The Relationship Between Sleep Problems and Daytime Behavior in Children of Different Ages With Autism Spectrum Disorders

The Relationship Between Sleep Problems and Daytime Behavior in Children of Different Ages With Autism Spectrum Disorders

abstract
BACKGROUND: The purpose of the current study was to evaluate the relationships among sleep problems and daytime behaviors in a large, well-defined cohort of children with autism spectrum disorder (ASD).

METHODS: Out of a registry population of 3452 children with ASDs, a subset of 1193 children aged 4 to 10 years of age from 14 centers across the country was used to evaluate the relationship between varying levels of sleep problems and daytime behavior. Measures included Children’s Sleep Habits Questionnaire, Vineland Adaptive Behavior Scales, Survey Interview Form, Second Edition, and Child Behavior
Checklist. Multiple analysis of covariance was used to assess the association between sleep and behavior.

RESULTS: Results suggest that sleep problems, as identified by parent report by use of the Children’s Sleep Habits Questionnaire, have a negative relationship with daytime behavior. More specifically, children
with ASDs and sleep problems had more internalizing and externalizing behavior problems, as measured by the Child Behavior Checklist, and poorer adaptive skill development, as measured by the Vineland
Adaptive Behavior Scales, than children with ASDs and no sleep problems. Children with moderate to severe sleep problems had greater behavior difficulties, but not necessarily poorer adaptive functioning,
than children with mild to moderate sleep problems. Both preschooland school-aged children demonstrated a negative relationship between behavior and sleep, whereas the relationship between sleep and
adaptive functioning was much more variable.

CONCLUSIONS: These results suggest that, although sleep has a negative relationship with internalizing and externalizing behavior, it may have a different relationship with the acquisition of adaptive skills. 

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Prenatal Smoking Linked to High-Functioning Autism in Kids

Goodwin, Jenifer. U.S. News & World Report (May 2012): 1

FRIDAY, May 4 (HealthDay News) -- If a woman smokes during pregnancy, it may increase her child's risk of high-functioning autism, a new study suggests.

But the raised risk was slight, experts said. And researchers found no association between maternal smoking and more severe forms of autism.

What the findings suggest is that although autism spectrum disorders share many of the same symptoms, subtypes of the disorder likely have many different genetic and environmental causes that vary from person to person and by type of autism, explained study author Amy Kalkbrenner, an assistant professor in the University of Wisconsin-Milwaukee Zilber School of Public Health.

"We know 'autism spectrum disorders' is an umbrella term. What we're showing is the response to a environmental toxin may differ by the subtype of autism a child has," Kalkbrenner said.

The study was published online in the journal Environmental Health Perspectives.

Kalkbrenner and her colleagues examined data on maternal smoking from birth certificates of nearly 634,000 U.S. children born in 11 states in 1992, 1994, 1996 and 1998. That data was compared with information on 3,315 children aged 8 and under diagnosed with an autism spectrum disorder from the U.S. Centers for Disease Control and Prevention's Autism and Developmental Disabilities Monitoring Network.

About 13 percent of the mothers smoked during pregnancy, and 11 percent of the mothers of kids with an autism spectrum disorder smoked during pregnancy, the investigators found.

According to the study, kids born to moms who smoked during pregnancy had about a 25 percent increased risk of having high-functioning autism, such as Asperger's syndrome. However, the results did not reach statistical significance.

Nor was smoking a clear risk factor for autistic disorder (a more severe form of autism).

The researchers noted that the data used in the study may underestimate the true prevalence of autism spectrum disorders among mothers who smoke because lower-income kids are less likely to be identified as having autism, and lower-income mothers are also more likely to smoke during pregnancy.

When researchers did another statistical analysis that took into account a suspected undercounting of kids with autism, the analysis did suggest a statistically significant association between smoking and high-functioning autism in offspring.

Alycia Halladay, director for environmental research for Autism Speaks, said the research is consistent with prior studies that have found either no association or only a mild association between smoking during pregnancy and autism in children. What's interesting about this paper is that it included data on large numbers of kids, she added, and it hinted at differences in the contributing factors for various types of autism spectrum disorders.

"It really supports the idea that there are multiple causes of autism, both genetic and environmental. When we talk about autism being one group or disorder, we really need to ensure we have these groups as well-defined as possible," Halladay said. "This is a very heterogeneous disorder."

There are multiple reasons why tobacco might raise the risk of autism, Kalkbrenner noted. Tobacco can restrict oxygen flow to the baby, while the nicotine is known to interact with the nervous system and cross the placenta into the developing fetus. "There are many potential biological pathways for which tobacco can harm the developing baby," she said.

Autism is a neurodevelopmental disorder that's characterized by problems with social interaction, verbal and nonverbal communication and restricted interests and behaviors. An estimated one in 88 U.S. children has the disorder, according to the CDC.

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