 DOI: 10.1016/j.sleep.2023.02.026] [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] [Received: 12/31/2022] [Revised: 02/25/2023] [Accepted: 02/28/2023] [Indexed: 03/26/2023]
Abstract
OBJECTIVE Sleep disturbance and emotional dysregulation (ED) are common and often functionally impairing in young children with neurodevelopmental disorders (NDD). This study investigated the relationship between sleep disturbance and ED in a sample of preschoolers with ASD, intellectual disability, or global developmental delay, and examined possible predictors of their persistence over time. METHODS All children under 6 years of age clinically referred between July 2018 and May 2022 to two neuropsychiatric specialized centers for NDD received a comprehensive diagnostic evaluation, including the Child Behavior Checklist 1.5-5 (CBCL), the Autism Diagnostic Observation Schedule-2 (ADOS-2), and standardized tests of cognitive and global development. Sleep disturbances were assessed with the CBCL-sleep score, and ED with the CBCL Attention, Aggression, and Anxious/Depressed scales (CBCL-AAA). A reassessment of sleep and ED was conducted after 6 months or longer, including the Child Sleep Habits Questionnaire (CSHQ). Multivariate analyses and mixed linear regression models were conducted. RESULTS A total of 136 children, 75.7% male, median age 38.27 months, IQR 15.39, 41.2% with global developmental disorder (GDD) or intellectual disability (ID) participated in the study. Of them, 64.7% were diagnosed with autism spectrum disorder (ASD) and 35.3% with other NDD (w/o ASD). Sleep disturbances (CBCL-Sleep) and ED (CBCL-AAA) were positively correlated (p < 0.001), after accounting for age, ID/GDD and autism symptom severity, in both the entire sample and separately in each diagnostic group (ASD and NDD w/o ASD). Seventy-five children (55%) were reassessed a mean 17.2 months afterwards. There was persistence of the positive correlation between sleep problems and ED (p < 0.001) in both the entire sample and each diagnostic group. The longitudinal mixed linear model showed that ED at follow-up was predicted by baseline sleep problems (p = 0.008), ED (p < 0.001), and ASD severity (p = 0.015). CONCLUSIONS Sleep disturbances are significantly associated with ED in young children with NDD, either with or without ASD, both cross-sectionally and prospectively over time. Sleep problems represent an important comorbidity and a potential treatment target for improving emotional stability in NDD.
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Affiliation(s)
- Irene Favole
- Section of Child and Adolescent Neuropsychiatry, Department of Public Health and Pediatric Sciences, University of Turin, 10126, Turin, Italy
| | - Chiara Davico
- Section of Child and Adolescent Neuropsychiatry, Department of Public Health and Pediatric Sciences, University of Turin, 10126, Turin, Italy
| | - Daniele Marcotulli
- Section of Child and Adolescent Neuropsychiatry, Department of Public Health and Pediatric Sciences, University of Turin, 10126, Turin, Italy.
| | - Roberta Sodero
- Section of Child and Adolescent Neuropsychiatry, Department of Public Health and Pediatric Sciences, University of Turin, 10126, Turin, Italy
| | - Barbara Svevi
- Section of Child and Adolescent Neuropsychiatry, Department of Public Health and Pediatric Sciences, University of Turin, 10126, Turin, Italy
| | - Federico Amianto
- Department of Neuroscience, University of Turin, 10100, Turin, Italy
| | - Federica S Ricci
- Section of Child and Adolescent Neuropsychiatry, Department of Public Health and Pediatric Sciences, University of Turin, 10126, Turin, Italy
| | - G Maurizio Arduino
- Autism Center, Developmental Psychology and Psychopathology, ASL CN1, Cuneo, Italy
| | - Benedetto Vitiello
- Section of Child and Adolescent Neuropsychiatry, Department of Public Health and Pediatric Sciences, University of Turin, 10126, Turin, Italy
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Evaluation of Gastroesophageal Reflux Disease in Children on the Autism Spectrum: A Study Evaluating the Tolerance and Utility of the BRAVO Wireless pH Monitoring. J Pediatr Gastroenterol Nutr 2022; 75:450-454. [PMID: 35830732 DOI: 10.1097/mpg.0000000000003561] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
OBJECTIVES Children on the autism spectrum disorder (ASD) may express pain or discomfort through stereotypic or self-injurious behaviors. Gastroesophageal reflux disease (GERD) may be challenging to diagnose in a child who is non-verbal or has impaired communication skills, diagnostic testing for GERD may be the only way to establish the diagnosis. We report our experience using the BRAVO wireless pH monitoring device for the evaluation of GERD in this patient population. METHODS Tolerance and feasibility as well as pH parameters and symptom correlation of the BRAVO pH were evaluated retrospectively in ASD children and compared it to a large cohort of non-ASD children. Only patients with studies lasting >24 hours were included. RESULTS A total of 172 patients were included, 27 of those were diagnosed with autism (median age 11 years, 17 male). We found no difference in age and weight between both groups but there was a male predominance in the autism group ( P = 0.007). We found no difference in the ability to complete at least 24 hours of study duration between both groups (24/27 or 89% in ASD vs 133/145 or 92% non-ASD patients, P = 0.632). We also found no difference in the median reflux index on the worst day ( P = 0.27) or the average of both days ( P = 0.75), BRAVO pH parameters and the proportion of abnormal studies between ASD and non-ASD children. When evaluating the overall symptom correlation with GER episodes, we did not find a difference between both groups, but we did find a higher symptom correlation for GER symptom during supine position in ASD children. Study was performed for behavioral indication in 11 ASD children, all had normal esophageal mucosa but 4 of those had an abnormal BRAVO pH study. No significant side effects were reported during the study, only 2 patients (1 non-ASD and 1 ASD) complained of self-limited chest pain. CONCLUSIONS BRAVO wireless pH is well tolerated and feasible in evaluating GER and behavioral symptoms in ASD children and provides a reasonable alternative to standard trans-nasal pH monitoring.
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Yao D, Wang S, Li F, Gao M, Shao J. Analysis of sleep problem in children aged 1-3 years with autism spectrum disorder in Zhejiang province, China. Front Psychiatry 2022; 13:923757. [PMID: 36111309 PMCID: PMC9468753 DOI: 10.3389/fpsyt.2022.923757] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Accepted: 08/01/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND High prevalence of sleep problems have been founded in children with Autism Spectrum Disorder (ASD), with rates ranging from 50 to 80%. We aimed to study the sleep status and the occurrence of sleep problems in children with autism spectrum disorder (ASD) aged 1-3 years, and to provide reference for guiding early comprehensive intervention for ASD children from the perspective of sleep. METHODS From January 1 to December 31, 2021, 74 ASD children who met the diagnostic criteria of "Diagnostic and Statistical Manual of Mental Disorders-5 (DSM-V)" served as case group while 84 typically-developing children of the same sex and age served as control group. An original Children's Sleep Habit Questionnaire was adopted to compare the sleep status of children in the two groups and to conduct statistical analysis on related factors. RESULTS The incidence of sleep problems in the case group (78.4%) was significantly higher than that in the control group (34.5%) (P < 0.001). Compared with the children in the control group, children in the case group had later bedtime (P < 0.05) and less sleep duration (P < 0.05), and required longer time to fall asleep (P < 0.001) The incidence of sleep problems in children who could fall asleep autonomously in the case group was significantly lower than that in children who needed parental help (P < 0.05). In the case group, the longer the screen exposure time, the higher the incidence of sleep problems (P < 0.05). CONCLUSIONS The incidence of sleep problems in ASD children aged 1-3 years is also high, mainly manifested in late bedtime, difficulty falling asleep, frequent night awakenings and less sleep duration. Both sleep patterns and screen exposure can impact their sleep. In the early comprehensive intervention of ASD children, it is necessary to pay full heed to their sleep status and take timely intervention measures in order to improve the quality of life for the ASD children and their families.
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Affiliation(s)
- Dan Yao
- Department of Pediatric Health Care, The Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China
| | - Shasha Wang
- Department of Pediatric Health Care, The Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China
| | - Fangfang Li
- Department of Pediatric Health Care, The Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China
| | - Minjie Gao
- Department of Pediatric Health Care, The Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China
| | - Jie Shao
- Department of Pediatric Health Care, The Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China
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