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Frequency and Clinical Correlates of Sleep-Related Problems Among Anxious Youth with Autism Spectrum Disorders

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Abstract

Sleep-related problems (SRPs) are common and problematic among anxious youth but have not been investigated in anxious youth with autism spectrum disorder (ASD). Participants were 102 youth (ages 7–16 years) with ASD and comorbid anxiety. Youth and their primary caregiver were administered the Pediatric Anxiety Rating Scale. Parents completed the Multidimensional Anxiety Scale for Children–Parent (MASC-P) Report, Social Responsiveness Scale, and the Child Behavior Checklist (CBCL). A measure of SRPs was created from items from the CBCL and MASC-P. Results suggest SRPs were relatively common among youth with ASD and comorbid anxiety. The number of SRPs endorsed directly associated with parent ratings of social deficits, internalizing and externalizing symptoms, and anxiety symptoms, as well as with clinician-rated anxiety symptoms. Parent-rated internalizing symptoms predicted frequency of SRPs over and above social deficits, externalizing symptoms, and parent- and clinician-rated anxiety symptoms. A subset of 40 participants who completed family-based cognitive–behavioral therapy (CBT) experienced reduced SRPs following treatment. Implications, study limitations, and recommendations for future research are discussed.

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References

  1. National Sleep Foundation (1991) Sleep in America: a national survey of U.S. adults. Princeton, The Gallup Organization

    Google Scholar 

  2. Meltzer LJ, Mindell JA (2006) Sleep and sleep disorders in children and adolescents. Psychiatry Clinics of North America 29:1059–1076

    Article  Google Scholar 

  3. Alfano CA, Ginsburg GS, Kingery JN (2007) Sleep-related problems among children and adolescents with anxiety disorders. J Am Acad Child Adolesc Psychiatry 46:224–232

    Article  PubMed  Google Scholar 

  4. Fallone G, Owens JA, Deane J (2002) Sleepiness in children and adolescents: clinical implications. Sleep Med Rev 6:287–306

    Article  PubMed  Google Scholar 

  5. Kheirandish L, Gozal D (2006) Neurocognitive dysfunction in children with sleep disorders. Dev Sci 9:388–399

    Article  PubMed  Google Scholar 

  6. Sadeh A, Gruber R, Raviv A (2002) Sleep, neurobehavioral functioning, and behavior problems in school-age children. Child Dev 73:405–417

    Article  PubMed  Google Scholar 

  7. Corkum P, Tannock R, Moldofsky H, Hogg-Johnson S, Humphries T (2001) Actigraphy and parental ratings of sleep in children with attention deficit/hyperactivity disorder. Sleep 24:3030–3312

    Google Scholar 

  8. Malow BA, Marzec ML, McGrew SG, Wang L, Henderson LM, Stone WL (2006) Characterizing sleep in children with autism spectrum disorders: a multidimensional approach. Sleep 29:1563–1571

    PubMed  Google Scholar 

  9. Beebe DW, Wells CT, Jeffries J, Chini B, Kalra M, Amin R (2004) Neuropsychological effects of pediatric obstructive sleep apnea. J Int Neuropsychol Soc 10:962–975

    PubMed  Google Scholar 

  10. Gregory AM, O’Connor TG (2002) Sleep problems in childhood: a longitudinal study of developmental change and association with behavioral problems. J Am Acad Child Adolesc Psychiatry 41:964–971

    Article  PubMed  Google Scholar 

  11. Gregory AM, Caspi A, Eley TC, Moffitt TE, O’Connor TG, Poulton R (2005) Prospective longitudinal associations between persistent sleep problems in childhood and anxiety and depressive disorders in adulthood. J Abnorm Child Psychol 33:157–163

    Article  PubMed  Google Scholar 

  12. Ong SH, Wickramaratne P, Tang M, Weissman MM (2006) Early childhood sleep and eating problems as predictors of adolescent and adult mood and anxiety disorders. J Affect Disord 96:1–8

    Article  PubMed  Google Scholar 

  13. Chase RM, Pincus DB (2011) Sleep-related problems in children and adolescents with anxiety disorders. Behav Sleep Med 9:224–236

    Article  PubMed  Google Scholar 

  14. Storch EA, Murphy TK, Lack CW, Geffken GR, Jacob ML, Goodman WK (2008) Sleep-related problems in pediatric obsessive–compulsive disorder. J Anxiety Disord 22:877–885

    Article  PubMed Central  PubMed  Google Scholar 

  15. Alfano CA, Zakem AH, Costa NM, Taylor LK, Weems CF (2009) Sleep problems and their relation to cognitive factors, anxiety, and depressive symptoms in children and adolescents. Depress Anxiety 26:503–512

    PubMed  Google Scholar 

  16. Storch EA, Milsom V, Lack CW, Pence SL, Geffken GR, Jacob ML et al (2009) Sleep-related problems in youth with Tourette’s Syndrome and chronic tic disorder. Child Adolesc Mental Health 14:97–103

    Article  Google Scholar 

  17. Astill RG, Van der Heijden KB, Van Ijzendoorn MH, Van Someren EJW (2012) Sleep, cognition, and behavioral problems in school-age children: a century of research meta-analyzed. Psychol Bull 138:1109–1138

    Article  PubMed  Google Scholar 

  18. Anderson S, Morris J (2006) Cognitive behaviour therapy for people with Asperger syndrome. Behav Cogn Psychother 34:293–303

    Article  Google Scholar 

  19. Matson JL, Nebel-Schwalm MS (2007) Comorbid psychopathology with autism spectrum disorder in children: an overview. Res Dev Disabil 28:341–352

    Article  PubMed  Google Scholar 

  20. Nadeau J, Sulkowski ML, Ung D, Wood JJ, Lewin AB, Murphy TK et al (2011) Treatment of comorbid anxiety and autism spectrum disorders. Neuropsychiatry 1:567–578

    Article  PubMed Central  PubMed  Google Scholar 

  21. Williams PG, Sears LL, Allard A (2004) Sleep problems in children with autism. J Sleep Res 13:265–268

    Article  Google Scholar 

  22. Krakowiak P, Goodlin-Jones B, Hertz-Picciotto I, Croen LA, Hansen RL (2008) Sleep problems in children with autism spectrum disorders, developmental delays, and typical development: a population-based study. J Sleep Res 17:197–206

    Article  PubMed Central  PubMed  Google Scholar 

  23. Lord C, Rutter M, DiLavore PC, Risi S (1999) Autism diagnostic observation schedule. Western Psychological Services, Los Angeles

    Google Scholar 

  24. Polimeni MA, Richdale AL, Francis AJP (2005) A survey of sleep problems in autism, Asperger’s disorder and typically developing children. J Intellect Disabil Res 49:260–268

    Article  PubMed  Google Scholar 

  25. Tudor ME, Hoffman CD, Sweeney DP (2012) Children with autism: sleep problems and symptom severity. Focus Autism Other Dev Disabil 27:254–262

    Article  Google Scholar 

  26. de Bruin EI, Ferdinand RF, Meester S, de Nijs PF, Verheij F (2007) High rates of psychiatric co-morbidity in PDD-NOS. J Autism Dev Disord 37:877–886

    Article  PubMed  Google Scholar 

  27. Leyfer OT, Folstein SE, Bacalman S, Davis NO, Dinh E, Morgan J et al (2006) Comorbid psychiatric disorders in children with autism: interview development and rates of disorders. J Autism Dev Disord 36:849–861

    Article  PubMed  Google Scholar 

  28. Muris P, Steerneman P, Merckelbach H, Holdrinet I, Meesters C (1998) Comorbid anxiety symptoms in children with pervasive developmental disorders. J Anxiety Disord 12:387–393

    Article  PubMed  Google Scholar 

  29. Manassis K, Russell K, Newton AS (2010) The Cochrane Library and the treatment of childhood and adolescent anxiety disorders: an overview of reviews. Evid Based Child Health 5:541–554

    Article  Google Scholar 

  30. Silverman WK, Pina AA, Viswesvaran C (2008) Evidence-based psychosocial treatments for phobic and anxiety disorders in children and adolescents. J Clin Child Adolesc Psychol 37:105–130

    Article  PubMed  Google Scholar 

  31. Storch EA, Arnold EB, Lewin AB, Nadeau J, Jones AM, De Nadai AS et al (2013) The effect of cognitive–behavioral therapy versus treatment as usual for anxiety in children with autism spectrum disorders: a randomized, controlled trial. J Am Acad Child Adolesc Psychiatry 52:132–142

    Article  PubMed  Google Scholar 

  32. Wood J, Drahota A (2005) Behavioral interventions for anxiety in children with autism (BIACA). University of California—Los Angeles, Los Angeles

    Google Scholar 

  33. Kendall PC, Khanna MS (2008) Camp Cope-A-Lot Coach’s manual. Workbook, Ardmore

    Google Scholar 

  34. Wood JJ, Ehrenreich-May J, Alessandri M, Fujii C, Renno P, Laugeson E et al (2014) Cognitive behavioral therapy for early adolescents with autism spectrum disorders and clinical anxiety: a randomized, controlled trial. Behav Ther. doi:10.1016/j.beth.2014.01.002

  35. Le Couteur A, Lord C, Rutter M (2003) The autism diagnostic interview—revised. Western Psychological Services, Los Angeles

    Google Scholar 

  36. Silverman WK, Albano AM (1996) The anxiety disorders interview schedule for DSM-IV-child and parent versions. Graywinds, San Antonio

    Google Scholar 

  37. de Bildt A, Sytema S, Ketelaars C, Kraijer D, Mulder E, Volkmar F et al (2004) Interrelationship between autism diagnostic observation schedule-generic (ADOS-G), autism diagnostic interview-revised (ADI-R), and the diagnostic and statistical manual of mental disorders (DSM-IV-TR) classification in children and adolescents with mental retardation. J Autism Dev Disord 34(2):129–137

    Article  PubMed  Google Scholar 

  38. RUPP (2002) The Pediatric Anxiety Rating Scale: development and psychometric properties. J Am Acad Child Adolesc Psychiatry 41:1061–1069

    Article  Google Scholar 

  39. Walkup JT, Albano AM, Piacentini J, Birmaher B, Compton SN, Sherrill JT et al (2008) Cognitive behavioral therapy, sertraline, or a combination in childhood anxiety. N Engl J Med 359:2753–2766

    Article  PubMed Central  PubMed  Google Scholar 

  40. Storch EA, Ehrenreich May J, Wood JJ, Jones AM, de Nadai AS, Lewin A et al (2012) Multiple informant agreement on the anxiety disorders interview schedule in youth with autism spectrum disorders. J Child Adolesc Psychopharmacol 22:292–299

    Article  PubMed Central  PubMed  Google Scholar 

  41. March J (1998) Manual for the Multidimensional Anxiety Scale for Children. Multi-Health Systems, Toronto

    Google Scholar 

  42. March JS, Parker JD, Sullivan K, Stallings P, Conners CK (1997) The Multidimensional Anxiety Scale for Children (MASC): factor structure, reliability, and validity. J Am Acad Child Adolesc Psychiatry 36:554–565

    Article  PubMed  Google Scholar 

  43. Constantino J (2002) The Social Responsiveness Scale. Western Psychological Services, Los Angeles

    Google Scholar 

  44. Bölte S, Poustka F, Constantino JN (2008) Assessing autistic traits: cross-cultural validation of the social responsiveness scale (SRS). Autism Res 1:354–363

    Article  PubMed  Google Scholar 

  45. Chou MC, Chou WJ, Chiang HL, Wu YY, Lee JC, Wong CC et al (2012) Sleep problems among Taiwanese children with autism, their siblings and typically developing children. Res Autism Spectr Disord 6:665–672

    Article  Google Scholar 

  46. Wood JJ, Drahota A, Sze K, Har K, Chiu A, Langer DA (2009) Cognitive behavioral therapy for anxiety in children with autism spectrum disorders: a randomized, controlled trial. J Child Psychol Psychiatry 50:224–234

    Article  PubMed Central  PubMed  Google Scholar 

  47. Achenbach TM, Edelbrock C (2001) Manual for the child behavior checklist. Queen City Printers, Burlington

    Google Scholar 

  48. Aschenbrand SG, Angelosante AG, Kendall PC (2005) Discriminant validity and clinical utility of the CBCL with anxiety-disordered youth. J Clin Child Adolesc Psychol 34:735–746

    Article  PubMed  Google Scholar 

  49. Heubeck BG (2000) Cross-cultural generalizability of CBCL syndromes across three continents: from the USA and Holland to Australia. J Abnorm Child Psychol 28:439–450

    Article  PubMed  Google Scholar 

  50. Schlomer GL, Bauman S, Card NA (2010) Best practices for missing data management in counseling psychology. J Couns Psychol 57:1

    Article  PubMed  Google Scholar 

  51. Arbuckle JL (1996) Full information estimation in the presence of incomplete data. In: Marcoulides GA, Schumacher RE (eds) Advanced structural equation modeling: issues and techniques, pp 243–277

  52. Cotton S, Richdale A (2006) Brief report: parental descriptions of sleep problems in children with autism, Down syndrome, and Prader–Willi syndrome. Res Dev Disabil 27:151–161

    Article  PubMed  Google Scholar 

  53. Richdale AL, Schreck KA (2009) Sleep problems in autism spectrum disorders: prevalence, nature, and possible biopsychosocial aetiologies. Sleep Med Rev 13:403–411

    Article  PubMed  Google Scholar 

  54. Wood JJ, Drahota A, Sze K, Van Dyke M, Decker K, Fujii C et al (2009) Brief report: effects of cognitive behavioral therapy on parent-reported autism symptoms in school-age children with high-functioning autism. J Autism Dev Disord 39:1608–1612

    Article  PubMed Central  PubMed  Google Scholar 

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Acknowledgments

This work was supported in part by grants from the All Children’s Hospital Research Foundation, the University of South Florida Internal Grants Program, and the National Institutes of Child Health and Human Development to Dr. Storch (5R34HD065274-02). The views of this manuscript do not necessarily reflect those of the National Institutes of Health.

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Authors and Affiliations

  1. Department of Pediatrics, University of South Florida, 880 6th Street South, Box 7523, St. Petersburg, FL, 33701, USA

    Joshua M. Nadeau, Elysse B. Arnold, Amanda C. Keene, Amanda B. Collier, Adam B. Lewin, Tanya K. Murphy & Eric A. Storch

  2. Department of Psychology, University of South Florida, St. Petersburg, FL, USA

    Elysse B. Arnold, Adam B. Lewin & Eric A. Storch

  3. Department of Psychiatry and Behavioral Neurosciences, University of South Florida, St. Petersburg, FL, USA

    Adam B. Lewin, Tanya K. Murphy & Eric A. Storch

  4. Rogers Behavioral Health – Tampa Bay, Tampa, FL, USA

    Joshua M. Nadeau & Eric A. Storch

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  1. Joshua M. Nadeau
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  7. Eric A. Storch
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Correspondence to Joshua M. Nadeau.

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Nadeau, J.M., Arnold, E.B., Keene, A.C. et al. Frequency and Clinical Correlates of Sleep-Related Problems Among Anxious Youth with Autism Spectrum Disorders. Child Psychiatry Hum Dev 46, 558–566 (2015). https://doi.org/10.1007/s10578-014-0496-9

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