The Relationship between Sleep Problems, Neurobiological Alterations, Core Symptoms of Autism Spectrum Disorder, and Psychiatric Comorbidities

Abstract

Children with Autism Spectrum Disorder (ASD) are at an increased risk for sleep disturbances, and studies indicate that between 50 and 80% of children with ASD experience sleep problems. These problems increase parental stress and adversely affect family quality of life. Studies have also suggested that sleep disturbances may increase behavioral problems in this clinical population. Although understanding the causes of sleep disorders in ASD is a clinical priority, the causal relationship between these two conditions remains unclear. Given the complex nature of ASD, the etiology of sleep problems in this clinical population is probably multi-factorial. In this overview, we discuss in detail three possible etiological explanations of sleep problems in ASD that can all contribute to the high rate of these symptoms in ASD. Specifically, we examine how neurobiological alterations, genetic mutations, and disrupted sleep architecture can cause sleep problems in individuals with ASD. We also discuss how sleep problems may be a direct result of core symptoms of ASD. Finally, a detailed examination of the relationship between sleep problems and associated clinical features and psychiatric comorbidities in individuals with ASD is described.

Keywords: Autism Spectrum Disorder; behavioral problems; comorbidities; etiology; sleep problems.

Figure 1

Possible etiological explanations of sleep problems in Autism Spectrum Disorder (ASD). (1) Sleep problems are a consequence of biological and genetic abnormalities (involving serotonin, melatonin, and GABA) and disrupted sleep architecture present in individuals with ASD; (2) Sleep problems are intrinsic to the clinical phenotype of ASD; (3) Sleep problems represents a co-occurring condition completely independent from ASD. RRBs = Restricted interests and repetitive behaviours; MD = Mood Disorders.