Abstract
Sleep disorder emerges as a common comorbidity in children with autism spectrum disorder (ASD), and the interaction between the core symptoms of ASD and its sleep disorder remains unclear. Repetitive transcranial magnetic stimulation (rTMS) was used on the bilateral dorsolateral prefrontal cortex (DLPFC) to investigate the efficacy of rTMS on the core symptoms of ASD and comorbid sleep problems as well as the mediation role of the ASD symptoms between rTMS intervention and sleep improvement. A total of 41 Chinese children with ASD and who met the criteria in the fifth edition of the American Diagnostic and Statistical Manual of Mental Disorders were recruited, and 39 of them (mean age: 9.0 ± 4.4 years old; the male–female ratio was 3.9: 1) completed the study with the stimulating protocol of high frequency on the left DLPFC and low frequency on the right DLPFC. They were all assessed three times (before, at 4 weeks after, and at 8 weeks after the stimulation) by the Children's Sleep Habits Questionnaire (CSHQ), Strengths and Difficulties Questionnaire (SDQ), Childhood Autism Rating Scale, Repetitive Behavior Questionnaire-2, and Short Sensory Profile (SSP). The repeated-measures ANOVA showed that the main effect of “intervention time” of CSHQ (F = 25.103, P < 0.001), SSP (F = 6.345, P = 0.003), and SDQ (F = 9.975, P < 0.001) was statistically significant. By Bayesian mediation analysis, we only found that the total score of SSP mediated the treating efficacy of rTMS on CSHQ (αβ = 5.11 ± 1.51, 95% CI: 2.50–8.41). The percentage of mediation effect in total effect was 37.94%. Our results indicated the treating efficacy of rTMS modulation on bilateral DLPFC for both autistic symptoms and sleep disturbances. The sensory abnormality of ASD mediated the improvement of rTMS on sleep problems of ASD.
Highlights
Autism spectrum disorder (ASD) is a severe neurodevelopmental disorder characterized by social–communicative atypicality and a restrictive and rigid repertoire of behaviors [1]
For Strengths and Difficulties Questionnaire (SDQ), the main effect of “time” of the total score was statistically significant (F = 9.975, P < 0.001), and the substantial improvement emerged at the second (T0 vs. T1) and the third (T0 vs. T2) assessment, but with no difference between the Repetitive transcranial magnetic stimulation (rTMS) for Sleep Problems in autism spectrum disorder (ASD)
As mentioned in the “Introduction,” the high prevalence of sleep problems in children with ASD is more likely to be attributed to the pathogenesis of ASD, such as brain wave organizational and maturational differences, arousal and sensory dysregulation, circadian-relevant genes, and abnormal melatonin production [28, 29]
Summary
Autism spectrum disorder (ASD) is a severe neurodevelopmental disorder characterized by social–communicative atypicality and a restrictive and rigid repertoire of behaviors [1]. In the United States, around one out of 59 children have been diagnosed with ASD [2]. Cumulative evidence has shown that as many as 80% of children with ASD suffered from a variety of sleep problems [3], such as insomnia [4], daytime sleepiness, sleep-disordered breathing, and parasomnias [5], which is much higher than that in typically developing children [6–8]. The core symptoms of ASD and their comorbid sleep disturbances interact severely with each other. The symptoms of ASD, such as intolerance to change and persistence in the same pattern, make autistic children more intolerant of the sleeping environment and have more difficulty in falling asleep [10, 11]. The sleep problems exacerbate the severity of the core ASD symptoms, such as repetitive behaviors, social, and communication difficulties [12, 13], and other maladaptive behaviors [14, 15]. Exploring the interaction between them can help us to understand the etiology of ASD and provide more information on effective intervention
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
