Abstract
Children with Fetal Alcohol Spectrum Disorders (FASD) and Autism Spectrum Disorders (ASD) experience significantly higher rates of sleep disturbances than their typically developing peers. However, little is known about the association between sleep and the cognitive phenotype in these clinical populations. Structural damage affecting cortical and subcortical connectivity occurs as a result of prenatal alcohol exposure in children with FASD, whilst it is believed an abundance of short-range connectivity explains the phenotypic manifestations of childhood ASD. These underlying neural structural and connectivity differences manifest as cognitive patterns, with some shared and some unique characteristics between FASD and ASD. This is the first study to examine sleep and its association with cognition in individuals with FASD, and to compare sleep in individuals with FASD and ASD. We assessed children aged 6–12 years with a diagnosis of FASD (n = 29), ASD (n = 21), and Typically Developing (TD) children (n = 46) using actigraphy (CamNTech Actiwatch 8), digit span tests of working memory (Weschler Intelligence Scale), tests of nonverbal mental age (MA; Ravens Standard Progressive Matrices), receptive vocabulary (British Picture Vocabulary Scale), and a choice reaction time (CRT) task. Children with FASD and ASD presented with significantly shorter total sleep duration, lower sleep efficiency, and more nocturnal wakings than their TD peers. Sleep was significantly associated with scores on the cognitive tests in all three groups. Our findings support the growing body of work asserting that sleep is significant to cognitive functioning in these neurodevelopmental conditions; however, more research is needed to determine cause and effect.
Highlights
Sleep is not a cessation of the waking state; rather, it is an active brain state subserving neural health
We found that Typically Developing (TD) children had the highest mean mental age (MA), and the Fetal Alcohol Spectrum Disorders (FASD) group had the lowest, which was expected given the higher levels of learning difficulties in children with FASD [10]
Sleep was significantly associated with several cognitive domains in all three groups, and sleep disturbances were observed at significantly higher rates in the clinical groups than the TD group
Summary
Sleep is not a cessation of the waking state; rather, it is an active brain state subserving neural health. Brain Sci. 2020, 10, 863 an increasingly important area of therapeutic concern, especially given that sleep interventions can ameliorate behavioural and cognitive outcomes in children [7]. The Childhood Autism Rating Scale, Parents Version (CARS) [40] This is a 15-item screening questionnaire that determines the severity of autism symptoms, using a seven-point Likert Scale, ranging from typical to atypical behaviour. Neurobehavioural Screening Tool (NST) [41] This is a ten-item binary checklist that screens for possible FASD in children. The NST has low sensitivity but high specificity (62% and 100%, respectively) and in the absence of a more accurate measurement tool, is a widely used screening mechanism for FASD in children. Scores above 8, plus confirmed prenatal alcohol exposure, indicate probable FASD [41]
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