Sleep and Executive Control Among Young High Functioning Children with Autism Spectrum Disorders

Background: Among typically developing children sleep patterns have been related to executive control (e.g., Karpinski et al., 2008; Beebe et al., 2004) and sleep disorders are more common among children with autism spectrum disorders (ASD) (Richdale & Schreck, 2009). To our knowledge, there have been no published investigations of sleep and executive control in children with ASD.

Objectives: To test whether young, high-functioning children with ASD differ from controls in parent reported sleep duration and sleep problems. And, to test whether sleep is related to executive control ability among children with ASD.

Methods: Subjects were 21 6- and 7-year-olds with ASD and 21 age- and IQ-matched controls. Diagnosis was confirmed with the ADOS, ADI-R and DSM-IV-TR. All children in both groups had cognitive ability in the average to above average range (measured by the Differential Ability Scales). Parent report of sleep-related breathing disorders (SRBD), snoring, sleepiness, and associated behavioral difficulties were measured using the Pediatric Sleep Questionnaire (PSQ; Chervin et al., 2000). Children completed a battery of executive control tasks. Parents provided additional information about executive functioning and symptoms in other settings via the Behavioral Rating Inventory of Executive Function (BRIEF) and Repetitive Behavior Scale-Revised (RBS-R). 

Results: Children with ASD had more sleep-related breathing disorders overall, t(39) = 3.87, p < .001, and greater sleep-related behavior challenges, t(39) = -4.93, p < .001, but scores on the sleepiness and snoring scales did not differ. Children with ASD also slept less during the week than controls, t(38) = -2.29, p = .03. Children with ASD who slept less during the week exhibited more difficulty with behavioral regulation (BRIEF BRI, r(19)= -.55, p = .01) and overall executive functioning (BRIEF GEC, r(19)= -.50, p = .03), as well as more repetitive behaviors (RBS-R, r(19)= -.46, p < .05). Higher SRBD scores also corresponded with more executive difficulties, (BRIEF GEC, r(19)= -.614, p = .005) and repetitive behaviors (RBS-R, r(19)= .79, p < .001). Increased snoring related to more errors during a basic stimulus-reward association task (r(19)= .484, p = .03). Working memory and short-term spatial memory were not related to sleep.

Conclusions: Children with ASD slept less during the week and had greater parent reported sleep-related breathing disorders and behavioral disruptions. These difficulties corresponded to greater impairments in executive control, repetitive behaviors, and information processing, suggesting that more investigation is needed to understand how sleep disruptions are related to poor executive control in children with ASD.