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

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. 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). Thirty-two 8−12-year-olds with AS/HFA, 28 boys and 4 girls, and 32 ageand 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. 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 (bedand 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. 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. 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 parent-reported 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. 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. Conclusion: In childhood AS/HFA, difficulty initiating sleep is a common and distressing symptom, and mothers of children with AS/HFA frequently report impaired physical well-being. LIST OF PUBLICATIONS The thesis is based on the following original papers. They will be referred to in the text by the Roman numerals. I. Allik H, Larsson JO, Smedje H. (2006). Sleep patterns of school-age children with Asperger syndrome or high-functioning autism. Journal of Autism and Developmental Disorders, 36, 585-595. II. Allik H, Larsson JO, Smedje H. (2006). Insomnia in school-age children with Asperger syndrome or high-functioning autism. BMC Psychiatry, 6, 18. III. Allik H, Larsson JO, Smedje H. Sleep patterns in school-age children with Asperger syndrome or high-functioning autism and in typically developing children: a longitudinal comparison. Manuscript submitted. 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 and Quality of Life Outcomes, 4, 1.