The relationship between autism spectrum and sleep-wake traits.
Circadian sleep-wake disruption tracks with core autism and executive-function traits—consider sleep-actigraphy screening in assessment protocols.
01Research in Context
What this study did
Kremkow et al. (2022) asked adults to wear a wrist-watch-like device for two weeks. The device tracked when they fell asleep, woke up, and how steady their daily rhythm was.
Each adult also filled out short forms about autism traits and executive-function skills like planning and staying focused.
What they found
Adults who scored higher on autism traits also showed messier sleep-wake cycles. Their bedtimes and wake times jumped around more from day to day.
They also rated their own sleep quality lower, even when they slept the same number of hours.
How this fits with other research
Scahill et al. (2024) now gives us a quick rating scale for insomnia in autistic kids. The scale turns the 2022 warning into a tool you can use in intake.
Abel et al. (2018) saw the same link in children doing ABA: steady, poor sleep predicted more self-injury and repetitive acts the next day. The adult pattern matches the kid pattern.
McMillan et al. (1999) warned that parent questionnaires alone can miss sleep problems. Kremkow et al. (2022) proved actigraphy still matters with adults.
Dembo et al. (2023) looked at fragile-X mothers and found poor sleep hurt their health. The sleep link looks opposite because it sits in caregivers, not autistic clients themselves.
Why it matters
If your client’s autism traits are strong, add a two-week actigraphy check to your assessment. One simple wrist device can show you circadian drift that parent logs miss. Share the read-out with the family doctor before you start a new skill program; fixing sleep first can cut daytime problem behavior without extra teaching trials.
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02At a glance
03Original abstract
Autistic children and adults often have sleep disturbances, which may affect their and their family's quality of life. Yet, the relationship between sleep-wake patterns and autism spectrum traits is understudied. Identifying such relationships could lead to future research elucidating common mechanistic underpinnings. Thus, we aimed to determine whether sleep-wake patterns, specifically related to sleep, physical activity, and the daily sleep-wake rhythm (i.e., circadian rhythm), are associated with autism spectrum-related traits. Accelerometer-derived sleep-wake parameters were estimated in individuals with autistic spectrum traits and their family members (N = 267). We evaluated autism spectrum traits using the Social Responsiveness Scale (SRS) to assess the presence and severity of social impairment and the Behavior Rating Inventory of Executive Function (BRIEF) to assess executive function. The linear multivariate regression analysis (using SOLAR-Eclipse) showed that in adults, increased core autism spectrum traits and executive dysfunction were associated with disruption of several sleep-wake parameters, particularly related to the daily sleep-wake rhythm, and that executive dysfunction was associated with disrupted sleep quality and level of physical activity. We highlight the interplay between daytime function and disrupted sleep-wake patterns, specifically related to the daily sleep-wake rhythm, that could guide future research into common mechanisms. LAY SUMMARY: Autistic children and adults often report sleep disturbances. To dissect the relationship between a range of autism spectrum traits and sleep-wake patterns, we assessed social interaction and executive function in participants who also wore actimetry watches on their wrists to assess their sleep-wake patterns. We found that increased impairments in social and executive function occurred with increased sleep-wake disturbances, particularly those related to the circadian rhythm, suggesting that these perturbations/disruptions in the sleep-wake cycle could be connected to autism spectrum traits.
Autism research : official journal of the International Society for Autism Research, 2022 · doi:10.1002/aur.2660