Better Sleep Habits Improve Functioning in Autism

Thomas S. May MA

BOSTON—Good sleep hygiene is associated with improved social and emotional functioning in children with autism spectrum disorders (ASDs), results of a recent study show.

Presented at the 2007 annual meeting of the American Academy of Neurology, the study was led by Beth Malow, MD, associate professor in the Department of Neurology, Vanderbilt University Medical Center, and medical director, Vanderbilt Sleep Disorders Center, Nashville, Tenn.

Dr. Malow’s team investigated whether parentally reported sleep concerns in children with ASDs could be substantiated by findings on sleep questionnaires and polysomnography (PSG). The researchers also wanted to find out if the quality and duration of sleep were related to daytime functioning in children with ASDs.

The investigators enrolled 21 children with ASDs and 10 typically developing children (age range, 4 to 10 years) in a cross-sectional study involving validated questionnaires, sleep histories and diaries, two nights of PSG and assessment with the Autism Diagnostic Observation Schedule (ADOS). Children with ASDs were defined as either good sleepers (n=10) or poor sleepers (n=11) on the basis of parental reports.

An analysis of PSG recordings showed that poor sleepers (as reported by the parents) had prolonged sleep latency, decreased sleep efficiency, decreased percentage of rapid eye movement (REM) sleep and increased percentage of non-REM sleep (stages 3 and 4) on night 1. There were no significant differences among the groups on night 2.

In addition to delayed sleep onset, poor sleepers also exhibited decreased sleep duration, compared with good sleepers. Furthermore, poor sleepers had higher scores related to affective problems on the Child Behavior Checklist and more problems with reciprocal social interaction on the ADOS.

These data show that parental concerns about their child’s sleep are substantiated by objective data, including sleep studies, according to Dr. Malow. “In the past, investigators claimed that parents of children with special needs may feel that their child is not sleeping well, due to parental overconcern,” she said. “Our study shows that the parents do have an accurate perception of how their child sleeps.” Additionally, the study revealed an association between children not sleeping well and having more difficulty with mood during the day, as well as more difficulty with reciprocal social interactions, on an assessment of autism performed by a psychologist, Dr. Malow noted.

“Finally, we documented that some children with autism spectrum disorders are in fact good sleepers, opening up the possibility of converting poor sleepers to good sleepers,” she added. This raises the possibility that improving sleep in children with ASDs may improve their daytime behaviors, although conducting interventional studies involving trials of parental education or medications to improve sleep, for example, will be necessary to test this theory.

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