Sleep Problems, Circadian Rhythms, and Their Relation to Behavioral Difficulties in Children and Adolescents with Autism Spectrum Disorder
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This was an exploratory cross-sectional study comparing 45 children with ASD to 24 typically developing drug-naïve controls, group-matched on age, sex, and body mass index. Objective data was obtained using the following: an ambulatory circadian monitoring device; saliva samples to determine dim light melatonin onset (DLMO): and three parent-completed measures: the Child Behavior Checklist (CBCL); the Repetitive Behavior Scale-Revised (RBS-R); and the General Health Questionnaire (GHQ28). The CBCL and RBS-R scales showed the highest scores amongst poor sleepers with ASD. Sleep fragmentation was associated with somatic complaints and self-injury, leading to a higher impact on family life. Sleep onset difficulties were associated with withdrawal, anxiety, and depression. Those with phase advanced DLMO had lower scores for "somatic complaints"; "anxious/depressed" state; and "social problems", suggesting that this phenomenon has a protective role.
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Sleep difficulties not only exacerbate behavioral symptoms in ASD but may also interfere with sensorimotor integration, thereby perpetuating toe walking behavior.
“Sleep difficulties not only exacerbate behavioral symptoms in ASD but may also interfere with sensorimotor integration, thereby perpetuating TW behavior [41].”
From The Prevalence and Clinical Significance of Toe Walking in Autism Spectrum Disorder: A Cross-Sectional Study in an Italian Pediatric Sample (2025) · cites this paper as [41]
The Abstract says sleep disruption is linked to worse behavioral symptoms in children with ASD. The Discussion reports associations between sleep measures and behavioral difficulties but says the study cannot establish causality. Neither passage supports the proposed interference with sensorimotor integration or perpetuation of toe walking; searches for those terms found no such finding. (LLM, conf=0.88)
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Sleep in Autism Spectrum Disorder: A Systematic Update
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- Authors
- Martinez-Cayuelas, E., Gavela-Pérez, T., Rodrigo-Moreno, M., Losada-Del Pozo, R., Moreno-Vinues, B., Garces, C., & Soriano-Guillén, L.
- Affiliations
- Instituto de Investigación Sanitaria Fundación Jiménez Díaz (ES)
- Venue
- Journal of Autism and Developmental Disorders
- Published
- 2023-03-04
- Volume
- 54
- Issue
- 5
- Pages
- 1712-1726
- ISSN
- 0162-3257 (ISSN-L)
- 1573-3432
- PMC
- PMC9984759
- OpenAlex
- W4323050061
- Cited by
- 24
- References
- 72
- Citations by year
- 2026: 8 · 2025: 13 · 2024: 1 · 2023: 2
- FWCI
- 6.20
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- Locations
- Journal of Autism and Developmental Disorders (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Funders
- fundacion familia Alonso (PIC006-18)
- Topics
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Sleep and related disorders
- Life Sciences › Neuroscience › Cognitive Neuroscience › Autism Spectrum Disorder Research
- Life Sciences › Neuroscience › Endocrine and Autonomic Systems › Circadian rhythm and melatonin
- Keywords
- autism spectrum disorder, sleep disorders, circadian rhythm, dim light melatonin onset, phase advance, sleep fragmentation, sleep onset difficulty, behavioral problems, self-harm, anxiety, depression, somatic symptoms, children and adolescents, family impact
- MeSH terms
- Problem Behavior, Autism Spectrum Disorder, Adolescent, Anxiety, Child, Circadian Rhythm, Cross-Sectional Studies, Depression, Female, Humans, Male, Melatonin, Surveys and Questionnaires, Saliva, Sleep Wake Disorders
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