Search

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. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

BACKGROUND: Engaging in classroom‐based physical activity (PA) breaks may help increase children's subjective wellbeing and enjoyment of PA, important precursors for children to remain engaged in PA. We conducted a systematic review to investigate the effect of brief classroom‐based PA interventions on primary school children's subjective wellbeing and enjoyment of PA. METHODS: Databases were reviewed between the earliest date of records and April 2020. Eligibility criteria included peer‐reviewed empirical quantitative or mixed methods studies reporting enjoyment of PA or wellbeing outcomes of participating in a brief classroom‐based PA program. Fifteen papers were included. Interventions supported 7022 child participants enrolled at baseline and 6286 children analyzed in interventions across 148 schools. RESULTS: Thirteen studies examined the effect of brief classroom‐based PA interventions on subjective wellbeing. Four found a significant positive effect for children in the intervention group (specifically for children's self‐efficacy in learning with video exercises, quality of life, and self‐confidence). Eight studies examined the effect of brief classroom‐based PA interventions on enjoyment of PA. Five studies reported a positive effect for children in the intervention group and only 1 study found a negative effect for 1 grade level of children in the intervention group. The remaining studies with wellbeing and/or enjoyment outcomes reported no significant effect. CONCLUSIONS: Findings from these studies indicate that the integration of brief PA breaks may support PA enjoyment and specific self‐beliefs and quality of life perceptions that contribute to children's subjective wellbeing. However, more research is needed to confirm this effect. [ABSTRACT FROM AUTHOR]

The interactions between sleep problems, autism symptoms and emotional and behavioural difficulties were explored using network analysis in 240 autistic children (mean age: 8.8 years, range 5–13 years) with moderate to severe sleep problems. Findings revealed a highly connected and interpretable network, with three separate clusters identified of the modelled variables. Depression, anxiety and behavioural difficulties were the most central variables of the network. Depression, anxiety and restricted repetitive and stereotyped patterns behaviours (RRBs) were the strongest bridging variables in the network model, transmitting activation both within and between other symptom clusters. The results highlight that depression and anxiety were highly connected symptoms within the network, suggesting support in these areas could be helpful, as well as future research. [ABSTRACT FROM AUTHOR]

Background: Children with disabilities often engage in less than the recommended amount of daily physical activity (PA). Classroom-based PA breaks are a favourable method of promoting PA for children. However, evaluations of these programs in specialist schools are scarce, with even less research into their feasibility and acceptability. This may hinder effective implementation and program scalability. This pilot study investigated the feasibility and acceptability of implementing a classroom-based PA break program in Australian specialist school classrooms, using the Australian Joy of Moving (AJoM) program.Methods: Forty primary/junior classes and their teachers across five specialist schools implemented the AJoM program for eight weeks as the intervention group within a pilot cluster randomised controlled trial. A mixed-methods design investigated classroom teachers' (N = 22; 6 males, 16 females) perspectives of the feasibility and acceptability of the program after implementation through semi-structured telephone interviews (n = 7 teachers), qualitative survey responses (n = 18 teachers) and quantitative survey items (n = 19 teachers). Qualitative data were analysed using predominantly deductive thematic analysis. Quantitative data were analysed using descriptive statistics.Results: Classroom-based PA breaks may be feasible for getting children with disabilities more active at school. However, considerable variation exists in teachers' perception of the AJoM experience. While several teachers indicate that the program content could be pertinent for their class, common divergences in perceptions of feasibility and acceptability appear to relate to the age and developmental level or needs of the students in the class.Conclusions: This study provides preliminary evidence for the feasibility and acceptability of implementing classroom-based PA breaks in specialist schools. However, results demonstrate the importance of (1) allowing a high level of flexibility in the design and implementation of programs to meet the varying needs of class groups and (2) providing a large variety of resources to cater to the heterogeneity of the children.Trial Registration: This trial was prospectively registered with the Australian New Zealand Clinical Trials Registry ( ACTRN12619000193178 ) on 11 February 2019. [ABSTRACT FROM AUTHOR]

Objective/Background: Children with attention-deficit/hyperactivity disorder (ADHD) experience more sleep problems than typically developing children. In addition, higher rates of depression are experienced by mothers of children with ADHD compared to mothers of children without ADHD. This study aimed to determine whether particular sleep problems in children with ADHD are associated with specific maternal mental health difficulties. Participants: Female caregivers of 379 children with ADHD (5–13 years) participated. The child's ADHD diagnosis was reconfirmed during recruitment by caregivers completing the ADHD Rating Scale-IV. Method: Caregivers reported on their mental health using the Depression Anxiety Stress Scale and their child's sleep using the Children's Sleep Habits Questionnaire. Unadjusted and adjusted regression analyzes were undertaken. Results: In the adjusted analyzes, there were small significant associations between most aspects of child sleep (i.e. Bedtime Resistance, Night Waking, Parasomnias, Sleep Duration, Daytime Sleepiness and Total Sleep Problems) and maternal Anxiety and Stress, with the exception of Sleep-Onset Delay. Bedtime Resistance, Sleep Duration, Daytime Sleepiness and Total Sleep Problems also had small significant associations with maternal Depression. Sleep Anxiety had a small significant association with maternal Anxiety only. Conclusions: This study demonstrates important connections between many child sleep problems and particular aspects of maternal mental health, suggesting adaptations to behavioral sleep interventions for children and mental health interventions for parents to take a family approach may be beneficial. Future research should consider the longitudinal associations between child sleep and parent mental health in an effort to inform future intervention approaches. [ABSTRACT FROM AUTHOR]

Objectives/Background: A high proportion of children with Attention Deficit Hyperactivity Disorder- Combined type (ADHD-CT) experience sleep and motor problems. This study investigated (a) whether motor proficiency moderated the relationship between ADHD symptoms and sleep problems in children with and without ADHD-CT and (b) whether this moderation differed as a function of ADHD diagnosis. Participants: A sample of 70 primary school male children between 8–15 years were recruited; children with ADHD-CT (n = 38; mean age 10 years, 2 months [SD = 1 year, 6 months]) and a typically developing (TD) (n = 32; mean age 9 years, 6 months [SD = 1 year, 5 months]) group. Methods: Motor proficiency was measured using the Movement Assessment Battery for Children-2nd Edition (MABC-2), ADHD symptoms were measured using the Conners' Parent Rating Scale (CPRS) and parent reported sleep problems were measured using the Children's Sleep Habits Questionnaire (CSHQ). Results: Children who reported higher ADHD symptoms and lower motor proficiency scores reported more sleep problems. The moderation effect only held in children with a diagnosis of ADHD-CT and not in the typically developing group. Conclusions: These findings indicate that children who experience greater severity of ADHD symptoms who also have lower motor proficiency may be at increased risk of experiencing sleep problems. These findings also illustrate the importance of considering motor proficiency when exploring risk factors for sleep problems in children with ADHD-CT as well as sleep interventions. [ABSTRACT FROM AUTHOR]

Abstract: This study aimed to compare the gait of children with ADHD – Combined Type (ADHD-CT) to typically developing (TD) children. Children with ADHD-CT (n=14; mean age 10 years 4 months) and a TD group (n=13; mean age 10 years 9 months) walked at self-selected slow, preferred and fast speed on an electronic walkway system. Participants completed a total of 15 walking trials; 5 trials per walking condition. Groups were matched on age, intellectual functioning, height and weight. In the preferred walking condition, there was no difference in spatio-temporal gait variables between the ADHD-CT and TD control groups. At self-selected fast speed, children with ADHD-CT were faster and walked with a higher cadence. The subtle alterations in gait pattern that may reflect a timing deficit is consistent with previous ADHD motor studies. In addition, this study extends previous studies in characterising the unique gait profile of non-medicated children with ADHD-CT where a diagnosis of autism spectrum disorder has been ruled out. [Copyright &y& Elsevier]

Motor proficiency was investigated in a sample of children with Attention Deficit Hyperactivity Disorder-Combined type (ADHD-CT) without autism. Accounting for the influence of co-morbid autistic symptoms in ADHD motor studies is vital given that motor impairment has been linked to social-communication symptoms in children who have co-morbid ADHD and autistic-like symptoms. Two groups of children aged between 7-14 years were recruited; children with ADHD-CT (n = 16; mean age 10 years, 7 months [SD = 1 year, 10 months]) and a typically developing (n = 16; mean age 10 years, 6 months [SD = 2 years, 6 months]) group. Motor proficiency was measured using the Movement Assessment Battery for Children-2nd Edition, ADHD symptoms were measured using the Conner's Parent Rating Scale. Children with ADHD-CT who had been screened for co-morbid autism did not display motor difficulties on the MABC-2. Higher levels of inattention, but not hyperactivity or impulsivity were associated with poorer motor performance. These findings provide indirect evidence that the motor problems that children with ADHD experience may be related to co-occurring social responsiveness impairments. [ABSTRACT FROM AUTHOR]

The relationship of motor proficiency with emotional/behavioural disturbance, autistic symptoms and communication disturbance was investigated in children diagnosed with autism and Asperger’s disorder (AD). The Movement Assessment Battery for Children was used as a measure of motor impairment, and the Developmental Behavioural Checklist was used as a measure of emotional/behavioural disturbance in the following groups: AD (n = 22), high functioning autism (HFA) (n = 23), LFA (n = 8) and typically developing children (n = 20). The HFA group had more difficulty with motor items, such as ball skills and balance, than did the AD group. There were significant positive correlations between impairments in motor proficiency (in particular ball skills and balance) and emotional/behavioural disturbance, autistic symptoms and communication disturbance. These findings are consistent with the hypothesis that there are qualitative and quantitative differences in the motor profile between autism and AD. In addition, the association between motor proficiency impairment and emotional/behavioural disturbance in autism and AD emphasizes the importance for screening of co-occurring emotional/behavioural symptoms in individuals with motor difficulties. These findings have implications for the potential use of adjunct motor measures in the diagnosis and definition of autism spectrum disorders. [ABSTRACT FROM PUBLISHER]

Disordered sleep is common in autistic children. This study aimed to evaluate the cost-effectiveness of a brief behavioural sleep intervention, the ‘Sleeping Sound intervention’, in primary school-aged autistic children in Australia. A cost-effectiveness analysis was undertaken alongside a randomised controlled trial over a 6-month follow-up period from both a societal and healthcare sector perspective. Resources used by participants were collected from a resource-use questionnaire and administrative data; intervention costs were determined from study records. Mean costs and quality-adjusted life-years (QALYs) were compared between the intervention and treatment as usual (TAU) groups. Uncertainty analysis using bootstrapping and sensitivity analyses were conducted. The sample included 245 children, with 123 participants randomised to the intervention group and 122 to TAU. The mean total costs were higher for the Sleeping Sound intervention with a mean difference of A$745 (95% CI 248; 1242; p = 0.003) from a healthcare sector perspective and A$1310 (95% CI 584; 2035, p < 0.001) from a societal perspective. However, the intervention also resulted in greater QALYs compared with TAU, with a mean difference of 0.038 (95% CI 0.004; 0.072; p = 0.028). The incremental cost-effectiveness ratio was A$24,419/QALY (95% CI 23,135; 25,703) from a healthcare sector perspective and A$41,922/QALY (95% CI 39,915; 43,928) from a societal perspective; with a probability of being cost-effective of 93.8% and 74.7%, respectively. Findings remained robust in the sensitivity analyses. The Sleeping Sound intervention offers a cost-effective approach in improving sleep in primary school-aged autistic children.Trial registration The trial was registered with the International Trial Registry (ISRCTN14077107). [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

An abstract of the article "Understanding Risk Factors for Sleep Problems in Children With Attention-Deficit/Hyperactivity Disorder: Exploring the Influence of Motor Problems" by Nicole V. Papadopoulos and colleagues is presented.

Objective: The aim of the current study was to evaluate parental perceptions of the acceptability of a brief behavioural sleep intervention for autistic children (aged 5-13 years) using the Theoretical Framework of Acceptability (TFA).Methods: Qualitative data were collected during a large randomised controlled trial evaluating the efficacy of the Sleeping Sound intervention: 123 families were randomised to the intervention group, of which 115 (93%) completed at least one intervention session and 82 (67%) provided qualitative evaluation data in the 3-month follow-up survey. Consultation records from intervention sessions and parent surveys were qualitatively analysed post hoc using a hybrid approach to thematic analysis.Results: Findings were categorised under the seven themes of the TFA (affective attitude, burden, ethicality, intervention coherence, opportunity costs, perceived effectiveness, self-efficacy) in addition to three themes that were defined following inductive and deductive coding (barriers to implementation, facilitators to implementation, suggestions for improvement). Participants spoke positively about their experience participating in the intervention and perceived the intervention to be appropriate and effective. Most parents (95.5%) reported that they would recommend the Sleeping Sound intervention to other families of autistic children. Barriers to implementation included child and parent anxiety, child health problems, parental preferences, family circumstances, and other (e.g., school holidays). Facilitators to implementation included family support and consistency with strategies.Conclusions: The Sleeping Sound intervention was considered acceptable to parents of autistic children as evidenced by largely positive feedback regarding their experience. The results highlighted areas for improvement which can be used to inform future iterations of the intervention. [ABSTRACT FROM AUTHOR]

Highlights: [•] Findings reveal instability of the motor plan of base handwriting movements in ASD. [•] Fundamental handwriting movements are significantly larger in children with ASD. [•] Higher movement velocities and greater neuromotor noise in fine motor movements. [•] Trajectory variability was correlated with standard measures of aiming and catching. [ABSTRACT FROM AUTHOR]

Romantic development is a distinctive characteristic of puberty. However, a significant proportion of adolescents present with avoidant romantic attachment (ARA) tendencies, which have significant impact on their general adaptation. ARA variations have been suggested in relation to age, gender, engagement with a romantic partner and Excessive Internet Use (EIU) behaviours. In this longitudinal, two-wave study of a normative sample of 515 Greek adolescents at 16 and 18 years, ARA was assessed with the relevant subscale of the Experiences in Close Relationships-Revised and EIU with the Internet Addiction Test. A three-level hierarchical linear model found ARA tendencies to decrease between 16 and 18 while engagement in a romantic relationship and EIU were associated with lower and higher ARA tendencies respectively. Gender did not differentiate ARA severity either at the age of 16 or its changes over time. Results highlight the need of adopting a longitudinal-contextualized approach and provide implications for prevention and intervention initiatives in relation to the romantic development of adolescents. [ABSTRACT FROM AUTHOR]

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. [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]

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]