Sleep disturbances and emotional dysregulation in young children with autism spectrum, intellectual disability, or global developmental delay

Irene Favole; Chiara Davico; Daniele Marcotulli; Roberta Sodero; Barbara Svevi; Federico Amianto; Federica S Ricci; G Maurizio Arduino; Benedetto Vitiello

doi:10.1016/j.sleep.2023.02.026

Sleep disturbances and emotional dysregulation in young children with autism spectrum, intellectual disability, or global developmental delay

Sleep Med. 2023 May:105:45-52. doi: 10.1016/j.sleep.2023.02.026. Epub 2023 Mar 8.

Authors

Irene Favole¹, Chiara Davico¹, Daniele Marcotulli², Roberta Sodero¹, Barbara Svevi¹, Federico Amianto³, Federica S Ricci¹, G Maurizio Arduino⁴, Benedetto Vitiello¹

Affiliations

¹ Section of Child and Adolescent Neuropsychiatry, Department of Public Health and Pediatric Sciences, University of Turin, 10126, Turin, Italy.
² Section of Child and Adolescent Neuropsychiatry, Department of Public Health and Pediatric Sciences, University of Turin, 10126, Turin, Italy. Electronic address: daniele.marcotulli@unito.it.
³ Department of Neuroscience, University of Turin, 10100, Turin, Italy.
⁴ Autism Center, Developmental Psychology and Psychopathology, ASL CN1, Cuneo, Italy.

PMID: 36963320
DOI: 10.1016/j.sleep.2023.02.026

Abstract

Objective: Sleep disturbance and emotional dysregulation (ED) are common and often functionally impairing in young children with neurodevelopmental disorders (NDD). This study investigated the relationship between sleep disturbance and ED in a sample of preschoolers with ASD, intellectual disability, or global developmental delay, and examined possible predictors of their persistence over time.

Methods: All children under 6 years of age clinically referred between July 2018 and May 2022 to two neuropsychiatric specialized centers for NDD received a comprehensive diagnostic evaluation, including the Child Behavior Checklist 1.5-5 (CBCL), the Autism Diagnostic Observation Schedule-2 (ADOS-2), and standardized tests of cognitive and global development. Sleep disturbances were assessed with the CBCL-sleep score, and ED with the CBCL Attention, Aggression, and Anxious/Depressed scales (CBCL-AAA). A reassessment of sleep and ED was conducted after 6 months or longer, including the Child Sleep Habits Questionnaire (CSHQ). Multivariate analyses and mixed linear regression models were conducted.

Results: A total of 136 children, 75.7% male, median age 38.27 months, IQR 15.39, 41.2% with global developmental disorder (GDD) or intellectual disability (ID) participated in the study. Of them, 64.7% were diagnosed with autism spectrum disorder (ASD) and 35.3% with other NDD (w/o ASD). Sleep disturbances (CBCL-Sleep) and ED (CBCL-AAA) were positively correlated (p < 0.001), after accounting for age, ID/GDD and autism symptom severity, in both the entire sample and separately in each diagnostic group (ASD and NDD w/o ASD). Seventy-five children (55%) were reassessed a mean 17.2 months afterwards. There was persistence of the positive correlation between sleep problems and ED (p < 0.001) in both the entire sample and each diagnostic group. The longitudinal mixed linear model showed that ED at follow-up was predicted by baseline sleep problems (p = 0.008), ED (p < 0.001), and ASD severity (p = 0.015).

Conclusions: Sleep disturbances are significantly associated with ED in young children with NDD, either with or without ASD, both cross-sectionally and prospectively over time. Sleep problems represent an important comorbidity and a potential treatment target for improving emotional stability in NDD.

Keywords: Autism spectrum disorder; Emotional dysregulation; Neurodevelopmental disorders; Sleep; Sleep disturbances.

MeSH terms

Autism Spectrum Disorder* / complications
Autism Spectrum Disorder* / psychology
Autistic Disorder*
Child
Child, Preschool
Female
Humans
Intellectual Disability*
Male
Sleep
Sleep Wake Disorders* / complications
Sleep Wake Disorders* / epidemiology