Sleep & Autism
We used data from the National Survey of Early Childhood Health, a nationally representative, cross-sectional study of the health and health care of children 4 to 35 months of age. Our main outcome measures were whether children had irregular naptime and bedtime schedules. Our main predictor was hours of television watched on a daily basis. We performed multivariate logistic regression analyses, adjusting for a variety of factors including demographic information, measures of maternal mental health, and measures of family interactions, to test the independent association of television viewing and irregular naptime and bedtime schedules... Television viewing among infants and toddlers is associated with irregular sleep schedules. More research is warranted to determine whether this association is causal.
Pineal glands of humans and other mammals secrete melatonin at night. Consequently, plasma levels of the hormone exhibit pronounced circadian rhythms, with nighttime levels rising tenfold or more above those observed during daylight hours.
Some kids with symptoms of autism may not have the disorder at all. In fact, a lack of sleep may be what's really causing the problem. That's what some scientists are suggesting as Salt Lake's national sleep conference winds to a close. Lack of concentration, motor restlessness, irritability, excessive impulsiveness, and learning problems. They're symptoms of autism - even attention deficit, and hyperactivity. But do all kids exhibiting these symptoms really have the disorders? National researchers, meeting in Salt Lake this week, believe many may be sleep deprived. If so, they're misdiagnosed and placed on stimulants like Ritalin for the wrong reason.
Children with autism spectrum disorders appear to experience these sleep disturbances more frequently and intensely than typically developing children. A child's sleeping problems can quickly become a daily parenting challenge.
Checking for medical issues and environmental variables and then planning and consistently as possible following a bedtime routine and a sleep training method can improve the quality of life for the whole family.
It is thought that all children with autism will experience disturbed sleep patterns at some point. This can have an enormous impact on their families.
Asperger syndrome (AS) and high-functioning autism (HFA) are pervasive developmental disorders (PDD) in individuals of normal intelligence. Childhood AS/HFA is considered to be often associated with disturbed sleep, in particular with difficulties initiating and/or maintaining sleep (insomnia). However, studies about the topic are still scarce. The present study investigated childhood AS/HFA regarding a wide range of parent reported sleep-wake behaviour, with a particular focus on insomnia. Thirty-two 8Ė12 yr old children with AS/HFA were compared with 32 age and gender matched typically developing children regarding sleep and associated behavioural characteristics. Several aspects of sleep-wake behaviour including insomnia were surveyed using a structured paediatric sleep questionnaire in which parents reported their children's sleep patterns for the previous six months. Recent sleep patterns were monitored by use of a one-week sleep diary and actigraphy. Behavioural characteristics were surveyed by use of information gleaned from parent and teacher-ratings in the High-Functioning Autism Spectrum Screening Questionnaire, and in the Strengths and Difficulties Questionnaire. Parent-reported difficulties initiating sleep and daytime sleepiness were more common in children with AS/HFA than in controls, and 10/32 children with AS/HFA (31.2%) but none of the controls fulfilled our definition of paediatric insomnia. The parent-reported insomnia corresponded to the findings obtained by actigraphy. Children with insomnia had also more parent-reported autistic and emotional symptoms, and more teacher-reported emotional and hyperactivity symptoms than those children without insomnia. Parental reports indicate that in childhood AS/HFA insomnia is a common and distressing symptom which is frequently associated with coexistent behaviour problems. Identification and treatment of sleep problems need to be a routine part of the treatment plan for children with AS/HFA.
Sleep in AS presents with a variety of disturbances: sleep time in early night was low, sleep spindles were decreased, REM sleep was disrupted and PLMS was prevalent.
Recently, reports have been forthcoming which suggest that melatonin given at bedtime improved the sleep of autistic children as well as other aspects of their behavior.
Melatonin is a well-tolerated, safe, relatively inexpensive, and effective drug, with minimal side effects, for the treatment of severe circadian rhythm sleep disorder in handicapped children. Wider use of this drug is recommended.
Administration of 3mg melatonin to five severely psychomotor retarded children resulted in a significant improvement
in their sleep-wake patterns.
The circadian rhythm of melatonin secretion is generated by the central pacemaker, or 'clock,' in the suprachiasmatic nuclei of the hypothalamus.
Although there are sound theoretical reasons for believing that autistic children may be manufacturing either too much melatonin or too little, our own viewpoint has been that many kids do not secrete enough.
Discusses neurobehavioral consequences of sleep loss, factors that impair sleeping, the pervasiveness of sleepiness and new ways to manage sleepiness.
The National Sleep Foundation and Best Practice Project Management, Inc., held a 2-day conference for expert representatives involved in the study and treatment of pediatric insomnia to examine the role of pharmacologic management of pediatric and adolescent insomnia and to make recommendations regarding the development of clinical trials in this area. Unanimously, the participants agreed on the need for trials of the safety and efficacy of pharmacologic agents used for insomnia in children and adolescents. Often, this population is prescribed pharmacotherapy despite the lack of evidence for efficacy or safety. Rigorous large-scale clinical trials are mandated to provide information on tolerability and efficacy profiles of sedative/hypnotics, allowing these patients to get a better night's sleep.
It seems possible that the study of the sleep-wake schedule may offer new insights into the understanding of behaviour and mood. Nonpharmacological interventions offer promise in the management of sleep disorders both of children and of adults.
Sleep, and particularly deep non-rapid-eye-movement sleep, increase interictal epileptiform activity. Sleep increases certain seizure types and the rate of generalization of partial seizures, however rapid-eye-movement sleep seems to suppress seizures.
Although the physiological mechanisms that underlie sleep disorders in children differ little from those seen in adults, the clinical manifestations may differ considerably between the two. For example, sleep apnea in adults affects men more than women, is more prevalent in the obese, and presents with symptoms of snoring and excessive somnolence. In preadolescent children, sleep apnea affects both sexes equally, is more closely correlated with adenotonsillar enlargement than obesity, and may be more likely to present with daytime inattention and learning problems rather than frank somnolence. Likewise, the insomnia and associated bedtime struggles of a 3-year-old bear little resemblance to the insomnia of a mature adult apart from the fact that both individuals are unable to easily fall asleep. Sleep disorders in children are reviewed with particular focus on age-related changes in normal sleep and on sleep disorders that primarily or exclusively affect children. Pediatric aspects of other sleep disorders will be reviewed in more limited detail, with examination of how age, developmental level, and comorbid conditions cause clinical presentation and treatment to differ from that of adults.
This study examined sleep patterns, sleep problems, and their correlates in children with autism spectrum disorders (ASD). Subjects consisted of 167 ASD children, including 108 with autistic disorder, 27 with Asperger's syndrome, and 32 with other diagnoses of ASD. Mean age was 8.8 years (SD = 4.2), 86% were boys. Parents completed a self-administered child sleep questionnaire. Results showed that average night sleep duration was 8.9 h (SD = 1.8), 16% of children shared a bed with parent. About 86% of children had at least one sleep problem almost every day, including 54% with bedtime resistance, 56% with insomnia, 53% with parasomnias, 25% with sleep disordered breathing, 45% with morning rise problems, and 31% with daytime sleepiness. Multivariate logistic regression analyses indicated that younger age, hypersensitivity, co-sleeping, epilepsy, attention-deficit/hyperactivity disorder (ADHD), asthma, bedtime ritual, medication use, and family history of sleep problems were related to sleep problems. Comorbid epilepsy, insomnia, and parasomnias were associated with increased risk for daytime sleepiness. Results suggest that both dyssomnias and parasomnias are very prevalent in children with ASD. Although multiple child and family factors are associated with sleep problems, other comorbid disorders of autism may play a major role.
Sleep problems are commonly reported in children with autistic disorders. Most studies are based on sleep questionnaires and sleep diaries, but polysomnographic and actigraphic data have also been used. In this study we investigated sleep in older individuals (aged 15-25 years) with autism and Asperger syndrome, using sleep questionnaires, sleep diaries and actigraphy. Although the sleep questionnaires completed by parents and caretakers revealed only a moderate degree of sleep problems, greater sleep disturbance was recorded with actigraphy. Using the latter method, low sleep efficiency (below 85 percent) or long sleep latency (more than 30 minutes) were found in 80 percent of the individuals. There was no early morning awakening, contrary to some earlier reports. This study suggests that even though subjective complaints of sleep disturbances are less common in adolescents and young adults with autism, this may be due to an adaptation process rather than an actual reduction in sleep disturbances.
It has been reported that 34% to 80% of children with an intellectual disability have sleep difficulties. Patzold, Richdale, and Tonge (1998) found that parents stress levels were increased due to their lack of sleep when their children diagnosed with Pervasive Developmental Disorder had short night sleep and early morning waking.
This sleep disturbance can bring complete havoc to the entire family, especially to the parent who has to stay up late with the child who has the sleep problem only to have to get up early with another child who doesn't have a sleep problem.
The sleep service represents a timely Scottish response to the uncovering of a considerable need resulting from the devastating impact of sleep problems on families of children with special needs.
The present study was undertaken in order to determine whether a set of clinical features, which are not included in the DSM-IV or ICD-10 for Asperger Syndrome (AS), are associated with AS in particular or whether they are merely a familial trait that is not related to the diagnosis... An aberrant processing of sensory information appears to be a common feature in AS. The impact of these and other clinical features that are not incorporated in the ICD-10 and DSM-IV on our understanding of AS may hitherto have been underestimated. These associated clinical traits may well be reflected by the behavioural characteristics of these individuals.
For certain children treatment with melatonin, with its dual effect as a hypnotic and as a means of altering the circadian pacemaker which controls the time of sleeping and waking will improve their sleep patterns and many aspects of behavior.
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In other words: Sublime or ridiculous? You decide!
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