0106 Prospective Sleep Patterns in Infants Later Diagnosed with ASD: A Case Series

Abstract

Abstract Introduction Sleep problems among individuals with autism spectrum disorder (ASD) are pervasive across the lifespan. However, little is known about the emergence of sleep patterns in the months preceding a child’s diagnosis. It is unclear whether sleep problems precede diagnoses and the emergence of core diagnostic features, or whether they simply co-emerge with early behavioral markers across the first three years of life. Thus, our study examined prospective patterns of sleep and development from 6-36 months among children at high familial likelihood for ASD, beginning prior to features of ASD/atypical development. Methods Using a case series approach, participants included 9 children at high familial likelihood for ASD—3 who developed ASD, 3 who had early ASD concerns but did not develop ASD (ASD-C), and 3 who were typically developing (TD). Sleep was assessed using actigraphy. Developmental competence and ASD features were monitored using standardized assessments (ASOS-2 and MSEL) and parent reports (VABS, M-CHAT). Results All children with ASD experienced sleep difficulties in early development (e.g., extended night wakings). However, different patterns emerged for each child: adequate sleep at six months, followed by less severe but persistent sleep problems across development (case 1); low levels of sleep problems during early infancy, followed by improved sleep from 9-15 months and a sharp increase in sleep problems at 24 months (case 2); sleep problems at 9 and 12 months, followed by a decrease in sleep problems across the remainder of early development (case 3). In general, sleep problems emerged prior to ASD diagnoses and did not appear to covary with ASD symptoms. However, sleep problems for case 2 intensified in line with a significant regression in skills and the onset of ASD features at 24 months. Conclusion Sleep problems are a normative part of infancy for most children—including those with TD. However, sleep may begin to distinguish some children with ASD from their peers around 12 months of age. Although sleep problems appear most severe and persistent for children with ASD, patterns are variable and sleep intervention efforts should be individualized to meet the heterogeneity in ASD. Support (if any) R00 MH092431; PI Schwichtenberg.