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High prevalence of sleep problems in children with autism spectrum disorder

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Cooperation key to addressing ASD sleep problems

We can help reduce night waking and improve sleep onset within 5-15 weeks after parents have been trained. “Successful behavioral programs include bedtime fading, teaching healthy sleep practices, and increasing a child’s physical activity during the day,” Catherine Lord, PhD, wrote. Although research supports melatonin as an effective intervention for helping children fall asleep and sleep longer, the high percentage of children in the study already taking melatonin reveals its limitations. “Thus, it is recommended that families try behavioral programs before trials with melatonin,” she wrote.

But families and providers can only work together to address sleep issues if providers ask about sleep concerns, help families implement interventions, and follow up with progress. “In most cases, this help does not have to come from sleep experts, but does require dedicated time and effort using the now-growing base of evidence about effective interventions,” she concluded.

These comments are condensed from an editorial (Pediatrics. 2019 Feb 11. doi: 10.1542/peds.2018-2629) by Dr. Lord , a professor of psychiatry and biobehavioral sciences at the University of California Los Angeles. Dr. Lord reports royalties from diagnostic instruments used in this study that were donated to a not-for-profit agency. She is supported by grants from the National Institutes of Health and Simons Foundation Autism Research Initiative.



Scores were adjusted for maternal education and race/ethnicity, family income, child age and sex, and child cognitive scores on the Mullen Scales of Early Learning (MSEL). The researchers also adjusted for genetic and/or neurologic diagnoses, including Down syndrome, fragile X, Rett syndrome, tuberous sclerosis, cerebral palsy, and neurofibromatosis.

Autistic children tended to have lower MSEL scores than the other children. Both the autistic children and those with other developmental disorders and delays were more likely than those in the general population to have neurologic or genetic conditions.

Based on a cutoff score of 48, autistic children had more than double the odds of sleep problems, compared with children in the general population (adjusted odds ratio, 2.37; P = .001) and children with other developmental delays (aOR, 2.12; P = .001).

With a cutoff of 41, ASD children’s odds of sleep problems were 1.45 times greater than the general population (P = .023) and 1.75 times greater than those with developmental delays (P = .001).

But children with developmental delays who displayed autistic characteristics did not have not significantly different prevalence of sleep problems than children with ASD had.

“The phenotypic overlay between children with ASD and children with developmental delay with ASD [characteristics] may explain the similarities in sleep disturbance among these two groups,” the authors wrote. Both groups have “higher rates of obsessive-compulsive symptoms, self-injurious behavior, ADHD symptoms, and developmental and communication impairments” than children with developmental delays without autistic characteristics.

The research was funded by the Centers for Disease Control and Prevention, the National Institutes of Health, and the National Center for Advancing Translational Sciences Colorado Clinical and Translational Science Award. Dr Reynolds consults for Ovid Therapeutics regarding evaluation of sleep severity and improvement in clinical trials. No other authors had disclosures.

SOURCE: Reynolds AM et al. Pediatrics. 2019 Feb. 11. doi: 10.1542/peds.2018-0492.

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