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This study examined the sustained and moderating effects of a behavioural sleep intervention for autistic children in a randomised controlled trial. Autistic children (5-13 years) with sleep problems were randomised to the Sleeping Sound intervention or Treatment as Usual (TAU). At 12-month follow-up (n = 150), caregivers of children in the Sleeping Sound group reported greater reduction in child sleep problems compared to TAU (p < .001, effect size: - 0.4). The long-term benefits of the intervention were greater for children taking sleep medication, children of parents who were not experiencing psychological distress, and children with greater autism severity. The Sleeping Sound intervention demonstrated sustained improvements in child sleep. Identified moderators may inform treatment by indicating which subgroups may benefit from further support., (© 2022. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Background: Behavioural sleep problems are common in children with autism spectrum disorder (ASD); however, evidence for the efficacy of behavioural sleep interventions is limited. This study examined the efficacy of a brief behavioural sleep intervention in autistic children. It was hypothesised that the intervention would reduce overall child sleep problems (primary outcome), in addition to improvements in children's social, emotional, cognitive, academic functioning, and quality of life, and parent/caregivers' stress, quality of life, and mental health (secondary outcomes)., Methods: A randomised controlled trial was conducted with participants randomised via a computer-generated sequence to the sleeping sound intervention (n = 123) or treatment as usual (n = 122) group. Participants comprised 245 children with an ASD diagnosis. Inclusion criteria were as follows: confirmation of DSM IV or DSM-5 diagnosis of ASD, participants aged between 5 and 13 years and parent/caregiver report of moderate-severe sleep problems. Exclusion criteria were as follows: parent/caregiver intellectual disability or lacking sufficient English to complete questionnaires; and child participant with co-occurring medical conditions known to impact sleep. The intervention group received the sleeping sound intervention (2 × 50-min face-to-face sessions plus follow-up phone call) by a trained clinician., Results: Change in children's sleep problems was measured by the Children's Sleep Habits Questionnaire (CSHQ) at 3 months post randomisation. Parents/caregivers of children in the intervention group reported a reduction in child sleep problems at 3 months post randomisation (effect size: E.S -0.7). There were also small effects in a number of child (internalising symptoms, emotional behavioural disturbance and quality of life) and parent/caregiver (mental health, parenting stress and quality of life) outcomes; however, these did not remain significant when controlling for multiple comparisons., Conclusions: The sleeping sound ASD intervention is an efficacious and practical way to reduce sleep problems for autistic children. This brief behavioural intervention has the potential to be embedded easily into the Australian healthcare system., (© 2022 The Authors. Journal of Child Psychology and Psychiatry published by John Wiley & Sons Ltd on behalf of Association for Child and Adolescent Mental Health.)

Sleep problems are common in children with autism spectrum disorder (ASD). However, few studies have undertaken group comparisons of sleep profiles and factors associated with poorer sleep between children with ASD without intellectual disability (ID; hereafter referred to as ASD) and ASD with co-occurring ID (hereafter referred to as ASD + ID). This study aimed to (1) compare child (sleep problems and emotional and behavioural problems (EBPs)) and parent factors (parenting stress and mental health) for children with ASD compared to children with ASD + ID, and (2) examine the associations between sleep problems and child and parent factors in both groups. Parents of 56 children with ASD (22 ASD, 34 ASD + ID) aged 6-13 years took part in the study. No statistically significant differences in sleep problems were found between children with ASD compared to children with ASD + ID. However, total EBPs were independently associated with child sleep problems in both groups. Further, 'Self-Absorbed' and 'Communication Disturbance' EBPs were significantly greater in the ASD + ID compared to the ASD group. Overall treatment outcomes for children with ASD may be further improved if consideration is given to the specific types of EBPs being experienced by the child and their association with sleep problems.

This study investigated whether sleep problem severity in children with autism spectrum disorder was associated with maternal well-being. Mothers of 234 children reported on their mental health (Kessler Psychological Distress Scale), parenting stress (Parenting Stress Index-4-SF), health-related quality of life (HRQoL; Assessment of Quality of Life-4D) and their child's sleep (Children's Sleep Habits Questionnaire-ASD). Analyses revealed sleep initiation and duration problem severity scores were associated with increased mental health difficulties. Specific child sleep problems were not associated with parenting stress or HRQoL. This study revealed the importance of considering sleep and the family system when assessing maternal well-being. Future research considering parent, child and family factors will be important to informing a family focused approach to mental health.

Purpose of Review: Behavioural sleep problems in children with autism spectrum disorder (ASD) are common and burdensome for both the child and their family. We provide an up-to-date review on behavioural sleep interventions and their core features and conclude with expert recommendations regarding the modification of interventions for children with ASD., Recent Findings: In the past 3 years, four original research studies (n ≥ 10) have evaluated behavioural sleep interventions for children with ASD (one RCT, three pre-post studies). All four studies reported significant improvements across various sleep outcomes and daytime behaviours. The interventions varied, however, in assessment comprehensiveness, nature of implementation support, length and delivery of intervention, outcome measurements, and follow-up periods. Clinically, behavioural sleep interventions are regarded as the first-line of treatment for sleep problems experienced by children with ASD. However, there is still much to be learnt regarding their clinical effectiveness.

Introduction: Sleep problems are a characteristic feature of children with autism spectrum disorder (ASD) with 40% to 80% of children experiencing sleep difficulties. Sleep problems have been found to have a pervasive impact on a child's socio-emotional functioning, as well as on parents' psychological functioning. The Sleeping Sound ASD project aims to evaluate the efficacy of a brief behavioural sleep intervention in reducing ASD children's sleep problems in a fully powered randomised controlled trial (RCT). Intervention impact on child and family functioning is also assessed., Methods and Analysis: The RCT aims to recruit 234 children with a diagnosis of ASD, aged 5-13 years, who experience moderate to severe sleep problems. Participants are recruited from paediatrician clinics in Victoria, Australia, and via social media. Families interested in the study are screened for eligibility via phone, and then asked to complete a baseline survey online, assessing child sleep problems, and child and family functioning. Participants are then randomised to the intervention group or treatment as usual comparator group. Families in the intervention group attend two face-to-face sessions and a follow-up phone call with a trained clinician, where families are provided with individually tailored behavioural sleep strategies to help manage the child's sleep problems. Teacher reports of sleep, behavioural and social functioning are collected, and cognitive ability assessed to provide measures blind to treatment group. The primary outcome is children's sleep problems as measured by the Children's Sleep Habits Questionnaire at 3 months post-randomisation. Secondary outcomes include parent and child quality of life; child social, emotional, behavioural and cognitive functioning; and parenting stress and parent mental health. Cost-effectiveness of the intervention is also evaluated., Ethics and Dissemination: Findings from this study will be published in peer-reviewed journals and disseminated at national and international conferences, local networks and online., Trial Registration Number: ISRCTN14077107 (ISRCTN registry dated on 3 March 2017)., Competing Interests: Competing interests: NP, NR and JM receive philanthropic funding from the Moose Foundation, Ferrero Group Australia as part of its Kinder + Sport pillar of Corporate Social Responsibility initiatives, MECCA Brands, Wenig Family, Geelong Community Foundation, and Grace & Emilio Foundation; and industry partner funding from the Victorian Department of Education, to conduct research in the field of neurodevelopmental disorders and inclusion. NP, NR and JM have also previously received funding from the Australian Foortball Leagure and industry partner funding from the NDIS. NR has received donations form Vic Health and Bus Assoication Victoria; and previously received speaker honorarium from Novartis (2002), Pfzier (2006) and Nutricia (2007); and is a Director of the Amaze Board (Autism Victoria). None of the companies or organisational bodies listed above had a role in this research including the collection, analysis and interpretation of data; in writing of the manuscript; and /or in the decision to submit the article for publication., (© Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY. Published by BMJ.)

Background: Children with attention-deficit/hyperactivity disorder (ADHD) and autism spectrum disorder (ASD) experience high rates of sleep problems. Their parents experience higher parenting stress and more mental health difficulties than parents of typically developing children., Aim: To examine the association between child sleep problems, parenting stress and parent mental health for children with ADHD or ASD., Methods: MEDLINE Complete, EMBASE, PsycINFO and CINAHL Complete databases were searched. Studies needed to include: children aged 5-18 with ADHD or ASD, a child sleep measure, and a parenting stress or adult mental health measure., Results: Eleven studies were identified (four ADHD, seven ASD). Six studies examined parenting stress (five cross-sectional, one longitudinal) and five found associations, of varying strengths, with child sleep problems. Six studies examined parent mental health (four cross-sectional, two longitudinal) and five found associations, of differing magnitudes, with child sleep problems., Conclusions: These studies demonstrate child sleep problems are associated with poorer parent mental health and higher parenting stress., Implications: Future longitudinal research including multiple measurements of child sleep problems and family functioning is required to clarify the directionality of associations. Such knowledge is key in adapting sleep interventions to better meet the needs of children with ADHD or ASD and their families., (Copyright © 2019 Elsevier Ltd. All rights reserved.)

Objective: We explored the relationship between accidental injuries, motor impairment, and co-occurring autism spectrum disorder (ASD) symptoms in children with ADHD-combined type (ADHD-CT). Method: Participants were 32 male children diagnosed with ADHD-CT and 23 typically developing male children (7-12 years, full scale IQ [FSIQ] > 80). Parents completed a customized questionnaire on the occurrence of accidental injuries (e.g., bruises, cuts) their child experienced in the past 12 months. Motor proficiency was assessed using the Movement ABC-2 (MABC-2). Parents rated motor, ADHD-CT, ASD, and anxiety symptoms. Results: Children with ADHD-CT had significantly increased parent-reported accidental injuries compared with typically developing children. Among children with ADHD-CT, Spearman's rho rank correlations revealed no association between increased accidental injuries and MABC-2 score, but significant associations with increased hyperactivity/impulsivity, ASD, and anxiety symptoms. Conclusion: Although these findings require validation, they suggest a need for further research investigating the contribution of co-occurring ASD and anxiety symptoms to accidental injuries in children with ADHD-CT.

Objective: Sleep problems are common in children with autism spectrum disorders (ASD) and ADHD and impact adversely on child and parent well-being. The study evaluated the efficacy of a brief behavioral sleep intervention in children with comorbid ADHD-ASD., Method: A subsample of children with ADHD-ASD ( n = 61; 5-13 years; 89% male) participating in the Sleeping Sound With ADHD study were included in the current investigation. The subsample comprised of 28 children randomized to the sleep intervention group, while 33 were randomized to usual clinical care. The intervention consisted of two clinical consultations and a follow-up phone call covering sleep hygiene and standardized behavioral strategies., Results: Children with ADHD-ASD who received the intervention had large improvements in sleep problems and moderate improvements in child behavioral functioning 3 and 6 months post-randomization., Conclusion: These findings suggest that a brief behavioral sleep intervention can improve sleep problems in children with ADHD-ASD.

Objective: To examine (a) physical and daily functioning in children with ADHD and autism spectrum disorder (ASD) compared with ADHD alone and (b) whether decreased physical quality of life (QoL) is associated with increased emotional and behavioral problems in children with ADHD-ASD., Method: Cross-sectional study comprising 392 children with confirmed ADHD (ADHD-ASD, n = 93; ADHD alone, n = 299) recruited from 21 pediatric practices in Victoria, Australia. Data were collected via parent and teacher surveys. Key measures included the Strengths and Difficulties Questionnaire (SDQ) and Pediatric Quality of Life Inventory (PedsQL)., Results: Children with ADHD-ASD had poorer QoL across both psychosocial and physical health domains, and also had greater parent-reported behavioral, emotional, and peer problems, compared with children with ADHD alone. Poorer physical QoL partially mediated the relationship between comorbid ASD status and poorer emotional and behavioral functioning., Conclusion: The comorbid overlay of ASD in ADHD appears to influence not only problems in physical functioning but also the severity of problems relating to areas of emotional and behavioral functioning.

Objective: This study (a) compared behavioral sleep problems in children with comorbid ADHD and autism spectrum disorder (ASD) with those with ADHD and (b) examined child/family factors associated with sleep problems., Method: Cross-sectional study comparison of 392 children with a confirmed ADHD diagnosis (ADHD+ASD, n=93, ADHD, n=299) recruited from 21 peadiatric practises in Victoria, Australia. Data were collected from parents. Key measures included the Child Sleep Habits Questionnaire (CSHQ)., Results: Children with ADHD + ASD experienced similar levels and types of behavioral sleep problems compared with those with ADHD. In both groups, the presence of co-occurring internalizing and externalizing comorbidities was associated with sleep problems. Sleep problems were also associated with parent age in the ADHD + ASD group and poorer parent mental health in the ADHD group., Conclusion: Findings suggest comorbid ASD is not associated with increased behavioral sleep problems in children with ADHD and that co-occurring internalizing and externalizing comorbidities may flag children in these groups with sleep problems.

Autism Spectrum Disorder affects up to 2.5% of children and is associated with harmful health outcomes (e.g. obesity). Low levels of physical activity and high levels of sedentary behaviors may contribute to harmful health outcomes. To systematically review the prevalence and correlates of physical activity and sedentary behaviors in children with Autism Spectrum Disorder, electronic databases (PsycINFO, SPORTDiscus, EMBASE, Medline) were searched from inception to November 2015. The review was registered with PROSPERO (CRD42014013849). Peer-reviewed, English language studies were included. Two reviewers screened potentially relevant articles. Outcomes of interest were physical activity and sedentary behaviour levels and their potential correlates. Data were collected and analysed in 2015. Of 35 included studies, 15 reported physical activity prevalence, 10 reported physical activity correlates, 18 reported sedentary behavior prevalence, and 10 reported sedentary behavior correlates. Estimates of children's physical activity (34-166 mins/day, average 86 mins/day) and sedentary behavior (126-558 mins/day in screen time, average 271 mins/day; 428-750 mins/day in total sedentary behavior, average 479 mins/day) varied across studies. Age was consistently inversely associated, and sex inconsistently associated with physical activity. Age and sex were inconsistently associated with sedentary behavior. Sample sizes were small. All but one of the studies were classified as having high risk of bias. Few correlates have been reported in sufficient studies to provide overall estimates of associations. Potential correlates in the physical environment remain largely unexamined. This review highlights varying levels of physical activity and sedentary behavior in children with Autism Spectrum Disorder. Research is needed to consistently identify the correlates of these behaviors. There is a critical need for interventions to support healthy levels of these behaviors.

Objectives There is no medical test for autism spectrum disorder ( ASD), a heterogeneous condition currently defined in the Diagnostic and Statistical Manual of Mental Disorders Fifth Edition ( DSM-5) by dysfunction in social, communication, and behavioural dimensions. There is agreement in the literature that the motor profile of ASD may hold the key to improving clinical and diagnostic definition, with DSM-5 now referring to motor deficits, including 'odd gait' (p. 55), as part of the ASD clinical description. This review describes the history of motor impairment in ASD, types of motor problems, and age-related motor findings and highlights evidence gaps and future research. Method A narrative review is provided of the research literature describing motor impairment in ASD and its ability to differentiate between ASD versus non- ASD cohorts. Results Findings show differences in motor development in children with ASD from infancy onwards, including difficulties across motor coordination, arm movements, gait, and postural stability. Motor disturbance may appear in young children with ASD prior to social and language difficulties becoming clinically apparent. However, challenges remain in defining and measuring the early motor profile that is specific to ASD. Despite well-established motor impairments in ASD, there is a lack of evidence regarding which motor-based interventions will be effective in this group. Conclusions Motor impairment holds promise as an early diagnostic sign, a behavioural marker, and a means by which to improve identification and possibly phenotypic delineation in ASD. Further research is required to determine whether motor abnormalities can sensitively differentiate ASD from other developmental conditions and to establish evidenced-based interventions to reduce the associated impairment. [ABSTRACT FROM AUTHOR]

Although there is little overlap in core diagnostic criteria for ADHD and Autism Spectrum Disorder (ASD), ASD symptoms are estimated to co-occur in children with ADHD in 20–50% of cases. As motor control deficits are common to both disorders, we investigated the impact of ASD symptoms on ocular motor control in children with Attention Deficit Hyperactivity Disorder-Combined Type (ADHD-CT), using a cued saccade paradigm sensitive to cerebellar ocular motor impairment in ASD. Basic saccade metrics (latency, velocity and accuracy), trial-to-trial variability, and main sequences relationships (saccade velocity for a given amplitude) were assessed, for 14 males with ADHD-CT and 14 typically developing (TD) males (aged 8–14, IQ > 80). Our results revealed that saccade profiles of the ADHD-CT group showed a pattern of hypermetria and altered main sequence. As the cerebellum is crucially involved in the regulation of saccade parameters, we propose that this pattern of deficit in ADHD-CT is consistent with the widely reported morphological abnormalities in ocular motor vermis (cerebellar lobules VI-VII) in ADHD-CT and ASD. [ABSTRACT FROM AUTHOR]