Asperger syndrome and high-functioning autism in school-age children : the children's sleep and behaviour, and aspects of their parents' well-being

<p>Asperger syndrome (AS) and high-functioning autism (HFA) are pervasive developmental disorders (PDD) in children of normal range intelligence. Individuals with AS/HFA have impairments in social interaction, communication, and restricted behavioural repertoire, deficits that significantly interfere with their well-being and ability to adapt to ordinary everyday life. Moreover, AS and HFA are presumed to be frequently accompanied by co-existing psychiatric problems and disturbed sleep. Such comorbidities may impose further distress on the children and may increase caregiver burden.</p><p>Two main objectives of this thesis were to explore if children with AS and HFA have disturbed sleep, and if their parents have impaired health-related quality of life (HRQL).</p><p>Thirty-two 8-12-year-olds with AS/HFA, 28 boys and 4 girls, and 32 age- and gender- matched typically developing children participated. Sleep patterns of the children were assessed at baseline, and at a follow-up, 2-3 years later, by parental questionnaire and by one-week sleep diary and actigraphy.</p><p>Paper I compared sleep patterns of the children with AS/HFA and the controls at baseline. The AS/HFA group had more parent-reported sleep problems, earlier sleep timing (bed- and get up time) at weekends, prolonged sleep latencies during the whole week, and lower sleep efficiencies on school days. Separate analyses within the AS/HFA group showed longer sleep latencies, and greater night-to-night variability of sleep latency in children with, compared to those without parent-reported sleep problems.</p><p>Paper II detailed a wide range of sleep-wake behaviour and symptoms of paediatric insomnia at baseline. Children with AS/HFA had more difficulties initiating sleep, and more daytime sleepiness than controls, and 10/32 children in the AS/HFA group, but none of the controls, fulfilled current criteria for paediatric insomnia. Within the AS/HFA group, children with insomnia had higher scores of parent-reported autistic and emotional symptoms, and more teacher-reported emotional and hyperactivity symptoms than those children without insomnia.</p><p>Paper III examined development of sleep patterns from baseline to a follow-up in 23/32 of the children with AS/HFA and in 22/32 of the controls. Results indicated that persisting parentreported sleep problems were much more common in the children with AS/HFA than in the controls; 10/23 versus 1/22, respectively. Also, prolonged actigraphic sleep latencies on school days, and earlier sleep timing (get up time) on weekends were persistent in a significant proportion of children with AS/HFA.</p><p>Paper IV investigated the self-reported HRQL of the parents of the children with AS/HFA and of the parents of the controls. The mothers of the children with AS/HFA had poorer physical health than control mothers, and than fathers of both groups. Maternal HRQL in the AS/HFA group was also related to co-existing behaviour problems in the child.</p><p>Conclusion: In childhood AS/HFA, difficulties initiating and maintaining sleep are common and distressing symptoms, and mothers of children with AS/HFA frequently report impaired physical well-being.</p><h3>List of scientific papers</h3><p>I. Allik H, Larsson JO, Smedje H (2006). Sleep patterns of school-age children with Asperger syndrome or high-functioning autism. J Autism Dev Disord. 36(5): 585-95. <br><a href="https://doi.org/10.1007/s10803-006-0099-9">https://doi.org/10.1007/s10803-006-0099-9</a><br><br> </p><p>II. Allik H, Larsson JO, Smedje H (2006). Insomnia in school-age children with Asperger syndrome or high-functioning autism. BMC Psychiatry. 6: 18. <br><a href="https://doi.org/10.1186/1471-244X-6-18">https://doi.org/10.1186/1471-244X-6-18</a><br><br> </p><p>III. Allik H, Larsson JO, Smedje H (2006). Sleep patterns in school-age children with Asperger syndrome or high-functioning autism and in typically developing children: a longitudinal comparison. [Submitted]</p><p>IV. Allik H, Larsson JO, Smedje H. (2006). Health-related quality of life in parents of school-age children with Asperger Syndrome or High-Functioning Autism. Health Qual Life Outcomes. 4: 1. <br><a href="https://doi.org/10.1186/1477-7525-4-1">https://doi.org/10.1186/1477-7525-4-1</a><br><br> </p>