Is There a Relationship Between Sleep Problems and Motor Impairment in Children with Autism Spectrum Disorder?

Background: Two of the main neurological problems children with Autism Spectrum Disorder (ASD) are faced with are; motor impairment, and sleep problems. Sleep problems have been reported to occur in up to 83% of children with ASD and have both behavioural and neurological underpinnings (Cortesi et al., 2010). Motor impairment has been reported to occur in up to 79% of children with ASD (Green et al., 2002). Both sleep problems and motor impairment have been linked to dysfunction in specific cortical and subcortical structures such as the fronto-straital circuits (Maski & Kothare, 2013). Previous studies have linked sleep deprivation to problems with motor movements in healthy adolescents and adults (Maski & Kothare, 2013). To date, no studies have investigated the possible association between sleep problems and impaired motor proficiency in children with ASD. It is plausible that impaired motor function will be associated with greater sleep problems as a result of disruption to similar underlying brain circuitry.

Objectives: The current study aimed to investigate the association between motor proficiency and behavioural sleep problems in children with ASD.

Methods:   Participants aged 4-6 years (n=30, 80% male, 80% without Intellectual Disability) with a current ASD diagnosis were recruited from the larger Active Kids study, a study investigating physical activity, sleep and motor impairment in children with ASD. Level of motor proficiency was measured using the Movement Assessment Battery for Children (MABC-2) subscales (manual dexterity, ball skills and balance and coordination) and total score. Behavioural sleep problems were measured using the subscales and total scores Children’s Sleep Habits Questionnaire (CSHQ; sleep onset delay, sleep duration, bedtime resistance, sleep anxiety, night waking, parasomnias, sleep disordered breathing, daytime sleepiness). Correlations investigated associations between the subscales and total MABC-2 and with the subscales and total CSHQ.

Results: There were moderate negative correlations between sleep onset delay and poorer motor proficiency as measured by the MABC-total (r = -.49, p =.008), manual dexterity (r = -.60, p=.001), ball skills (r = -.41, p=.03, and balance and coordination (r = -.40, p=.03). Moderate negative correlations between sleep duration and motor proficiency as measured by the MABC total score (r = -.41, p=.03) and manual dexterity (r = -.41, p=.03) were also found. There were no further associations between the other subscales of the CSHQ and the subscales or total MABC-2.

Conclusions: The findings confirm the presence of a relationship between motor proficiency and sleep in children with ASD. Further research to investigate the overlap in brain circuitry between sleep problems and motor proficiency and directions of these relationships (i.e. to determine whether behavioural sleep problems influence children’s motor impairment or whether motor impairment predicts behavioural sleep problems) is required. Such research will set the scene for informing the development of assessments and novel interventions that seek to promote healthy outcomes in individuals with ASD such as improving sleep patterns and motor proficiency.