Skip to main content

Examining the Behavioural Sleep-Wake Rhythm in Adults with Autism Spectrum Disorder and No Comorbid Intellectual Disability

Abstract

This study aimed to examine the behavioural sleep-wake rhythm in 36 adults with autism spectrum disorder (ASD) and to determine the prevalence of circadian sleep-wake rhythm disorders compared to age- and sex-matched controls. Participants completed an online questionnaire battery, a 14-day sleep-wake diary and 14-day actigraphy assessment. The results indicated that a higher proportion of adults with ASD met criteria for a circadian rhythm sleep-wake disorder compared to control adults. In particular, delayed sleep-wake phase disorder was particularly common in adults with ASD. Overall the findings suggest that individuals with ASD have sleep patterns that may be associated with circadian rhythm disturbance; however factors such as employment status and co-morbid anxiety and depression appear to influence their sleep patterns.

This is a preview of subscription content, access via your institution.

Fig. 1
Fig. 2
Fig. 3
Fig. 4

References

  • Allik, H., Larsson, J. O., & Smedje, H. (2006). Sleep patterns of school-age children with Asperger syndrome or high-functioning autism. Journal of Autism and Developmental Disorders, 36(5), 585–595. doi:10.1007/s10803-006-0099-9.

    Article  PubMed  Google Scholar 

  • American Academy of Sleep Medicine (2005). The international classification of sleep disorders : Diagnostic and coding manual (2nd edn.). Westchester: American Academy of Sleep Medicine.

    Google Scholar 

  • American Academy of Sleep Medicine (2014). International Classification of Sleep Disorders (3rd edn.). Darien, IL: American Academy of Sleep Medicine.

    Google Scholar 

  • American Psychiatric Association (2013). Diagnostic and statistical manual of mental disorders (5th edn.). Arlington, VA: American Psychiatric Publishing.

    Book  Google Scholar 

  • Aschoff, J., Fatranska, M., Giedke, H., Doerr, P., Stamm, D., & Wisser, H. (1971). Human circadian rhythms in continuous darkness: entrainment by social cues. Science, 171(3967), 213–215.

    Article  PubMed  Google Scholar 

  • Baker, E. K., & Richdale, A. L. (2015). Sleep patterns in adults with a diagnosis of high-functioning autism spectrum disorder. Sleep, 38(11), 1765–1774. doi:10.5665/sleep.5160.

    Article  PubMed  PubMed Central  Google Scholar 

  • Baron-Cohen, S., Wheelwright, S., Skinner, R., Martin, J., & Clubley, E. (2001). The autism-spectrum quotient (AQ): Evidence from Asperger syndrome/high-functioning autism, males and females, scientists and mathematicians. Journal of Autism and Developmental Disorders, 31(1), 5–17. doi:10.1023/a:1005653411471.

    Article  PubMed  Google Scholar 

  • Bourgeron, T. (2007). The possible interplay of synaptic and clock genes in autism spectrum disorders. Cold Spring Harbor Symposia on Quantitative Biology, 72, 645–654. doi:10.1101/sqb.2007.72.020.

    Article  PubMed  Google Scholar 

  • Buck, T., Viskochil, J., Farley, M., Coon, H., McMahon, W., Morgan, J., et al. (2014). Psychiatric comorbidity and medication use in adults with autism spectrum disorder. Journal of Autism and Developmental Disorders, 44(12), 3063–3071. doi:10.1007/s10803-014-2170-2.

    Article  PubMed  PubMed Central  Google Scholar 

  • Burgess, H. J., & Molina, T. A. (2014). Home lighting before usual bedtime impacts circadian timing: A field study. Photochemistry and Photobiology, 90, 723–726.

    Article  PubMed  PubMed Central  Google Scholar 

  • Buysse, D. J., Reynolds, C. F. III, Monk, T. H., Berman, S. R., & Kupfer, D. J. (1989). The Pittsburgh Sleep Quality Index: A new instrument for psychiatric practice and research. Psychiatry Research, 28(2), 193–213.

    Article  PubMed  Google Scholar 

  • Chang, A., Aeschbach, D., Duffy, J. F., & Czeisler, C. A. (2015). Evening use of light-emitting eReaders negatively affects sleep, circadian timing and next morning alertness. Proceedings of the National Academy of Sciences, 112(4), 1232–1237.

    Article  Google Scholar 

  • Croen, L. A., Zerbo, O., Qian, Y., Massolo, M. L., Rich, S., Sidney, S., et al. (2015). The health status of adults on the autism spectrum. Autism: The International Journal of Research and Practice, 19(7), 814–823. doi:10.1177/1362361315577517.

    Article  Google Scholar 

  • Gamaldo, C. E., Chung, Y., Kang, Y. M., & Salas, R. M. E. (2014). Tick–tock–tick–tock: The impact of circadian rhythm disorders on cardiovascular health and wellness. Journal of the American Society of Hypertension, 8(12), 921–929. doi:10.1016/j.jash.2014.08.011.

    Article  PubMed  Google Scholar 

  • Germain, A., & Kupfer, D. J. (2008). Circadian rhythm disturbances in depression. Human Psychopharmacology, 23(7), 571–585. doi:10.1002/hup.964.

    Article  PubMed  PubMed Central  Google Scholar 

  • Glickman, G. (2010). Circadian rhythms and sleep in children with autism. Neuroscience and Biobehavioral Reviews, 34(5), 755–768. pii] 10.1016/j.neubiorev.2009.11.017.

    Article  PubMed  Google Scholar 

  • Goldman, S. E., Adkins, K. W., Calcutt, M. W., Carter, M. D., Goodpaster, R. L., Wang, L., et al. (2014). Melatonin in children wit autism spectrum disorders: Endogenous and pharmacokinetic profiles in relation to sleep. Journal of Autism and Developmental Disorders, 44(10), 2525–2535. doi:10.1007/s10803-014-2123-9.

    Article  PubMed  PubMed Central  Google Scholar 

  • Grandner, M. A., Patel, N. P., Gehrman, P. R., Xie, D., Sha, D., Weaver, T., & Gooneratne, N. (2010). Who gets the best sleep? Ethnic and socioeconomic factors related to sleep complaints. Sleep Medicine, 11, 470–478. doi:10.1016/j.sleep.2009.10.006.

    Article  PubMed  PubMed Central  Google Scholar 

  • Hare, D. J., Jones, S., & Evershed, K. (2006). A comparative study of circadian rhythm functioning and sleep in people with Asperger syndrome. Autism: The International Journal of Research and Practice, 10(6), 565–575. doi:10.1177/1362361306068509.

    Article  Google Scholar 

  • Hettema, J. M., Prescott, C. A., & Kendler, K. S. (2004). Genetic and environmental sources of covariation between generalized anxiety disorder and neuroticism. The American Journal of Psychiatry, 161(9), 1581–1587. doi:10.1176/appi.ajp.161.9.1581.

    Article  PubMed  Google Scholar 

  • Horne, J. A., & Ostberg, O. (1976). A self-assessment questionnaire to determine morningness-eveningness in human circadian rhythms. Chronobiology International, 4(2), 97–110.

    Google Scholar 

  • Inanuma, K. (1984). Sleep-wake patterns in autistic children. The Japanese Journal of Adolescent Psychiatry, 25, 205–217.

    Google Scholar 

  • Jonsson, L., Ljunggren, E., Bremer, A., Pedersen, C., Landen, M., Thuresson, K., et al. (2010). Mutation screening of melatonin-related genes in patients with autism spectrum disorders. BMC Medical Genomics, 3, 10. doi:10.1186/1755-8794-3-10.

    Article  PubMed  PubMed Central  Google Scholar 

  • Kulman, G., Lissoni, P., Rovelli, F., Roselli, M. G., Brivio, F., & Sequeri, P. (2000). Evidence of pineal endocrine hypofunction in autistic children. Neuro Endocrinology Letters, 21(1), 31–34. pii].

    PubMed  Google Scholar 

  • Limoges, É., Bolduc, C., Berthiaume, C., Mottron, L., & Godbout, R. (2013). Relationship between poor sleep and daytime cognitive performance in young adults with autism. Research in Developmental Disabilities, 34(4), 1322–1335. doi:10.1016/j.ridd.2013.01.013.

    Article  PubMed  Google Scholar 

  • Limoges, É., Mottron, L., Bolduc, C., Berthiaume, C., & Godbout, R. (2005). Atypical sleep architecture and the autism phenotype. Brain: A Journal of Neurology, 128, 1049–1061.

    Article  Google Scholar 

  • Levy, A., & Perry, A. (2011). Outcomes in adolescents and adults with autism: A review of the literature. Research in Autism Spectrum Disorders, 5(4), 1271–1282. doi:10.1016/j.rasd.2011.01.023.

    Article  Google Scholar 

  • Lord, C., Rutter, M., DiLavore, P. C., Risi, S., Gotham, K., & Bishop, S. L. (2012). Autism diagnostic observation schedule (2nd edn.). Los Angeles, CA: Western Psychological Services.

    Google Scholar 

  • Mannion, A., & Leader, G. (2014). Sleep problems in autism spectrum disorder: A literature review. Review Journal of Autism and Developmental Disorders, 1(2), 101–109. doi:10.1007/s40489-013-0009-y.

    Article  Google Scholar 

  • Mazurek, M. O., Shattuck, P. T., Wagner, M., & Cooper, B. P. (2012). Prevalence and correlates of screen-based media use among youths with autism spectrum disorders. Journal of Autism and Developmental Disorders, 42(8), 1757–1767. doi:10.1007/s10803-011-1413-8.

    Article  PubMed  PubMed Central  Google Scholar 

  • Mazurek, M. O., & Wenstrup, C. (2013). Television, video game and social media use among children with ASD and typically developing siblings. Journal of Autism and Developmental Disorders, 43(6), 1258–1271. doi:10.1007/s10803-012-1659-9.

    Article  PubMed  Google Scholar 

  • Melke, J., Goubran Botros, H., Chaste, P., Betancur, C., Nygren, G., Anckarsater, H., et al. (2008). Abnormal melatonin synthesis in autism spectrum disorders. Molecular Psychiatry, 13(1), 90–98. pii] 10.1038/sj.mp.4002016.

    Article  PubMed  Google Scholar 

  • Nir, I., Meir, D., Zilber, N., Knobler, H., Hadjez, J., & Lerner, Y. (1995). Brief report: Circadian melatonin, thyroid-stimulating hormone, prolactin, and cortisol levels in serum of young adults with autism. Journal of Autism and Developmental Disorders, 25(6), 641–654.

    Article  PubMed  Google Scholar 

  • Paine, S., Fink, J., Gander, P. H., & Warman, G. R. (2014). Identifying advanced and delayed sleep phase disorders in the general population: A national survey of New Zealand adults. Chronobiology International, 31, 627–636.

    Article  PubMed  Google Scholar 

  • Patzold, L. M., Richdale, A. L., & Tonge, B. J. (1998). An investigation into sleep characteristics of children with autism and Asperger’s disorder. Journal of Paediatrics and Child Health, 34, 528–533.

    Article  PubMed  Google Scholar 

  • Richdale, A. L., & Schreck, K. A. (2009). Sleep problems in autism spectrum disorders: Prevalence, nature & possible biopsychosocial aetiologies. Sleep Medicine Reviews, 13(6), 403–411. doi:10.1016/j.smrv.2009.02.003.

    Article  PubMed  Google Scholar 

  • Roenneberg, T., Kuehnle, T., Pramstaller, P. P., Ricken, J., Havel, M., Guth, A., et al. (2004). A marker for the end of adolescence. Current Biology, 14(24), R1038–R1039. doi:10.1016/j.cub.2004.11.039.

    Article  PubMed  Google Scholar 

  • Segawa, M. (1985). Circadian rhythm in early infantile autism. Shinkei Kenkyu No Shinpo, 29, 140–153.

    Google Scholar 

  • Smith, C. S., Reilly, C., & Midkiff, K. (1989). Evaluation of three circadian rhythm questionnaires with suggestions for an improved measure of morningness. The Journal of Applied Psychology, 74, 728–738.

    Article  PubMed  Google Scholar 

  • Smith, M. R., & Eastman, C. I. (2009). Phase delaying the human circadian clock with blue-enriched polychromatic light. Chronobiology International, 26, 709–725. doi:10.1080/07420520902927742.

    Article  PubMed  PubMed Central  Google Scholar 

  • Souders, M. C., Mason, T. B., Valladares, O., Bucan, M., Levy, S. E., Mandell, D. S., et al. (2009). Sleep behaviors and sleep quality in children with autism spectrum disorders. Sleep, 32(12), 1566–1578.

    PubMed  PubMed Central  Google Scholar 

  • Spielberger, C. D., Gorsuch, R. L., Lushene, R., Vagg, P. R., & Jacobs, G. A. (1983). Manual for the state-trait anxiety inventory. Palo Alto, CA: Consulting Psychologists Press.

    Google Scholar 

  • Stores, G., & Wiggs, L. (1998). Abnormal sleep patterns associated with autism. Autism: The International Journal of Research and Practice, 2(2), 157–169. doi:10.1177/1362361398022004.

    Article  Google Scholar 

  • Summa, K. C., & Turek, F. W. (2014). Biomedical Effects of Circadian Rhythm Disturbances. In S. Redline & N. A. Berger (Eds.), Impact of sleep and sleep disturbances on obesity and cancer (pp. 77–101). New York: Springer.

    Chapter  Google Scholar 

  • Takaesu, Y., InoueY., Murakochi, A., Komada, Y., Otsuka, A., Futenma, K., & Inoue, T. (2016). Prevalence of circadian rhythm sleep-wake disorders and associated factors in euthymic patients with bipolar disorder. PLoS One, 11, e0159578. doi:10.1371/journal.pone.0159578.

    Article  PubMed  PubMed Central  Google Scholar 

  • Tordjman, S., Anderson, G. M., Bellissant, E., Botbol, M., Charbuy, H., Camus, F., ... Touitou, Y (2012). Day and nighttime excretion of 6-sulphatoxymelatonin in adolescents and young adults with autistic disorder. Psychoneuroendocrinology, 37, 1990–1997. doi:10.1016/j.psyneuen.2012.04.013.

    Article  PubMed  Google Scholar 

  • Tordjman, S., Anderson, G. M., Pichard, N., Charbuy, H., & Touitou, Y. (2005). Nocturnal excretion of 6-sulphatoxymelatonin in children and adolescents with autistic disorder. Biological Psychiatry, 57(2), 134–138. doi:10.1016/j.biopsych.2004.11.003.

    Article  PubMed  Google Scholar 

  • Tsaousis, I. (2010). Circadian preferences and personality traits: A meta-analysis. European Journal of Personality, 24(4), 356–373. doi:10.1002/per.754.

    Google Scholar 

  • Wechsler, D. (1999). WASI administration and scoring manual. San Antonio, TX: The Psychological Corporation.

    Google Scholar 

  • Wiggs, L., & Stores, G. (2004). Sleep patterns and sleep disorders in children with autistic spectrum disorders: Insights using parent report and actigraphy. Developmental Medicine & Child Neurology, 46(06), 372–380. doi:10.1017/S0012162204000611.

    Article  Google Scholar 

  • Woodbury-Smith, M. R., Robinson, J., Wheelwright, S., & Baron-Cohen, S. (2005). Screening adults for Asperger Syndrome using the AQ: aA preliminary study of its diagnostic validity in clinical practice. Journal of Autism and Developmental Disorders, 35(3), 331–335.

    Article  PubMed  Google Scholar 

  • Yang, Z., Matsumoto, A., Nakayama, K., Jimbo, E. F., Kojima, K., Nagata, K., et al. (2016). Circadian-relevant genes are highly polymorphic in autism spectrum disorder patients. Brain & Development, 38(1), 91–99. doi:10.1016/j.braindev.2015.04.006.

    Article  Google Scholar 

Download references

Acknowledgments

This study was partially supported by a PhD Grant awarded to the first author from the APEX Trust for Autism. We would like to thank all the participants for their time on this project. The funding was provided by Apex Foundation.

Author Contributions

EB participated in the design of the study, conducted the analyses and drafted the manuscript. AR participated in the design of the study, advised on the interpretation of data and reviewed the manuscript. Both authors read and approved the final manuscript.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Emma K. Baker.

Ethics declarations

Conflict of interest

This study was partially supported by a PhD grant awarded to the first author from the APEX Trust for Autism.

Ethical Standards

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed Consent

Informed consent was obtained from all individual participants included in the study.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Baker, E.K., Richdale, A.L. Examining the Behavioural Sleep-Wake Rhythm in Adults with Autism Spectrum Disorder and No Comorbid Intellectual Disability. J Autism Dev Disord 47, 1207–1222 (2017). https://doi.org/10.1007/s10803-017-3042-3

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10803-017-3042-3

Keywords

  • Autism
  • Adults
  • Sleep-wake rhythm
  • Circadian
  • DSWPD
  • ASWPD