Autism & sleep problems: Effects

In my previous article on autism & sleep problems, I looked at the causes of sleep problems. In this article, I will look at the consequences.

Research shows that sleep problems worsen autism symptoms across most core domains^[1]The relationship between sleep and behavior in autism spectrum disorder (ASD): a review—particularly in the social domain^[2]Sleep problems as possible predictors of intensified symptoms of autism—and were the highest predictor of challenging behaviors in autism.^[3]Sleep, anxiety and challenging behaviour in children with intellectual disability and/or autism spectrum disorder

Correlations with dysfunctions

Autistic children experience more sleep-related anxiety, night waking, parasomnias, sleep-disordered breathing, and daytime sleepiness than neurotypicals.^[4]Sleep and Executive Functioning Among High-IQ School-Aged Children with Autism

Certain sleep problems were found to correlate with certain dysfunctions:^[5]Sleep and Executive Functioning Among High-IQ School-Aged Children with Autism

• Sleep duration and resistance to falling asleep correlated with behavioral regulation and executive dysfunction.
• The ability to fall asleep quickly correlated with working memory.
• The ability to remain asleep through the night correlated with accuracy and efficiency of inhibiting conflicting information.

Sleep disorders

A study from 2015 that investigated the correlation between sleep disorders and the behavior of autistic people found correlations between sleep disorders and thinking- and behavioral problems:^[6]Influence of sleep disorders on the behavior of individuals with autism spectrum disorder

• Disorders of arousal (sleepwalking, sleep terrors, and confusional arousals) were correlated with thinking problems.
• Disorders of excessive somnolence (i.e. desire to sleep) were correlated with thinking and behavioral problems.

The high frequency of sleep disorders was found to correlate with some of the behavioral traits that autistic people already exhibit (see below).^[7]Influence of sleep disorders on the behavior of individuals with autism spectrum disorder

Behavioral traits

In terms of the effects of sleep problems on behavior, autistic people experience more social anxiety, depression, withdrawal, somatic complaints, attention issues, thought complaints, delinquency, aggression, internalizing (dealing with stressors in ways that don’t manifest externally), and externalizing (an unconscious defense mechanism where a person projects their own internal characteristics onto the outside world—in particular onto other people).^[8]Influence of sleep disorders on the behavior of individuals with autism spectrum disorder

In the diagram below you can see how autistic people compare to neurotypicals on these behavioral problems.^[9]Influence of sleep disorders on the behavior of individuals with autism spectrum disorder

So it’s these areas that are likely predominantly affected by sleep problems. Speaking from personal experience, my aggression and volatility, as well as my anxiety certainly go up, whereas cognitive functions decrease.

Sleep & challenging behaviors

Studies exploring the relationship between sleep and challenging behaviors in autism found:^[10]The relationship between sleep and behavior in autism spectrum disorder (ASD): a review

• Fewer hours of sleep per night predicted autism severity score, social skill deficit, and stereotypic behavior.^[11]Sleep problems as possible predictors of intensified symptoms of autism
• Hypersensitivity to stimuli, younger age, co-sleeping, medication, epilepsy, history of sleep problems, and ADHD are associated with sleep problems in autistic individuals.^[12]Sleep disturbances and correlates of children with autism spectrum disorders
• PDD children with sleep problems had higher rates of ADHD, oppositional behavior, and psychiatric symptoms compared to children without sleep problems.^[13]Sleep disturbance and its relation to DSM-IV psychiatric symptoms in preschool-age children with pervasive developmental disorder and community controls
• Controlling for diagnosis and age, night-time sleep problems determined by parent reports were significantly associated with decrements in daytime behavior.^[14]Sleep problems, sleepiness and daytime behavior in preschool-age children
• Sleep problems increased with extent of autistic symptoms.^[15]Variables related to sleep problems in children with autism
• Oppositional behavior, aggression, ADHD, and mood variability predicted sleep disturbance in autism.^[16]Variables related to sleep problems in children with autism
• Poor sleepers among autistics had more ADHD symptoms and more restricted and repetitive behaviors (RRBs) than good sleepers. Sleep fragmentation was correlated with more RRBs.^[17]Defining the sleep phenotype in children with autism
• Sleep problems were the highest predictor of challenging behaviors in autism.^[18]Sleep, anxiety and challenging behaviour in children with intellectual disability and/or autism spectrum disorder
• In the autistic group, poor sleep quality and poor sleep hygiene were related to higher levels of externalizing behaviors.^[19]The relation among sleep, routines, and externalizing behavior in children with an autism spectrum disorder
• Poor sleepers had a higher percentage of behavioral problems on all PCQ scales (e.g., aggression, RRBs, stereotypy, and hyperactivity) than good sleepers.^[20]Sleep is associated with problem behaviors in children and adolescents with Autism Spectrum Disorders
• Moderate–severe sleep problems in autism resulted in higher daytime externalizing behavior and poorer adaptive skills compared to autistic people without sleep problems.^[21]The relationship between sleep problems and daytime behavior in children of different ages with autism spectrum disorders
• Parent-reported sleep problem—but not actigraphy recordings—were associated with more core behavior problems in autism.^[22]Sleep and daytime functioning: a short-term longitudinal study of three preschool-age comparison groups
• Sleep-onset delay and duration were positively correlated with the extent of autism symptoms, and were the strongest predictor of communication deficits and stereotypic behavior.^[23]Children With Autism: Sleep Problems and Symptom Severity
• Communication abnormalities and RRBs were associated with an increased risk of sleep problems in autism. Autistic individuals had higher internalizing/externalizing problems compared to their unaffected siblings.^[24]Sleep problems and their correlates and comorbid psychopathology of children with autism spectrum disorders
• Children who slept fewer hours per night had lower IQ, verbal skills, adaptive functioning, socialization, and communication skills.^[25]Sleep disruption as a correlate to cognitive and adaptive behavior problems in autism spectrum disorders
• Anxiety, autism severity, sensory sensitivity, and GI issues all predicted sleep disturbance.^[26]Correlates and risk markers for sleep disturbance in participants of the Autism Treatment Network
• IQ positively predicted sleep disturbance.^[27]Correlates and risk markers for sleep disturbance in participants of the Autism Treatment Network
• Avoidant behavior, under-eating, and GI symptoms predicted sleep problems in autistic individuals.^[28]An investigation of comorbid psychological disorders, sleep problems, gastrointestinal symptoms and epilepsy in children and adolescents with Autism Spectrum Disorder
• The autistic group had more sleep disturbance than the control group. Sleep disturbance decreased over the year in autistic children, which was associated with improved social ability.^[29]Sleep in high-functioning children with autism: longitudinal developmental change and associations with behavior problems

Next: Autism & sleep problems: Solutions