Date Presented 04/06/19
The results of this study potentially provide evidence-based support for the development and testing of therapeutic swimming programs for ASD. Insufficient sleep corresponds with exacerbated ASD symptoms and abnormal connectivity of neural networks. Participants who reported swimming as a preferred sport reported significantly higher sleep hygiene scores than nonswimmers. In ASD, higher sleep hygiene scores were associated with increased neural functional connectivity.
Primary Author and Speaker: Christiana Butera
Additional Authors and Speakers: Emily Kilroy
Contributing Authors: Cristin Zeisler, Sharada Krishnan, Gina Gosparini, Laura Harrison, Lisa Aziz-Zadeh
PURPOSE: Adequate sleep is essential to health and occupational engagement (Judd, 2017). There is evidence that sleep problems are common in children with autism spectrum disorder (ASD) and that insufficient sleep exacerbates the severity of core ASD symptoms (Park et al., 2012). Moreover, sleep quality impacts neural networks, including DMN (De Havas et al., 2012), which is important for elements of occupational engagement (i.e., executive and social functioning) (Mak et al., 2017). To explore how occupational therapists might expand their services to meet the needs of children with ASD, this study compares responses on the Child Behavior Checklist (CBCL; Achenbach, 1991) among a sample of children with ASD, developmental coordination disorder (DCD), and typically developing (TD) peers to assess how participation in occupations correlates with sleep hygiene scores on the Family Inventory of Sleep Habits (FISH; Malow et al., 2009) and with DMN connectivity.
DESIGN: This study utilized quantitative methods and an experimental design. Participants age 9-15 were recruited from local clinics, parent groups, social media groups, and schools in the Los Angeles area. Eligibility criteria included: right-handedness, English fluency, and an IQ > 80. Group eligibility criteria included: 1) ASD group: a clinical diagnosis of ASD, and confirmed research-qualifying scores on ASD assessments, 2) DCD group: Movement Assessment Battery for Children (MABC-2; Henderson, 2007) total score below the 16% range, and 3) TD group: no existing neurodevelopmental or psychiatric diagnosis.
METHODS: Data from participants ages 9-15 with ASD (n=8), DCD (n=8), and TD (n=8) were analyzed.
Composite scores from the 22-item FISH were compared across groups. The CBCL’s free-response questions were qualitatively coded and analyzed for frequency of occupation types associated with sports and hobbies. Response themes were compared across groups and related to FISH scores. Finally, DMN seed connectivity analysis from resting-state fMRI data were correlated with FISH scores.
RESULTS: The ASD group had higher mean FISH composite scores than the TD group although this difference was not significant (p=0.08). Across all participants, 40% identified swimming as a preferred sport (TD=1, ASD=6, DCD=5). These participants had significantly higher FISH scores than those who did not name swimming as a preferred sport (p=0.03). In the ASD group, FISH scores were positively related to parietal and prefrontal regions of the DMN (p<0.05).
CONCLUSION: Preliminary results suggest that contrary to previous literature, our ASD participants reported better sleep hygiene scores than study controls. Although no significant difference in FISH scores existed between groups, when analyzing FISH scores through an occupation-based lens, participants who reported swimming as a preferred sport demonstrated significantly higher scores than non-swimmers. Children with ASD comprised half of the swimming group, which potentially could account for the ASD group’s overall higher FISH scores. In the ASD group, higher FISH scores also were associated with increased DMN functional connectivity. These results provide an intriguing implication for occupational therapists who would like to develop evidence-based therapeutic swim programs to potentially improve sleep and functional network connectivity in ASD. Data collection is ongoing.
References
Judd, S. R. (2017). Uncovering common sleep disorders and their impacts on occupational performance. Workplace Health & Safety, 65(5), 232.
Park, S., Cho, S. C., Cho, I.H., Kim, B. N., Kim, J. W., Shin, M. S., Chung, U.S., Park, T.W., Son, J.W., & Yoo, H.J. (2012). Sleep problems and their correlates and comorbid psychopathology of children with autism spectrum disorders. Research in Autism Spectrum Disorders, 1068–1072.
De Havas, J. A., Parimal, S., Soon, C. S., & Chee, M. W. (2012). Sleep deprivation reduces default mode network connectivity and anti-correlation during rest and task performance. Neuroimage, 59(2), 1745-1751.
Mak, L. E., Minuzzi, L., MacQueen, G., Hall, G., Kennedy, S. H., & Milev, R. (2017). The default mode network in healthy individuals: a systematic review and meta-analysis. Brain Connectivity, 7(1), 25-33.
