Abstract
Children with Foetal Alcohol Spectrum Disorders (FASD) and Autism Spectrum Disorders (ASD) experience significantly higher rates of sleep disturbances than their typically developing (TD) peers. Pre-sleep anxiety and waking emotional content is known to affect the content and frequency of nightmares, which can be distressing to children and caregivers. This is the first study to analyse nightmare frequency and content in FASD, and to assess its association with psychometric outcomes. Using online caregiver questionnaires, we assessed reports from 277 caregivers of children with ASD (n = 61), FASD (n = 112), and TD children (n = 104) using the Children’s Sleep Habits Questionnaire (CSHQ), the Child Behaviour Checklist (CBCL), the Spence Children’s Anxiety Scale (SCAS), and the Behaviour Rating Inventory for Executive Functioning (BRIEF). Within the ASD group, 40.3% of caregivers reported their children had nightmares. Within the FASD group, 73.62% of caregivers reported their children had nightmares, and within the TD group, 21.36% of caregivers reported their children had nightmares. Correlation analysis revealed significant associations between anxiety and nightmares, maladaptive behaviour and nightmares, and executive functioning and nightmares in the TD and FASD groups, but not ASD group. This paper adds to the emerging body of work supporting the need for sleep interventions as part of clinical practice with regard to children with ASD and FASD. As a relatively niche but important area of study, this warrants much needed further research.
Highlights
During rapid eye movement (REM) sleep, it is thought that brainstem generators physically activate motor, perceptual, affective, cognitive, and amnestic circuits whose information is synthesised into what is known as dreaming [1]
Children in the typically developing (TD) group reported being chased by a ‘dog’ whilst children in the clinical groups reported being chased by more fantastic characters such as ‘aliens’, ‘monsters’, or ‘large insects’
Whilst TD children reported dreaming of the death of ‘people’ and ‘puppies’, the children from the Autism Spectrum Disorders (ASD) and Foetal Alcohol Spectrum Disorders (FASD) groups had dreamed of the death of unusual characters like ‘toys’ and ‘aliens’, or significant family members
Summary
During rapid eye movement (REM) sleep, it is thought that brainstem generators physically activate motor, perceptual, affective, cognitive, and amnestic circuits whose information is synthesised into what is known as dreaming [1]. Nightmares are defined as disturbing mental experiences that awaken the dreamer and generally occur in REM sleep [5,6,7,8,9], alongside typical negative emotions of terror, fear, and anxiety [9,10,11,12,13]. Nightmare frequency is associated with the mood regulation function of dreaming [18], suggesting nightmares occur as a result of intense pre-sleep negative emotions. Night time fears, anxiety, and recurrent nightmares are commonly presented problems in paediatric sleep, in children with significant trauma [20]. Negative affect and trauma is connected to both associative and hyperassociative nightmares [21]
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