Children with Autism Spectrum Disorder (ASD) or Attention Deficit Hyperactivity Disorder (ADHD) are often associated with sleep-related problems that can affect cognition and behavior. Higher scores in the Children’s Sleep Habits Questionnaire (CSHQ), after adjusting for demographics, stimulants, and IQ according to study results published in Sleep, were associated with poorer executive function (EF) on all scales of the EF Behavioral Assessment (BRIEF) health.
The main aim of this study was to evaluate whether the association between poor sleep and EF persists after considering various factors such as medication.
The study researchers recruited 735 children aged 8 to 12 years (323 who typically developed [TD], 177 with ASD and 235 with ADHD) through studies at the Kennedy Krieger Institute. They excluded children with a history of neurological disease or injury, genetic disorders, seizures, intellectual disability, major depression, bipolar disorder, and behavioral disorder.
Children with ASD or ADHD were asked not to take stimulants on the day and day prior to participating in the study. Children with ASD could continue other psychiatric drugs.
Children with ASD or ADHD had higher overall CSHQ scores on average than TD children – and had higher scores for all scores except sleep-related breathing disorders, even after adjusting for age, gender, race, ethnicity, socio-economic status, use of stimulants, and General Ability Index (GAI) from the Wechsler Intelligence Scale for Children (WISC) -IV or WISC-V (CSHQ total: TD 41.0; ASD 46.4; ADHD 46.2, P <0.05 for ASD- and ADHD groups, relative to TD).
After adjusting the CBCL (Child Behavior Checklist) anxiety problems T-Score, The CSHQ total score was significant with the BRIEF Emotional Control Score in children with TD (0.12; 95% CI, -0.03 to 0.28) and ADHD (0.16; 95% CI, -0.04 up to 0.35), but not in children with ASD (0.15) 95% CI, -0.08 to 0.37; P <0.05).
After adjusting for anxiety, the CSHQ total score was significantly associated with the clinical BRIEF scores of all 3 groups of children on 4 BRIEF metacognition scales (initiated, working memory, planning / organization and organization of materials; P <0.05).
After adjusting for the Conners scores for inattention and hyperactivity, the association was not significant in children with ASD, but significant associations remained for the initiate and working memory scores in the ADHD group (P <0.05).
The limitations of the study included the dependence of the CSHQ on the recognition of symptoms by the parents, the exclusion of certain patients (which reduced the generalizability of the results) and the low proportion of children with the ADHD subtype “hyperactive / impulsive” in the analytical group Sample.
According to the study’s researchers, targeting these symptoms in children with ASD can help study the effects of sleep disorders on behavioral regulation and the metacognitive components of executive function. They concluded: “We were able to demonstrate strong associations between sleep disorders and dysfunction in children with typical development, ASD and ADHD and show that symptoms of anxiety, inattentiveness and hyperactivity or impulsivity appearing at the same time seem to be responsible for the associations between sleep and executive function in children with ASD. ”
Disclosure: A study author declared an affiliation with the pharmaceutical industry. For a full list of the authors’ information, see the original reference.
Hole C, Volk H, Crocetti D, Gottlieb B, Spira AP, Mostofsky SH. Associations between parent-reported sleep disorder and executive function measurements in autism in children and attention deficit hyperactivity disorder. Sleep health. Published online January 15, 2021. doi: 10.1016 / j.sleh.2020.12.006