Skip to main content

Advertisement

Log in

Sleep in Children with Autism Spectrum Disorder

  • Sleep Disorders (P Gehrman, Section Editor)
  • Published:
Current Psychiatry Reports Aims and scope Submit manuscript

Abstract

The purposes of this paper are to provide an overview of the state of the science of sleep in children with autism spectrum disorder (ASD), present hypotheses for the high prevalence of insomnia in children with ASD, and present a practice pathway for promoting optimal sleep. Approximately two thirds of children with ASD have chronic insomnia, and to date, the strongest evidence on promoting sleep is for sleep education, environmental changes, behavioral interventions, and exogenous melatonin. The Sleep Committee of the Autism Treatment Network (ATN) developed a practice pathway, based on expert consensus, to capture best practices for screening, identification, and treatment for sleep problems in ASD in 2012. An exemplar case is presented to integrate key constructs of the practice pathway and address arousal and sensory dysregulation in a child with ASD and anxiety disorder. This paper concludes with next steps for dissemination of the practice pathway and future directions for research of sleep problems in ASD.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1
Fig. 2

Similar content being viewed by others

References

Papers of particular interest, published recently, have been highlighted as: • Of importance

  1. Gozal D. Sleep-disordered breathing and school performance in children. Pediatrics. 1998;102(3 Pt 1):616–20.

    Article  CAS  PubMed  Google Scholar 

  2. Maquet P. The role of sleep in learning and memory. Science. 2001;294(5544):1048–52. doi:10.1126/science.1062856.

    Article  CAS  PubMed  Google Scholar 

  3. Goodlin-Jones BL, Tang K, Liu J, Anders TF. Sleep patterns in preschool-age children with autism, developmental delay, and typical development. J Am Acad Child Adolesc Psychiatry. 2008;47(8):930–8. doi:10.1097/CHI.ObO13e3181799f7c.

    Article  PubMed  Google Scholar 

  4. Cohen DV, F. Handbook of autism and pervasive developmental disorders. 2nd ed. Toronto: John Wiley & Sons; 1997.

    Google Scholar 

  5. • Mazurek MO, Sohl K. Sleep and behavioral problems in children with autism Spectrum disorder. J Autism Dev Disord. 2016; doi:10.1007/s10803-016-2723-7. In this study, sleep disturbances in children with ASD are associated with daytime behavioral dysregulation. Night wakings in particular had the strongest correlation with daytime behavior problems, even after controlling for age and sex.

    PubMed  Google Scholar 

  6. DeVincent CJ, Gadow KD, Delosh D, Geller L. Sleep disturbance and its relation to DSM-IV psychiatric symptoms in preschool-age children with pervasive developmental disorder and community controls. J Child Neurol. 2007;22(2):161–9. doi:10.1177/0883073807300310.

    Article  PubMed  Google Scholar 

  7. Robinson-Shelton A, Malow BA. Sleep Disturbances in Neurodevelopmental Disorders. Curr Psychiatry Rep. 2016;18(1):6. doi:10.1007/s11920-015-0638-1.

    Article  PubMed  Google Scholar 

  8. Christensen CLBJ, Van Naarden Braun K, Bilder D, Charles J, Constantino JN, Daniels J, Durkin MS, Fitzgerald RT, Kurzius-Spencer M, Lee L, Pettygrove S, Robinson C, Schulz E, Wells C, Wingate MS, Zahorodny W, Yeargin-Allsopp M. Prevalence and characteristics of autism Spectrum disorder among children aged 8 years — Autism and developmental disabilities monitoring Network, 11 sites, United States. MMWR Surveill Summ. 2012;65(3):1–23.

    Article  Google Scholar 

  9. Parikshak NN, Luo R, Zhang A, Won H, Lowe JK, Chandran V, et al. Integrative functional genomic analyses implicate specific molecular pathways and circuits in autism. Cell. 2013;155(5):1008–21. doi:10.1016/j.cell.2013.10.031.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  10. Werling DM, Parikshak NN, Geschwind DH. Gene expression in human brain implicates sexually dimorphic pathways in autism spectrum disorders. Nat Commun. 2016;7:10717. doi:10.1038/ncomms10717.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  11. Yang Z, Matsumoto A, Nakayama K, Jimbo EF, Kojima K, Nagata K, et al. Circadian-relevant genes are highly polymorphic in autism spectrum disorder patients. Brain and Development. 2016;38(1):91–9. doi:10.1016/j.braindev.2015.04.006.

    Article  CAS  PubMed  Google Scholar 

  12. Willsey AJ, Sanders SJ, Li M, Dong S, Tebbenkamp AT, Muhle RA, et al. Coexpression networks implicate human midfetal deep cortical projection neurons in the pathogenesis of autism. Cell. 2013;155(5):997–1007. doi:10.1016/j.cell.2013.10.020.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  13. Wood CL, Warnell F, Johnson M, Hames A, Pearce MS, McConachie H, et al. Evidence for ASD recurrence rates and reproductive stoppage from large UK ASD research family databases. Autism Res. 2015;8(1):73–81. doi:10.1002/aur.1414.

    Article  PubMed  Google Scholar 

  14. Risch N, Hoffmann TJ, Anderson M, Croen LA, Grether JK, Windham GC. Familial recurrence of autism spectrum disorder: Evaluating genetic and environmental contributions. Am J Psychiatry. 2014;171(11):1206–13. doi:10.1176/appi.ajp.2014.13101359.

    Article  PubMed  Google Scholar 

  15. Eapen V, Crncec R, Walter A. Clinical outcomes of an early intervention program for preschool children with autism Spectrum disorder in a community group setting. BMC Pediatr. 2013;13(1):3. doi:10.1186/1471-2431-13-3.

    Article  PubMed  PubMed Central  Google Scholar 

  16. Eapen V, Crncec R, Walter A. Exploring links between genotypes, phenotypes, and clinical predictors of response to early intensive behavioral intervention in autism Spectrum disorder. Front Hum Neurosci. 2013;7:567. doi:10.3389/fnhum.2013.00567.

    Article  PubMed  PubMed Central  Google Scholar 

  17. Kanner L. Problems of nosology and psychodynamics of early infantile autism. Am J Orthop. 1949;19(3):416–26.

    Article  CAS  Google Scholar 

  18. Kanner L. Irrelevant and metaphorical language in early infantile autism. Am J Psychiatry. 1946;103(2):242–6. doi:10.1176/ajp.103.2.242.

    Article  CAS  PubMed  Google Scholar 

  19. Organization WH. International Classification of Diseases (ICD). 2016.

  20. Lord C, Rutter M, Le Couteur A. Autism diagnostic interview-revised: A revised version of a diagnostic interview for caregivers of individuals with possible pervasive developmental disorders. J Autism Dev Disord. 1994;24(5):659–85.

    Article  CAS  PubMed  Google Scholar 

  21. Association AP. Diagnostic and statistical manual of mental disorders. 5th ed. Arlington: American Psychiatric Publishing; 2013.

    Book  Google Scholar 

  22. Owens JA, Mindell JA. Pediatric insomnia. Pediatr Clin N Am. 2011;58(3):555–69. doi:10.1016/j.pcl.2011.03.011.

    Article  Google Scholar 

  23. Richdale AL, Schreck KA. Sleep problems in autism spectrum disorders: Prevalence, nature, & possible biopsychosocial aetiologies. Sleep Med Rev. 2009;13(6):403–11. doi:10.1016/j.smrv.2009.02.003.

    Article  PubMed  Google Scholar 

  24. Wiggs L, Stores G. Sleep patterns and sleep disorders in children with autistic spectrum disorders: Insights using parent report and actigraphy. Dev Med Child Neurol. 2004;46(6):372–80.

    Article  PubMed  Google Scholar 

  25. Schreck KA, Mulick JA, Smith AF. Sleep problems as possible predictors of intensified symptoms of autism. Res Dev Disabil. 2004;25(1):57–66.

    Article  PubMed  Google Scholar 

  26. Souders MC, Mason TB, Valladares O, Bucan M, Levy SE, Mandell DS, et al. Sleep behaviors and sleep quality in children with autism spectrum disorders. Sleep. 2009;32(12):1566–78.

    Article  PubMed  PubMed Central  Google Scholar 

  27. Owens J. Classification and epidemiology of childhood sleep disorders. Prim Care. 2008;35(3):533–546, vii. doi:10.1016/j.pop.2008.06.003.

    Article  PubMed  Google Scholar 

  28. Malow BA, Crowe C, Henderson L, McGrew SG, Wang L, Song Y, et al. A sleep habits questionnaire for children with autism spectrum disorders. J Child Neurol. 2009;24(1):19–24. doi:10.1177/0883073808321044.

    Article  PubMed  Google Scholar 

  29. Meltzer LJ. Brief report: Sleep in parents of children with autism spectrum disorders. J Pediatr Psychol. 2008;33(4):380–6. doi:10.1093/jpepsy/jsn005.

    Article  PubMed  Google Scholar 

  30. Elrod MG, Hood BS. Sleep differences among children with autism spectrum disorders and typically developing peers: A meta-analysis. J Dev Behav Pediatr. 2015;36(3):166–77. doi:10.1097/DBP.0000000000000140.

    Article  PubMed  Google Scholar 

  31. Bourgeron T. The possible interplay of synaptic and clock genes in autism spectrum disorders. Cold Spring Harb Symp Quant Biol. 2007;72:645–54. doi:10.1101/sqb.2007.72.020.

    Article  CAS  PubMed  Google Scholar 

  32. Malow BA, Adkins KW, Reynolds A, Weiss SK, Loh A, Fawkes D, et al. Parent-based sleep education for children with autism spectrum disorders. J Autism Dev Disord. 2014;44(1):216–28. doi:10.1007/s10803-013-1866-z.

    Article  PubMed  Google Scholar 

  33. Mindell JA, Meltzer LJ. Behavioural sleep disorders in children and adolescents. Ann Acad Med Singap. 2008;37(8):722–8.

    PubMed  Google Scholar 

  34. Meltzer LJ, Johnson C, Crosette J, Ramos M, Mindell JA. Prevalence of diagnosed sleep disorders in pediatric primary care practices. Pediatrics. 2010;125(6):e1410–8. doi:10.1542/peds.2009-2725.

    Article  PubMed  PubMed Central  Google Scholar 

  35. Tordjman S, Najjar I, Bellissant E, Anderson GM, Barburoth M, Cohen D, et al. Advances in the research of melatonin in autism spectrum disorders: Literature review and new perspectives. Int J Mol Sci. 2013;14(10):20508–42. doi:10.3390/ijms141020508.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  36. AARC-APT (American Association of Respiratory Care-Association of Polysomnography Technologists) clinical practice guideline. Polysomnography. Respir Care. 1995;40(12):1336–43.

    Google Scholar 

  37. Ornitz EM, Ritvo ER, Brown MB, La Franchi S, Parmelee T, Walter RD. The EEG and rapid eye movements during REM sleep in normal and autistic children. Electroencephalogr Clin Neurophysiol. 1969;26(2):167–75.

    Article  CAS  PubMed  Google Scholar 

  38. Tanguay PE, Ornitz EM, Forsythe AB, Ritvo ER. Rapid eye movement (REM) activity in normal and autistic children during REM sleep. J Autism Child Schizophr. 1976;6(3):275–88.

    Article  CAS  PubMed  Google Scholar 

  39. Diomedi M, Curatolo P, Scalise A, Placidi F, Caretto F, Gigli GL. Sleep abnormalities in mentally retarded autistic subjects: Down's syndrome with mental retardation and normal subjects. Brain and Development. 1999;21(8):548–53.

  40. Elia M, Ferri R, Musumeci SA, Del Gracco S, Bottitta M, Scuderi C, et al. Sleep in subjects with autistic disorder: A neurophysiological and psychological study. Brain and Development. 2000;22(2):88–92.

    Article  CAS  PubMed  Google Scholar 

  41. Godbout R, Bergeron C, Limoges E, Stip E, Mottron L. A laboratory study of sleep in Asperger's syndrome. Neuroreport. 2000;11(1):127–30.

    Article  CAS  PubMed  Google Scholar 

  42. Thirumalai SS, Shubin RA, Robinson R. Rapid eye movement sleep behavior disorder in children with autism. J Child Neurol. 2002;17(3):173–8.

    Article  PubMed  Google Scholar 

  43. Malow BA, Marzec ML, McGrew SG, Wang L, Henderson LM, Stone WL. Characterizing sleep in children with autism spectrum disorders: A multidimensional approach. Sleep. 2006;29(12):1563–71.

    Article  PubMed  Google Scholar 

  44. Buckley AW, Rodriguez AJ, Jennison K, Buckley J, Thurm A, Sato S, et al. Rapid eye movement sleep percentage in children with autism compared with children with developmental delay and typical development. Arch Pediatr Adolesc Med. 2010;164(11):1032–7. doi:10.1001/archpediatrics.2010.202.

    Article  PubMed  PubMed Central  Google Scholar 

  45. Wimpory D, Nicholas B, Nash S. Social timing, clock genes and autism: A new hypothesis. J Intellect Disabil Res. 2002;46(Pt 4):352–8.

    Article  CAS  PubMed  Google Scholar 

  46. Tordjman S, Anderson GM, Pichard N, Charbuy H, Touitou Y. Nocturnal excretion of 6-sulphatoxymelatonin in children and adolescents with autistic disorder. Biol Psychiatry. 2005;57(2):134–8. doi:10.1016/j.biopsych.2004.11.003.

    Article  CAS  PubMed  Google Scholar 

  47. Tordjman S, Davlantis KS, Georgieff N, Geoffray MM, Speranza M, Anderson GM, et al. Autism as a disorder of biological and behavioral rhythms: Toward new therapeutic perspectives. Front Pediatr. 2015;3:1. doi:10.3389/fped.2015.00001.

    Article  PubMed  PubMed Central  Google Scholar 

  48. Botbol M, Cabon P, Kermarrec S, Tordjman S. Biological and psychological rhythms: An integrative approach to rhythm disturbances in autistic disorder. J Physiol Paris. 2013;107(4):298–309. doi:10.1016/j.jphysparis.2013.03.009.

    Article  PubMed  Google Scholar 

  49. Travnickova-Bendova Z, Cermakian N, Reppert SM, Sassone-Corsi P. Bimodal regulation of mPeriod promoters by CREB-dependent signaling and CLOCK/BMAL1 activity. Proc Natl Acad Sci U S A. 2002;99(11):7728–33. doi:10.1073/pnas.102075599.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  50. Etchegaray JP, Lee C, Wade PA, Reppert SM. Rhythmic histone acetylation underlies transcription in the mammalian circadian clock. Nature. 2003;421(6919):177–82. doi:10.1038/nature01314.

    Article  CAS  PubMed  Google Scholar 

  51. Sasaki M, Yoshitane H, Du NH, Okano T, Fukada Y. Preferential inhibition of BMAL2-CLOCK activity by PER2 reemphasizes its negative role and a positive role of BMAL2 in the circadian transcription. J Biol Chem. 2009;284(37):25149–59. doi:10.1074/jbc.M109.040758.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  52. Barnes JW, Tischkau SA, Barnes JA, Mitchell JW, Burgoon PW, Hickok JR, et al. Requirement of mammalian Timeless for circadian rhythmicity. Science. 2003;302(5644):439–42. doi:10.1126/science.1086593.

    Article  CAS  PubMed  Google Scholar 

  53. Leroy C, Landais E, Briault S, David A, Tassy O, Gruchy N, et al. The 2q37-deletion syndrome: An update of the clinical spectrum including overweight, brachydactyly and behavioural features in 14 new patients. Eur J Hum Genet. 2013;21(6):602–12. doi:10.1038/ejhg.2012.230.

    Article  CAS  PubMed  Google Scholar 

  54. Nicholas B, Rudrasingham V, Nash S, Kirov G, Owen MJ, Wimpory DC. Association of Per1 and Npas2 with autistic disorder: Support for the clock genes/social timing hypothesis. Mol Psychiatry. 2007;12(6):581–92. doi:10.1038/sj.mp.4001953.

    Article  CAS  PubMed  Google Scholar 

  55. • Veatch OJ, Keenan BT, Gehrman PR, Malow BA, Pack AI. Pleiotropic genetic effects influencing sleep and neurological disorders. Lancet Neurol. 2017;16(2):158–70. doi:10.1016/S1474-4422(16)30339-8. A greater understanding of pleiotropic roles of genes influencing both sleep and neurological disorders could lead to new treatment strategies.

    Article  PubMed  Google Scholar 

  56. Ritvo ERRR, Yuliwer A, Brothers A, Freeman BJ, Plotkin S. Elevated daytime melatonin concentration in autism. Eur Child Adolesc Psychiatry. 1993;2:75–8.

    Article  Google Scholar 

  57. Nir I, Meir D, Zilber N, Knobler H, Hadjez J, Lerner Y. Brief report: Circadian melatonin, thyroid-stimulating hormone, prolactin, and cortisol levels in serum of young adults with autism. J Autism Dev Disord. 1995;25(6):641–54.

    Article  CAS  PubMed  Google Scholar 

  58. Kulman G, Lissoni P, Rovelli F, Roselli MG, Brivio F, Sequeri P. Evidence of pineal endocrine hypofunction in autistic children. Neuro Endocrinol Lett. 2000;21(1):31–4.

    PubMed  Google Scholar 

  59. Melke J, Goubran Botros H, Chaste P, Betancur C, Nygren G, Anckarsater H, et al. Abnormal melatonin synthesis in autism spectrum disorders. Mol Psychiatry. 2008;13(1):90–8. doi:10.1038/sj.mp.4002016.

    Article  CAS  PubMed  Google Scholar 

  60. Mulder EJ, Anderson GM, Kemperman RF, Oosterloo-Duinkerken A, Minderaa RB, Kema IP. Urinary excretion of 5-hydroxyindoleacetic acid, serotonin and 6-sulphatoxymelatonin in normoserotonemic and hyperserotonemic autistic individuals. Neuropsychobiology. 2010;61(1):27–32. doi:10.1159/000258640.

    Article  CAS  PubMed  Google Scholar 

  61. Veatch OJ, Veenstra-Vanderweele J, Potter M, Pericak-Vance MA, Haines JL. Genetically meaningful phenotypic subgroups in autism spectrum disorders. Genes Brain Behav. 2014;13(3):276–85. doi:10.1111/gbb.12117.

    Article  CAS  PubMed  Google Scholar 

  62. Chaste P, Clement N, Mercati O, Guillaume JL, Delorme R, Botros HG, et al. Identification of pathway-biased and deleterious melatonin receptor mutants in autism spectrum disorders and in the general population. PLoS One. 2010;5(7):e11495. doi:10.1371/journal.pone.0011495.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  63. Jonsson L, Ljunggren E, Bremer A, Pedersen C, Landen M, Thuresson K, et al. Mutation screening of melatonin-related genes in patients with autism spectrum disorders. BMC Med Genet. 2010;3:10. doi:10.1186/1755-8794-3-10.

    Google Scholar 

  64. Gupta R, Hutchins J. Melatonin: A panacea for desperate parents? (hype or truth). Arch Dis Child. 2005;90(9):986–7. doi:10.1136/adc.2005.075218.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  65. Andersen IM, Kaczmarska J, McGrew SG, Malow BA. Melatonin for insomnia in children with autism spectrum disorders. J Child Neurol. 2008;23(5):482–5. doi:10.1177/0883073807309783.

    Article  PubMed  Google Scholar 

  66. Galli-Carminati G, Deriaz N, Bertschy G. Melatonin in treatment of chronic sleep disorders in adults with autism: A retrospective study. Swiss Med Wkly. 2009;139(19–20):293–6.

    CAS  PubMed  Google Scholar 

  67. Jan JE, Espezel H, Appleton RE. The treatment of sleep disorders with melatonin. Dev Med Child Neurol. 1994;36(2):97–107.

    Article  CAS  PubMed  Google Scholar 

  68. Ishizaki A, Sugama M, Takeuchi N. Usefulness of melatonin for developmental sleep and emotional/behavior disorders--studies of melatonin trial on 50 patients with developmental disorders. No To Hattatsu. 1999;31(5):428–37.

    CAS  PubMed  Google Scholar 

  69. Paavonen EJ, Nieminen-von Wendt T, Vanhala R, Aronen ET, von Wendt L. Effectiveness of melatonin in the treatment of sleep disturbances in children with Asperger disorder. J Child Adolesc Psychopharmacol. 2003;13(1):83–95. doi:10.1089/104454603321666225.

    Article  PubMed  Google Scholar 

  70. Giannotti F, Cortesi F, Cerquiglini A, Bernabei P. An open-label study of controlled-release melatonin in treatment of sleep disorders in children with autism. J Autism Dev Disord. 2006;36(6):741–52. doi:10.1007/s10803-006-0116-z.

    Article  CAS  PubMed  Google Scholar 

  71. De Leersnyder H, Zisapel N, Laudon M. Prolonged-release melatonin for children with neurodevelopmental disorders. Pediatr Neurol. 2011;45(1):23–6. doi:10.1016/j.pediatrneurol.2011.02.001.

    Article  PubMed  Google Scholar 

  72. Malow BAAK, McGrew S, Wang L, Goldman S, Fawkes D, Burnette C. Melatonin for sleep in children with autism: A controlled trial examining dose, tolerability and outcomes. J Autism Dev Disord. 2011;42.

  73. McArthur AJ, Budden SS. Sleep dysfunction in Rett syndrome: A trial of exogenous melatonin treatment. Dev Med Child Neurol. 1998;40(3):186–92.

    Article  CAS  PubMed  Google Scholar 

  74. Garstang J, Wallis M. Randomized controlled trial of melatonin for children with autistic spectrum disorders and sleep problems. Child Care Health Dev. 2006;32(5):585–9. doi:10.1111/j.1365-2214.2006.00616.x.

    Article  CAS  PubMed  Google Scholar 

  75. Wasdell MB, Jan JE, Bomben MM, Freeman RD, Rietveld WJ, Tai J, et al. A randomized, placebo-controlled trial of controlled release melatonin treatment of delayed sleep phase syndrome and impaired sleep maintenance in children with neurodevelopmental disabilities. J Pineal Res. 2008;44(1):57–64. doi:10.1111/j.1600-079X.2007.00528.x.

    CAS  PubMed  Google Scholar 

  76. Wirojanan J, Jacquemont S, Diaz R, Bacalman S, Anders TF, Hagerman RJ, et al. The efficacy of melatonin for sleep problems in children with autism, fragile X syndrome, or autism and fragile X syndrome. J Clin Sleep Med. 2009;5(2):145–50.

    PubMed  PubMed Central  Google Scholar 

  77. Wright B, Sims D, Smart S, Alwazeer A, Alderson-Day B, Allgar V, et al. Melatonin versus placebo in children with autism spectrum conditions and severe sleep problems not amenable to behaviour management strategies: A randomised controlled crossover trial. J Autism Dev Disord. 2011;41(2):175–84. doi:10.1007/s10803-010-1036-5.

    Article  PubMed  Google Scholar 

  78. Cortesi F, Giannotti F, Sebastiani T, Panunzi S, Valente D. Controlled-release melatonin, singly and combined with cognitive behavioural therapy, for persistent insomnia in children with autism spectrum disorders: A randomized placebo-controlled trial. J Sleep Res. 2012;21(6):700–9. doi:10.1111/j.1365-2869.2012.01021.x.

    Article  PubMed  Google Scholar 

  79. Gringras P, Gamble C, Jones AP, Wiggs L, Williamson PR, Sutcliffe A, et al. Melatonin for sleep problems in children with neurodevelopmental disorders: Randomised double masked placebo controlled trial. BMJ. 2012;345:e6664. doi:10.1136/bmj.e6664.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  80. Goldman SE, Adkins KW, Calcutt MW, Carter MD, Goodpaster RL, Wang L, et al. Melatonin in children with autism spectrum disorders: Endogenous and pharmacokinetic profiles in relation to sleep. J Autism Dev Disord. 2014;44(10):2525–35. doi:10.1007/s10803-014-2123-9.

    Article  PubMed  PubMed Central  Google Scholar 

  81. Hall M, Buysse DJ, Dew MA, Prigerson HG, Kupfer DJ, Reynolds 3rd CF. Intrusive thoughts and avoidance behaviors are associated with sleep disturbances in bereavement-related depression. Depress Anxiety. 1997;6(3):106–12.

    Article  CAS  PubMed  Google Scholar 

  82. Levenson JC, Kay DB, Buysse DJ. The pathophysiology of insomnia. Chest. 2015;147(4):1179–92. doi:10.1378/chest.14-1617.

    Article  PubMed  PubMed Central  Google Scholar 

  83. Perlis ML, Smith MT, Orff H, Enright T, Nowakowski S, Jungquist C, et al. The effects of modafinil and cognitive behavior therapy on sleep continuity in patients with primary insomnia. Sleep. 2004;27(4):715–25.

    Article  PubMed  Google Scholar 

  84. Bonnet MH, Arand DL. Hyperarousal and insomnia: State of the science. Sleep Med Rev. 2010;14(1):9–15. doi:10.1016/j.smrv.2009.05.002.

    Article  PubMed  Google Scholar 

  85. Feige B, Baglioni C, Spiegelhalder K, Hirscher V, Nissen C, Riemann D. The microstructure of sleep in primary insomnia: An overview and extension. Int J Psychophysiol. 2013;89(2):171–80. doi:10.1016/j.ijpsycho.2013.04.002.

    Article  PubMed  Google Scholar 

  86. Healey ES, Kales A, Monroe LJ, Bixler EO, Chamberlin K, Soldatos CR. Onset of insomnia: Role of life-stress events. Psychosom Med. 1981;43(5):439–51.

    Article  CAS  PubMed  Google Scholar 

  87. Morin CM, Rodrigue S, Ivers H. Role of stress, arousal, and coping skills in primary insomnia. Psychosom Med. 2003;65(2):259–67.

    Article  PubMed  Google Scholar 

  88. Hutt C, Hutt SJ, Lee D, Ounsted C. Arousal and childhood autism. Nature. 1964;204:908–9.

    Article  CAS  PubMed  Google Scholar 

  89. Dawson G, Finley C, Phillips S, Galpert L, Lewy A. Reduced P3 amplitude of the event-related brain potential: Its relationship to language ability in autism. J Autism Dev Disord. 1988;18(4):493–504.

    Article  CAS  PubMed  Google Scholar 

  90. van Engeland H. The electrodermal orienting response to auditive stimuli in autistic children, normal children, mentally retarded children, and child psychiatric patients. J Autism Dev Disord. 1984;14(3):261–79.

    Article  PubMed  Google Scholar 

  91. Barry RJ, James AL. Coding of stimulus parameters in autistic, retarded, and normal children: Evidence for a two-factor theory of autism. Int J Psychophysiol. 1988;6(2):139–49.

    Article  CAS  PubMed  Google Scholar 

  92. Palkovitz RJ, Wiesenfeld AR. Differential autonomic responses of autistic and normal children. J Autism Dev Disord. 1980;10(3):347–60.

    Article  CAS  PubMed  Google Scholar 

  93. Hirstein W, Iversen P, Ramachandran VS. Autonomic responses of autistic children to people and objects. Proc Biol Sci. 2001;268(1479):1883–8.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  94. Ming X, Julu PO, Brimacombe M, Connor S, Daniels ML. Reduced cardiac parasympathetic activity in children with autism. Brain and Development. 2005;27(7):509–16.

    Article  PubMed  Google Scholar 

  95. Reynolds S, Lane SJ, Thacker L. Sensory processing, physiological stress, and sleep behaviors in children with and without autism spectrum disorders. Occupational Therapy Journal of Research. 2012;32(1). doi:10.3928/15394492-20110513-02.

  96. McIntosh DN, Miller LJ, Shyu V. Development and validation of the short sensory profile. In: Dunn W, editor. Sensory profile manual. San Antonio: Psychological Corporation; 1999. p. 59–73.

    Google Scholar 

  97. McIntosh DN, Miller LJ, Shyu V, Hagerman RJ. Sensory-modulation disruption, electrodermal responses, and functional behaviors. Developmental Medicine & Child Neurology. 1999;41(9):608–15. doi:10.1111/j.1469-8749.1999.tb00664.x.

    Article  CAS  Google Scholar 

  98. Dunn W. The sensory profile. San Antonio: The Psychological Corporation; 1999.

    Google Scholar 

  99. • Mazurek MO, Petroski GF. Sleep problems in children with autism spectrum disorder: Examining the contributions of sensory over-responsivity and anxiety. Sleep Med. 2015;16(2):270–9. doi:10.1016/j.sleep.2014.11.006. This study included 1, 347 children with ASD and revealed strong relationships among anxiety, sensory over-responsivity, and sleep disturbance, due to a state of hyperarousal.

    Article  PubMed  Google Scholar 

  100. • Hollway JA, Aman MG, Butter E. Correlates and risk markers for sleep disturbance in participants of the autism treatment Network. J Autism Dev Disord. 2013;43(12):2830–43. doi:10.1007/s10803-013-1830-y. This study found that GI disturbance, autism symptom severity, anxiety, and sensory sensitivities are correlated with sleep disturbances. IQ predicted sleep disturbances, suggesting that children with Asperger’s Disorder are vulnerable to sleep disturbances.

    Article  PubMed  Google Scholar 

  101. White SW, Lerner MD, McLeod BD, Wood JJ, Ginsburg GS, Kerns C, et al. Anxiety in youth with and without autism spectrum disorder: Examination of factorial equivalence. Behav Ther. 2015;46(1):40–53. doi:10.1016/j.beth.2014.05.005.

    Article  PubMed  Google Scholar 

  102. Kerns CM, Maddox BB, Kendall PC, Rump K, Berry L, Schultz RT, et al. Brief measures of anxiety in non-treatment-seeking youth with autism spectrum disorder. Autism. 2015;19(8):969–79. doi:10.1177/1362361314558465.

    Article  PubMed  Google Scholar 

  103. Kerns CM, Kendall PC, Berry L, Souders MC, Franklin ME, Schultz RT, et al. Traditional and atypical presentations of anxiety in youth with autism spectrum disorder. J Autism Dev Disord. 2014;44(11):2851–61. doi:10.1007/s10803-014-2141-7.

    Article  PubMed  PubMed Central  Google Scholar 

  104. Yerys BE, Wallace GL, Sokoloff JL, Shook DA, James JD, Kenworthy L. Attention deficit/hyperactivity disorder symptoms moderate cognition and behavior in children with autism spectrum disorders. Autism Res. 2009;2(6):322–33. doi:10.1002/aur.103.

    PubMed  PubMed Central  Google Scholar 

  105. Aston-Jones G, Rajkowski J, Cohen J. Role of locus coeruleus in attention and behavioral flexibility. Biol Psychiatry. 1999;46(9):1309–20.

    Article  CAS  PubMed  Google Scholar 

  106. Aston-Jones G, Cohen JD. An integrative theory of locus coeruleus-norepinephrine function: Adaptive gain and optimal performance. Annu Rev Neurosci. 2005;28:403–50.

    Article  CAS  PubMed  Google Scholar 

  107. Panju S, Brian J, Dupuis A, Anagnostou E, Kushki A. Atypical sympathetic arousal in children with autism spectrum disorder and its association with anxiety symptomatology. Mol Autism. 2015;6:64. doi:10.1186/s13229-015-0057-5.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  108. Brennan AR, Arnsten AF. Neuronal mechanisms underlying attention deficit hyperactivity disorder: The influence of arousal on prefrontal cortical function. Ann N Y Acad Sci. 2008;1129:236–45.

    Article  PubMed  PubMed Central  Google Scholar 

  109. Swanson LW. The locus coeruleus: A cytoarchitectonic, Golgi and immunohistochemical study in the albino rat. Brain Res. 1976;110(1):39–56.

    Article  CAS  PubMed  Google Scholar 

  110. Swanson LW, Hartman BK. The central adrenergic system. An immunofluorescence study of the location of cell bodies and their efferent connections in the rat utilizing dopamine-beta-hydroxylase as a marker. J Comp Neurol. 1975;163(4):467–505.

    Article  CAS  PubMed  Google Scholar 

  111. Aston-Jones G, Bloom FE. Activity of norepinephrine-containing locus coeruleus neurons in behaving rats anticipates fluctuations in the sleep-waking cycle. J Neurosci. 1981;1(8):876–86.

    CAS  PubMed  Google Scholar 

  112. Aston-Jones G, Bloom FE. Norepinephrine-containing locus coeruleus neurons in behaving rats exhibit pronounced responses to non-noxious environmental stimuli. J Neurosci. 1981;1(8):887–900.

    CAS  PubMed  Google Scholar 

  113. Valentino RJ, Van Bockstaele E. Convergent regulation of locus coeruleus activity as an adaptive response to stress. Eur J Pharmacol. 2008;583(2–3):194–203.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  114. Berridge CW, Schmeichel BE, Espana RA. Noradrenergic modulation of wakefulness/arousal. Sleep Med Rev. 2012;16(2):187–97. doi:10.1016/j.smrv.2011.12.003.

    Article  PubMed  PubMed Central  Google Scholar 

  115. Renton GH, Weil-Malherbe H. Adrenaline and noradrenaline in human plasma during natural sleep. J Physiol. 1956;131(1):170–5.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  116. Spielman AJ, Caruso LS, Glovinsky PB. A behavioral perspective on insomnia treatment. Psychiatr Clin North Am. 1987;10(4):541–53.

    CAS  PubMed  Google Scholar 

  117. • Malow BA, Byars K, Johnson K, Weiss S, Bernal P, Goldman SE, et al. A practice pathway for the identification, evaluation, and management of insomnia in children and adolescents with autism spectrum disorders. Pediatrics. 2012;130(Suppl 2):S106–24. doi:10.1542/peds.2012-0900I. This is the first consensus paper to provide a practical algorithm supporting decision-making for providers caring for children with ASD and insomnia.

    Article  PubMed  Google Scholar 

  118. Linehan MM. Skills training manual for treating borderline personality disorder. The Guilford Press; 1993.

  119. Kid N. Yoga for Kids. 2016.

  120. Silva LM, Cignolini A. A medical qigong methodology for early intervention in autism spectrum disorder: A case series. Am J Chin Med. 2005;33(2):315–27. doi:10.1142/S0192415X05002837.

    Article  PubMed  Google Scholar 

  121. Silva LM, Cignolini A, Warren R, Budden S, Skowron-Gooch A. Improvement in sensory impairment and social interaction in young children with autism following treatment with an original qigong massage methodology. Am J Chin Med. 2007;35(3):393–406. doi:10.1142/S0192415X07004916.

    Article  PubMed  Google Scholar 

  122. Silva LM, Schalock M, Ayres R, Bunse C, Budden S. Qigong massage treatment for sensory and self-regulation problems in young children with autism: A randomized controlled trial. Am J Occup Ther. 2009;63(4):423–32.

    Article  PubMed  Google Scholar 

  123. Silva LM, Schalock M, Gabrielsen K. Early intervention for autism with a parent-delivered qigong massage program: A randomized controlled trial. Am J Occup Ther. 2011;65(5):550–9.

    Article  PubMed  Google Scholar 

  124. Hanh TN. Mindful movements: Ten exercises for well-being. Berkley: Parralax Press; 2008.

    Google Scholar 

  125. Dadoly A. Two techniques for reducing stress. 2011. www.health.harvard.edu/blog/two-techniques-for-reducing-stress-201104092235.

  126. Owens JA, Spirito A, McGuinn M. The Children's Sleep Habits Questionnaire (CSHQ): Psychometric properties of a survey Instrument for school-aged children. Sleep. 2000;23(8):1043–51.

  127. Research Units on Pediatric Psychopharmacology Anxiety Study Group. The pediatric anxiety rating scale (PARS): Development and psychometric properties. J Am Acad Child Adolesc Psychiatry. 2002;41:1061–1069.

  128. Storch EA, Wood JJ, Ehrenreich-May J, Jones AM, Park JM, Lewin AB, et al. Convergent and discriminant validity and reliability of the pediatric anxiety rating scale in youth with autism spectrum disorders. J Autism Dev Disord. 2012;42(11):2374–82. doi:10.1007/s10803-012-1489-9.

    Article  PubMed  Google Scholar 

  129. Kerns CM, Renno, P. Kendall, P. C., Wood, J.J., & Storch, E. A. Anxiety Disorders Interview Schedule – Autism Addendum: Reliability and Validity in Children with Autism Spectrum Disorder. Journal of Child Clinical and Adolescent Psychology. 2017.

  130. Kerns CM, Wood JJ, Kendall PC, Renno P, Crawford EA, Mercado RJ, et al. The Treatment of Anxiety in Autism Spectrum Disorder (TAASD) study: rationale, design and methods. Journal of Child and Family Studies. 2016;25(6):1889–902.

  131. Storch EA, Arnold EB, Lewin AB, Nadeau JM, Jones AM, De Nadai AS, et al. The effect of cognitive-behavioral therapy versus treatment as usual for anxiety in children with autism spectrum disorders: A randomized, controlled trial. J Am Acad Child Adolesc Psychiatry. 2013;52(2):132–142 e2. doi:10.1016/j.jaac.2012.11.007.

    Article  PubMed  Google Scholar 

  132. Birmaher B, Brent DA, Chiappetta L, Bridge J, Monga S, Baugher M. Psychometric properties of the screen for child anxiety related emotional disorders (SCARED): A replication study. J Am Acad Child Adolesc Psychiatry. 1999;38(10):1230–6. doi:10.1097/00004583-199910000-00011.

    Article  CAS  PubMed  Google Scholar 

  133. Birmaher B, Khetarpal S, Brent D, Cully M, Balach L, Kaufman J, et al. The screen for child anxiety related emotional disorders (SCARED): Scale construction and psychometric characteristics. J Am Acad Child Adolesc Psychiatry. 1997;36(4):545–53. doi:10.1097/00004583-199704000-00018.

    Article  CAS  PubMed  Google Scholar 

  134. Reaven JA, Blakeley-Smith A, Nichols S, Dasari M, Flanigan E, Hepburn S. Cognitive-behavioral group treatment for anxiety symptoms in children with high-functioning autism spectrum disorders a pilot study. Focus on Autism and Other Developmental Disabilities. 2009;24(1):27–37.

    Article  Google Scholar 

Download references

Acknowledgements

The corresponding author completed a T32 postdoctoral sleep fellowship with Dr. Allan I. Pack at the University of Pennsylvania. The case presentation in this manuscript was a participant in a study funded by the Department of Defense, Office of the Congressionally Directed Medical Research Program, 2013 AR120166.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Margaret C. Souders.

Ethics declarations

Conflict of Interest

Margaret C. Souders, Stefanie Zavodny, Whitney Eriksen, Rebecca Sinko, James Connell, Connor Kerns, Roseann Schaaf, and Jennifer Pinto-Martin report that the case presented in this review manuscript was a participant in a study funded by a grant from the Department of Defense.

Human and Animal Rights and Informed Consent

The case presented in the article was part of a research study funded by the Department of Defense and approved by the IRB at the Children's Hospital of Philadelphia (IRB 13-010092). Informed consent from the parents and assent from the child were obtained.

Additional information

This article is part of the Topical Collection on Sleep Disorders

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Souders, M.C., Zavodny, S., Eriksen, W. et al. Sleep in Children with Autism Spectrum Disorder. Curr Psychiatry Rep 19, 34 (2017). https://doi.org/10.1007/s11920-017-0782-x

Download citation

  • Published:

  • DOI: https://doi.org/10.1007/s11920-017-0782-x

Keywords

Navigation