Abstract
BackgroundSleep difficulties are prevalent in children with autism spectrum disorder (ASD). The temporal nature of the association between sleep problems and ASD is unclear because longitudinal studies are lacking. Our aim is to clarify whether sleep problems precede and worsen autistic traits and ASD or occur as a consequence of the disorder.MethodsRepeated sleep measures were available at 1.5, 3, 6, and 9 years of age in 5151 children participating in the Generation R Study, a large prospective birth cohort in the Netherlands. Autistic traits were determined with the Pervasive Developmental Problems score (PDP) of the Child Behavior Checklist (CBCL) at 1.5 and 3 years and the Social Responsiveness Scale (SRS) at 6 years. This cohort included 81 children diagnosed with ASD.ResultsSleep problems in early childhood were prospectively associated with a higher SRS score, but not when correcting for baseline PDP score. By contrast, a higher SRS score and an ASD diagnosis were associated with more sleep problems at later ages, even when adjusting for baseline sleep problems. Likewise, a trajectory of increasing sleep problems was associated with ASD.ConclusionsSleep problems and ASD are not bidirectionally associated. Sleep problems do not precede and worsen autistic behavior but rather co-occur with autistic traits in early childhood. Over time, children with ASD have an increase in sleep problems, whereas typically developing children have a decrease in sleep problems. Our findings suggest that sleep problems are part of the construct ASD.
Highlights
Sleep difficulties are prevalent in children with autism spectrum disorder (ASD)
Our findings suggest that sleep problems are part of the construct of ASD, do not predict severity of autistic traits over time
Our findings indicate that sleep problems do not contribute to an exacerbation of autistic traits but rather that sleep problems manifest as part of the broad ASD symptomatology
Summary
Sleep difficulties are prevalent in children with autism spectrum disorder (ASD). The temporal nature of the association between sleep problems and ASD is unclear because longitudinal studies are lacking. Our aim is to clarify whether sleep problems precede and worsen autistic traits and ASD or occur as a consequence of the disorder. Sleep problems are common in early childhood with prevalence estimates of up to 50% [18]; prevalence decline in typically developing children but not in children with ASD [23]. Risk factors or correlates of early childhood sleep problems are, for example, maternal psychopathology, parenting practices, child temperament, difficulties setting bedtime, and feeding patterns [19, 24, 25]. Studies have indicated that children with ASD have more sleep problems than typically developing children [16]. To unravel the complex temporal nature of the association between sleep problems and ASD, it is essential to have prospective research that measures autistic traits and associated sleep problems repeatedly throughout childhood
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