Sleep problems in children with autism.

A review of: GOODLIN-JONES, B., TANG, K., LIU, J., ANDERS, T. (2008). Sleep Patterns in Preschool-Age Children With Autism, Developmental Delay, and Typical Development. . Journal of the American Academy of Child & Adolescent Psychiatry, 47(8), 932-940.

Parents of children with autism usually report that their children experience significant sleep problems, such as difficulty falling asleep. Yet, little research has been conducted on the specific type of sleep difficulties prevalent among children with autism. The authors of this paper first discussed the need to understand the nature of the sleep problems within this population. Research on sleep difficulties among children with other developmental disabilities indicate significant variability between the different disorders. For example, children with Prader-Willi syndrome have extended nighttime sleep and daytime sleepiness, while children with Rett syndrome have difficulty staying asleep during the night and frequent daytime napping. Therefore, in order to examine the type of sleep problems experienced by children with autism the authors examined the night and daytime sleep patterns of 68 pre-school children with autism, 57 children with non-autistic developmental delays, and 69 typically developing kids.

General findings:

The mean bedtime for the entire group was 9:00pm and the children took 38 additional minutes to fall asleep. The average waking time was 7:10am. Thus, the average time in bed was 10 hours, with 9:20 hours of actual sleep.

No sex differences were noted.

Autism findings:
Children with autism slept significantly less during a 24 hours cycle than children with other developmental disabilities and typically developing kids. In regards to awakening events during the night, typically developing children had more awakenings than children with autism, but the awakenings episodes of children with autism were significantly longer. This suggests that while children with autism do not seem to have difficulty staying asleep, they do experience difficulty falling asleep after sleep interruptions.

In regards to parental reports about their children sleep patterns, parents of children with autism reported significantly more sleep difficulties than parents of typically developing kids but not significantly more than those reported by parents of children with other developmental problems. However, parents of children with autism reported significantly more personal stress than parents in the two comparison groups.

Phonological Processing in Parents of Children with Autism.

A review of: Schmidt, G., Kimel, L., Winterrowd, E., Pennington, B., Hepburn, S., Rojas, D. (2008). Impairments in phonological processing and nonverbal intellectual function in parents of children with autism. Journal of Clinical and Experimental Neuropsychology, 30(5), 557-567. DOI: 10.1080/13803390701551225

I have previously reported on studies examining the “Broader Autism Phenotype,” a repeated finding that some parents of children with autism (most often fathers) have mild autistic tendencies themselves. I recently discussed a study on social cue perception and a study on seizure disorder. In the present study, the authors wanted to explore performance on language measures among parents of children with autism when compared to parents of typically developing kids. The study included 22 parents of kids with autism (14 mothers and 8 fathers) from 17 families (some families had both parents participating while most had only one parent). The comparison group included 22 parents that were matched for sex, age, IQ, and socioeconomic status. The two groups completed a battery of neuropsychological tests including the Wechsler Abbreviated Scale of Intelligence, and measures of receptive language, expressive language, phonological processing (processing of sounds), and history of reading difficulties. The authors found that when compared to parents of typically developing kids, parents of children with autism performed worse on measures of non-verbal reasoning and phonological processing. There were no significant differences on measures of verbal intelligence, expressive language, receptive language, verbal fluency, and history of reading difficulties. The findings would appear consistent with the ‘non-verbal disability’ profile that had been proposed as a marker of Asperger’s syndrome, although several recent studies have failed to provide evidence for this profile (see this review on a study on non-verbal learning disabilities in Asperger's syndrome). However, it was surprising to see any differences at all between the groups, in light of their very high intellectual functioning profile. That is, these parents were significantly above the norm in intellectual capacity, with IQ scores of 116 for the parents of children with autism and 120 for parents if typically developing children. Thus, in regards to non-verbal reasoning and phonological processing, we are not talking about “impairment” among parents of kids with autism, but instead slightly worse (but still above average) performance than parents of typically developing kids.

Autism and Parental Psychiatric Disorders

A brief review of: Daniels, J.L., Forssen, U., Hultman, C.M., Cnattingius, S., Savitz, D.A., Feychting, M., Sparen, P. (2008). Parental Psychiatric Disorders Associated With Autism Spectrum Disorders in the Offspring. PEDIATRICS, 121(5), e1357-e1362. DOI: 10.1542/peds.2007-2296

The journal of Pediatrics just published a population study based on the national Swedish registry, which examined the association between parental psychiatric history and autism. The authors compared the parental psychiatric history of 1,227 of children with autism spectrum disorder and 30,925 typically developing children. Children were identified as having autism spectrum disorder if they were born between 1977 and 2003 and had a diagnosis of ASD recorded in the registry between 1987 and 2003.

Parents of children with autism were 70% more likely than parents of typically developing kids to have a psychiatric diagnosis. When both parents had a psychiatric disorder, the children were 100% more likely to have a diagnosis of autism. Schizophrenia was more common in both parents among children with autism as compared to parents of typically developing kids (90% more likely for mothers and 110% more likely for fathers). In addition, mothers of children with autism were more likely than mothers of typically developing kids to have depression (70%), and personality disorders (70%).

In summary, the study suggests that in Sweden, during the last 30 years, children with a diagnosis of autism were more likely to have parents with psychiatric diagnoses than typically developing children. This could reflect a non-specific, possibly genetic, predisposition in affected families for psychiatric conditions, including autism. It could also reflect that having a child with autism increases stress in the parents possibly leading to psychiatric diagnoses. However, the association noted by the authors was even stronger if the parental diagnosis was provided before the child’s diagnosis. One important consideration, these results were based only on kids who had a history of inpatient treatment. Those with a history of only outpatient treatment were not included. It is possible that the observed link between parental psychiatric history and autism applies only, or mostly, to the most severe cases of autism requiring hospitalization.

One last comment: It's important to note that the rate of psychiatric conditions among even children with autism were very low. For example, schizophrenia was observed among 0.6% of the mothers of children with autism (compared to 0.2% of the typically developing mothers). 99.4% of the children with autism did not have mothers with schizophrenia. Therefore, the data only suggest that there may be a familial/genetic predisposition that is related to autism among very small subset of children with autism.

Autism and family psychopathology: A Neuroprotective Effect?

An autism endophenotype may be identified on the basis of family psychopathology, but not in the direction you may think.

A review of: Lajiness-O’Neill, R., Menard, P. (2007). Brief Report: An Autistic Spectrum Subtype Revealed Through Familial Psychopathology Coupled with Cognition in ASD. Journal of Autism and Developmental Disorders DOI: 10.1007/s10803-007-0464-3

A genotype refers to a specific genetic profile. A phenotype refers to the presentation (behaviors, physical features, etc) of a genotype. An endophenotype refers to specific characteristics (biological, social, cultural, etc, etc) that may influence the expression of a disorder-related genotype. In this very interesting study the researchers examined parental psychiatric history and the neurocognitive functioning of 24 kids with Autism Spectrum Disorders (5 Autism, 7 Asperger’s, 12 PDD NOS; average age 9.16) and 49 children with learning disability but not autism. Autism diagnosis was based on DSM-IV criteria via CARS and ADI-R. The researchers found a significant higher rate of mood disorders and anxiety on the maternal side of children with ASD as compared to children with LD. There was a significant higher rate of learning disabilities and ADHD in the paternal side of children with ASD as compared to children with LD. A surprising finding was noted: Children with ASD who had a history of mood disorders in the maternal side (n=9), demonstrated significantly higher visuospatial functioning when compared to children with ASD who did not have a maternal history of mood disorders (n=14). The authors reported that this is consistent with a different study that found maternal mood disorders to be associated with elevated cognitive and adaptive functioning in children with ASD (Cohen and Tsiouris, 2006). Thus, although maternal mood disorders were more common in children with ASDs than in children with LDs, high rates of of these mood disorders seem to serve a neuroprotective function.

Adults more tolerant when informed about Autism diagnosis?

Title: Adult Attitudes Toward Behaviors of a Six-year-old Boy with Autism
Source: Chambres, P., Auxiette, C., Vansingle, C., Gil, S. (2008). Adult Attitudes Toward Behaviors of a Six-year-old Boy with Autism. Journal of Autism and Developmental Disorders DOI: 10.1007/s10803-007-0519-5

A common experience reported by parents of children with autism is the perception of being ‘judged’ by other adults about their parenting skills or the appropriateness of behaviors displayed by their children. In order to understand this phenomenon, at team of French researchers conducted a very clever study using a methodology popular in social psychology research. The team showed clips of a video of a six year old boy with high functioning autism to 88 French adults. The clips showed the boy engaging in 4 different behaviors, namely: leaning back on a chair and moaning, having a temper tantrum without clear reasons, using a computer, and sitting at a table talking in front of a camera. One half of the adult participants were told that the child had Autism while the other half was not informed of the diagnosis. After showing the clips of each behavior, the adult participants were instructed to rate the child on 10 continuous dimensions (unruly, nice, alert, anxiety-ridden, etc). The authors found that when participants knew the clinical diagnosis of the child, they were more tolerant of the “negative” behaviors shown in the clips. Likewise, these informed adults were also more likely to rate the child positively in cognitive dimensions (intelligent, quick-minded, alert). The authors also found a gender effect. When the adults were informed, there was no difference between male and female participants. However, when the participants were uninformed, males were more harshly in the evaluation of the child than females. The authors commented that one possible reason that adults tend to show judgment towards parents of children with autism is that these children “look” like any typically developing child, so most people unfamiliar with the child would not know that the child had autism. The results are consistent with that idea indicating that when adults know that the child has autism they are more tolerant of behaviors that "do not conform to social norms" and see the child more positively in many dimensions. The results of this study could provide needed empirical support for the need of educational campaigns about ASDs targeted to the general population.

Parents of Children with High Functioning Autism and the Broader Autism Phenotype

Title: Broader Autism Phenotype in parents of Autistic Children: Reality or Myth
Authors: Anke M Cheeren & Johannes E. A. Stauder. University of Maastricht. Neatherlands.
Source: Journal of Autism and Developmental Disorders, (2008), 38, 276-287

This relatively short and focused article was published in the last issue of the Journal of Autism and Developmental Disorders. The authors wanted to test the hypothesis that parents of children with Autism Spectrum Disorders have mild autistic features, a finding that has been labeled the “Broader Autism Phenotype” (BAF). The authors compared the parents of 25 children with "high functioning autism" with the parents of 25 typically developing children. These parents were compared in regards to their performance to the block design task (a visual-motor spatial perception task that is part of a standard IQ test), the Autism-Spectrum Quotient (AQ - a test of common autistic features), and a reaction time task designed to measure how fast a person respond to social vs. non-social cues (gaze vs. arrows). The authors found that parents of children with high functioning autism scored similarly than parents of typically developing children on the bock design task and the AQ task, suggesting no clear differences between these parents in visual-motor spatial perception and global traits of autism. However, parents of children with high functioning autism were slower to react to social cues (as compared to non-social cues) than parents of typically developing children, an effect that was particularly strong for Fathers. There are a few things worth discussing. First, the authors examined parents of "high functioning autism" kids, however the group included a mix of children with autism, Asperger’s syndrome, and PPD NOS. Why is this significant? First because some researchers have discussed the Broader Autism Phenotype as a phenomenon possibly common among parents of children with Asperger’s disorder only. I believe this is in line with the author’s selection of the block design as a measuring tool. There is some evidence that suggests that children with Asperger’s disorder, but not children with high functioning autism, present a cognitive profile indicative of a Non-Verbal Learning Disability. In fact, this effect has been used as a possible marker of the proposed difference between Asperger’s and High Functioning Autism. Another interesting result is that reduced reaction time to social cues was more pronounced in fathers of children with ASD, which is consistent with some suggestions that the BAF is mostly limited to fathers and not mothers. The idea of differences in some measures of social cue processing amongst parents of children with autism is not necessarily novel or out of sync with the rest of the literature. We know there is a higher familial risk for autism when a parent or a sibling has an ASD (autism runs in families), and we know that there is a genetic component to these disorders. Thus, some differences (and in this case very mild and limited to reaction time) between parents of children with ASD (especially fathers and likely only in regards to Asperger’s) and typically developing children could be expected.

What contributes to Maternal Involvement in their kids’ education?

Title: Maternal involvement in the education of young children with autism spectrum disorders.
Source: Autism 2008; 12; 47
Study Authors: Paul Benson Kristie L. Karlof Gary N. Siperstein At the University of Massachusetts

The authors of this elegant study asked a very simple but neglected question? What are the factors that contribute to mothers’ level of involvement in the education of their children with ASD? The authors conducted interviews and surveys with 95 mothers, teachers, and children, and found that mothers educational involvement (both at school and at home) increased significantly if the school actively encouraged this involvement. This suggests that the schools have an important role in promoting educational involvement amongst mothers. Unfortunately a paradoxical but common finding was noted. Mothers of children who had more disruptive behavior problems also reported much lower levels of involvement in their children's education. Is this because the high levels of behavior problems discourage mothers from becoming more involved (“I give up”)? That is the most likely explanation provided by the researchers. They argue that mothers with kids who have severe behavioral problems are simply too overwhelmed to become more involved in the child’s education. One mother stated “Once he’s home, I have to watch him continually just to keep him and his younger sister safe . . . It’s exhausting. I simply can’t deal with anything else.’

Ethnic differences in mothers perception of the negative impact of having a child with Autism

Title: Predictors of perceived negative impact in mothers of children with autism spectrum disorder.
Authors: Bishop, Somer L; Richler, Jennifer; Cain, Albert C; Lord, Catherine.
Source: American Journal on Mental Retardation. Vol 112(6) Nov 2007, 450-461.

This study, conducted at the University of Michigan, explores what factors predict how mothers perceive the possible negative impact of having a child with Autism. The researchers evaluated data from 110 children with autism spectrum disorders and their mothers. Surprisingly, a race difference was found. The researchers found that African American mothers reported lower negative impact of having a child with autism when compared to Caucasian mothers. At least two possible explanations were provided by the authors 1) It is possible that African American mothers have better skills for coping with daily stress than Caucasian mothers, possibly because they are exposed to higher levels of every day stressors , or 2) it is possible that African American mothers in general experience more daily stressors and therefore may be less likely to attribute their stress to their children. Higher repetitive behaviors and lower adaptive behaviors (as measured by the Vineland scale) were the two child variables most highly associated with perceived negative impact. What does “perceived” negative impact mean? This distinction is made to separate “perceived” from “real” negative impact. It is possible that people have an accurate perception of the negative impact of having a child with autism, but it is also possible that such perception does not necessarily reflect reality.

PS, Congrats Somer (old college friend).