Amy Licis, MD: Biological Markers of Sleep Disruption in Children with ADHD or Autism

Expert Amy Licis, MD, MSCI, Associate Professor, Pediatric Neurology and Sleep Medicine, Washington University Department of Neurology, gave a presentatgave a presentationion titled "Tired and Wired: Sleep in Children with Autism or Attention Deficit Hyperactivity Disorder (ADHD)" at the Associated Professional Sleep Societies (SLEEP) 2022 Annual Meeting.

Problems with sleep are not uncommon, but when focusing specifically on pediatric patients, those with ADHD or autism have an especially high prevalence.

Licis explained that up to 80% of parents report that their children with autism experience sleep issues. Some of the common concerns include insomnia, frequent wakings throughout the night and short sleep time.

In children with ADHD, she said about 30-45% of parents report sleep problems with main concerns being insomnia and hypersomnia.

An interesting finding Licis shared from her research was that underlying biological differences associated with sleep were observed in these populations.

"Children with autism have been found to have reduced melatonin production, both in the daytime and nighttime compared to, either children without autism, or children with other causes of developmental delay but who do not have autism," she said.

In addition to having relatively high rates of mutations in the circadian genes regulating the day night cycle, an altered sleep architecture was found in children with autism. Licis explained that this meant these children experienced much less REM sleep and a greater percentage of slow wave sleep according to some studies.

"Children with ADHD were found to have abnormalities in the noradrenergic and dopaminergic systems that we think play a role in sleep disruption," she said. "So, they were found to have metabolic changes in their prefrontal cortex. They also were found to have some areas of hypoactivity in the brain, including areas that regulate attention and arousal, we think contributing to worse quality sleep, and also just more attention issues."

Licis further stated that these were found in numerous areas of the brain responsible for regulating attention and arousal, including the anterior cingulate cortex, precentral gyrus, anfara frontal gyrus, and the parietal lobe.

"They're thought to have some underlying neurobiological reasons or neuroanatomical reasons for their sleep disturbances as well, that contribute to the the shorter sleep time and the prolonged sleep onset that's described by parents," she said.