Rana M Zeina* PhD, 2, Laila AL- Ayadhi, MBBS, PhD 3, Shahid basher PhD.

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1 Research Ivety: Iteratioal Joural Of Egieerig Ad Sciece Vol.4, Issue 11 (November2014), PP Iss (e): , Iss (p): , Brief report o usig europsychological computerized battery to measure the associatio betwee Poor Sleep ad Cogitive Ability i Childre with Autism Spectrum Disorder ASD 1, Raa M Zeia* PhD, 2, Laila AL- Ayadhi, MBBS, PhD 3, Shahid basher PhD. ABSTRACT: Poor sleep is a commo feature i autism, but the impact of poor sleep o daytime cogitive fuctioig i autism is ot well-kow ad we, therefore, ivestigated whether sleep i autism correlates with daytime cogitive performace. We used a Neuropsychological Test Cogitive Assessmet (CANTAB). Sigificat s betwee sleep behavior ad Big/little circle (BLC) were foud. The fidigs of this study suggest that ASD childre with sleep problems are facig deficits i learig ad comprehesio. However, the associatio betwee poor sleep ad ASD requires the use of differet types of Cogitive Assessmet (CANTAB) tests ad a icrease i the sample size of the study. Keywords: Autism, Sleep disorder, Cogitive Assessmet I. INTRODUCTION Autism spectrum disorders (ASD) are a group of developmetal disorders estimated to affect about 1% of childre i the geeral populatio (Baird et al., 2006; Baro-Cohe et al., 2009; Hoda et al., 2005). It is believed to exist o a distributio curve of autism spectrum problems (ASP) that exist i the geeral populatio, oe for which there is o easily defied cut-off betwee subcliical ad cliical presetatios. ASP ca have profoud effects o both the child ad his/her family. I additio to the core symptoms of social/commuicatio deficits ad a restricted repertoire of behaviors, childre with ASD ofte experiece sleep problems (Allik et al., 2006a; Richdale, 1999; Wiggs ad Stores, 2004). The majority of studies o sleep i childre with ASD iclude cliical samples ad use of crosssectioal desig (Goodli-Joes et al., 2008; Richdale ad Prior, 1995; Wiggs ad Stores, 2004). A populatiobased case cotrol study o ASD ad sleep (Krakowiak et al., 2008) foud a high rate of sleep oset problems ad ight wakig i two- to five-year-old childre with ASD compared with typically developig childre. I a cliical follow-up study of school age childre, higher rates of sleep problems were foud i those with autism as compared with childre with ormal developmet (Allik et al., 2008). Chages i sleep patter over time were similar i both groups. There are also retrospective cliical studies idicatig that sleep problems i childre with ASD are persistet (Giaotti et al., 2006; Wiggs ad Stores, 2004), but to our kowledge, there are o populatio-based studies o sleep i older childre with ASD. There is also a paucity of logitudial studies i the literature assessig the developmet of sleep problems over time i childre with ASD. We kow from studies of the adult geeral populatio that chroic sleep problems have a severe impact o both quality of life ad physical ad metal health (Taylor et al., 2005, 2007). As such, sleep problems i childre/adolescets with ASD will most likely costitute a additioal burde o both the childre ad their families, as they are already affected by the severe symptoms of ASD. I additio, there are studies idicatig that isomia i itself aggravates the autistic symptoms (Allik et al., 2006a; Schreck et al., 2004). Sleep is a critical compoet of health. Although we do ot uderstad all its fuctios, sleep is essetial to grow, to restore our body ad immue system ad to ehace ad solidify memory ad learig. For childre with ASD, isufficiet sleep appears to impact daytime behaviors, makig challegig behaviors worse. Sleepig difficulties for the child also lead to sleepig difficulties for parets ad sometimes sibligs cosequetly addig to the stresses ad challeges of paretig a child who has autism. No oe ca fuctio at their best whe they are sleep deprived. Based o the above cosideratios, the aim of this study was to assess the betwee sleep problems i childre with ASD, ad cogitive ability; our specific aims were to assess the effect of sleep behavior, bedtime, wakig durig the ight, morig wake o learig comprehesio, attetio ad memory i childre with Autism Spectrum Disorder ASD. 35

2 II. Materials ad Method Participats 14 childre with ASDs aged 4 years old participated i this study. ASDs were diagosed by a child psychologist based o DSM-IV criteria (14). The Autism Diagostic Observatio Scale (ADOS) ad Childhood Autism Ratig Scale (CARS) was also admiistered to cofirm the diagosis. All participats had IQ above 70 based o Staford Biet 4 (SB4). Measures 1-Visual ad memory tasks were assessed i all participats usig some tests from Cambridge Neuropsychological Test Automated Battery (CANTAB): (a) Big/Little Circle (BLC): BLC is a simple test of comprehesio this is a visual discrimiatio test, i this test the subject is preseted with series of pairs of circles, oe large ad oe small, the subject istructed first to touch the small circle ad the,after 20 trials, to touch the larger circle for a further 20 trials. (b) Itra/Extra Dimesioal Set Shift (IED): Itra / Extra dimesioal set shift is a test of rule acquisitio ad reversal. It features: Visual discrimiatio ad attetio set formatio ad, maiteace, shiftig ad flexibility of attetio. This test is primarily sesitive to chages to the froto-striatal areas of the brai. Two artificial dimesios are used i the test: color filled shapes, white lies, simple stimuli are made up of just oe of these dimesios, whereas compoud stimuli are made up of both, amely white lies over lyig color-filled shapes. Subject progresses through the test by satisfyig a set criterio of learig at each stage (6 cosecutive correct resposes). If at ay stage the subject fails to reach this criterio after 50 trials, the test termiates. The test starts with block 1, the presetatio of two simple color filled shapes. The subject must lear which of stimuli is correct by touchig it, ad cotiue util the criterio is reached. I block 2, the cotigecies are reversed, so that ow the previously icorrect stimulus is correct. I block 3, the secod dimesio is the itroduced iitially lyig adjacet to ad the, for block 4, overlappig. (c) Spatial Recogitio Memory (SRM): it is a test of spatial recogitio memory i a forced choice paradigm. This test is primarily sesitive to dysfuctio i frotal lobe, ad relatively isesitive to temporal lobe damage. A white square is show o the scree i various locatios. I the presetatio phase, a white square is show o the scree i five differet locatios. Each appearace of a square marks a locatio o the scree which the subject must later remember. I the recogitio phase, the square reappears i the same five locatios as i the presetatio phase, i reverse order. O each appearace, it is paired with a idetical distracter square i a locatio ot used i the presetatio phase. The subject must touch the square i the locatio that has appeared before, whilst igorig the distracter this is oe block. This block is repeated three more times, each time with five ew locatios. The test is scored usig four idices: (a) Mea correct latecy; (b) maximum correct latecy, (c) S.D. correct latecy; (d) Total corrects. 2-The Staford Biet 4 (SB4): It was admiistered to evaluate the participats itellectual abilities. 3-Autism Diagostic Observatio (ADOS): the ADOS is a stadardized, semi structured observatio of commuicatio, social iteractio, ad repetitive behaviors of idividuals with possible autism spectrum disorder. Items are scored from 0 (ot abormal) to 2 or 3 (most abormal), ad a diagoses of autism or ASD is established cut-off values i the commuicatio domai, the social domai, ad the sum of the two. 4-Childood Autism Ratig Scale (CARS): rates the child from 1 to 4 i each of the 15 areas (relatig to people, emotioal respose, imitatio, body use, object use, listeig respose, visual respose, verbal commuicatio, overbal commuicatio, activity level, level of itellectual respose, adaptatio to chage, touch ad smell respose, geeral impressio. 5-Sleep Habit Questioaire: The parets completed the Childre's Sleep Habits Questioaire (CSHQ). A questioaire validated i childre ages 4-10 years. The CSHQ has bee used to examie sleep behavior i childre with variety of coditios icludig ASD, ad iclude four domais: bedtime, sleep behavior, wakig durig the ight, ad morig wake. 36

3 Procedure The participats were firstly iterviewed by a child psychologist ad diagosed as havig Autism Spectrum Disorders based o DSM-IV criteria. Next, they were evaluated usig the Autism Diagostic Observatio Scale (ADOS) ad Childhood Autism Ratig Scale CARS score to cofirm the diagosis, ad were the aswered the sleep questioaire durig structured iterview, ad examied usig europsychological tests (CANTAB). Statistical Aalysis Spearma s were used to study the effect of sleep problems o cogitive ability i terms of differet variables. I this research, all statistical aalyses were performed usig the Statistical Package for the Social Scieces (SPSS), versio 20. Result The mea age of childre with ASDs was 4.5 while the mea IQ was (SD=25.06) There were o sigificat differeces betwee groups i terms of age ad IQ (Table 1). There was a sigificat betwee the sleep behavior ad Big/Little circle (BLC) O the "Percet of Correct" score ( = 0.6, p=0.02), but o sigificat betwee Big/Little circle (BLC) ad bed time ( =0.07, p=0.79), wakig durig the ight ad Big/Little circle (BLC) (=0.04, p= 0.88), morig wake ad Big/Little circle (BLC) (=0.14, p=0.61) (Table 2).There was o sigificat betwee the bedtime ad Itra/Extra dimesioal set shift (IED) "Total Error 1" ad bedtime (=0.39, p=0.23), Itra /Extra dimesioal set shift (IED) "Total Error 2" ad bedtime (=0.04, p=0.86). I regards to sleep behavior, o sigificat betwee the sleep behavior ad Itra/Extra dimesioal set shift (IED) "Total Error 1" ad sleep behavior (=0.3, p=0.28), Itra/Extra dimesioal set shift (IED) "Total Error 2" ad sleep behavior (=0.32, p=0.25) was foud. I terms of wakig durig the ight, o sigificat betwee wakig durig the ight ad Itra/Extra dimesioal set shift (IED) "Total Error 1" ad wakig durig the ight (=0.19, p=0.51), Itra /Extra dimesioal set shift (IED) "Total Error 2" ad wakig durig the ight (=0.10, p=0.72) was foud. With regards to morig wake, o sigificat betwee the morig wake ad Itra /Extra dimesioal set shift (IED) "Total Error 1" ad morig wake (=0.24, p=0.39), Itra /Extra dimesioal set shift (IED) "Total Error 2" ad morig wake (=0.32, p=0.26) was foud. Ad o sigificat s betwee bedtime ad Spatial Recogitio Memory (SRM) task percet correct ( =0.24, p=0.39), sleep behavior ad Spatial Recogitio Memory (SRM) task percet correct (=0.47, p= 0.08), wakig durig the ight ad Spatial Recogitio Memory (SRM) task percet correct (=0.04, p=0.88), morig wake ad Spatial Recogitio Memory (SRM) task percet correct (=0.09, p=0.75) was foud. SUBJECTS age IQ N Mea SD T p value Table 1. Demographic Variables i Childre with ASD. 37

4 Table 2. Results of CANTAB tests i Childre with ASD. Bed time Sleep behaviour Wakig durig the ight Morig wake CANTAB tests Big / Little circle (BLC) Percet correct P value Itra /Extra dimesioal set shift (IED) total errors 1 P value total errors 2 P value Spatial Recogitio Memory (SRM) percet correct P value Discussio Researchers have bee ivestigatig sleep problems i childre with autism for some time ow. It is accepted that sleep problems are more commo i autism tha i most other developmetal disorders (Richdale ad Prior, 1995), but we still do ot kow why ad i what ways it affects the cogitive ability. The aim of this study was to assess the effect of sleep behavior, bedtime, wakig durig the ight, morig wake o learig comprehesio, attetio ad memory i childre with Autism Spectrum Disorder (ASD). The result was a sigificat betwee sleep behavior ad Big/little circle (BLC), this meas that there is a sigificat betwee the amout of child sleep, movig durig sleep, gridig o teeth, sorig screamig, beig ucomfortable durig the sleep, ad learig comprehesio i childre with Autism Spectrum Disorder ASD. Sleep problems seem to occur i childre with autism at all IQ levels icludig those who do ot have a itellectual disability. The sleep difficulties reported i childre with autism iclude problems with: Sleep oset ad maiteace, irregular sleep-wake patters, poor sleep, early wakig, alteratios i sleep oset ad wake times ad ight wakig. These problems ted to improve with age but older childre with autism have bee foud to sleep less at ight tha other childre. Some childre with autism have uusual routies for settlig to sleep ad may sleep walk ad have ightmares more tha other childre. Future researches should also focus o the relatioship betwee these sleep problems ad use differet types of CANTAB tests to study the. Coclusio We coclude that sigificat sigs reflectig the presece of poor sleep i childre with autism correlate with various aspects of learig difficulties o overbal performace tasks i the CANTAB test. The fidigs of this study suggest that ASD childre with sleep problems are facig deficits i learig, comprehesio. However, the modest gais that were observed require the use of differet types of CANTAB tests ad a icrease i the sample size of the study. Ackowledgemets This work was fiacially supported by the Kig Abdulaziz City for Sciece ad Techology, Riyadh, Saudi Arabia. It was also supported by NPST, Health Research ad Studies program at Kid Saud Uiversity. 38

5 REFERENCES [1]. Allik, H., Larsso, J.O. &Smedje, H. (2006a). Isomia i School-age Childre with Asperger Sydrome or High-fuctioig Autism, BMC Psychiatry 6: 18. [2]. Allik, H., Larsso, J.O. &Smedje, H. (2008). Sleep Patters i School-age Childre with Asperger Sydrome or High-fuctioig Autism: A Follow-up Study, Joural of Autism ad Developmetal Disorders 38(9): [3]. Baird, G., Simooff, E., Pickles, A., et al. (2006) Prevalece of Disorders of the Autism Spectrum i a Populatio Cohort of Childre i South Thames: The Special Needs ad Autism Project (SNAP), Lacet 368(9531): [4]. Baro-Cohe, S., Scott, F.J., Alliso, C., et al. (2009). Prevalece of Autism-spectrum Coditios: UK School-based Populatio Study, British Joural of Psychiatry 194(6): [5]. Giaotti, F., Cortesi, F., Cerquiglii, A., et al. (2006). A Ope-label Study of Cotrolled-release Melatoi i Treatmet of Sleep Disorders i Childre with Autism, Joural of Autism ad Developmetal Disorders 36(6): [6]. Goodli-Joes, B.L., Tag, K., Liu, J., et al. (2008). Sleep Patters i Preschool-age Childre with Autism, Developmetal Delay, ad Typical Developmet, Joural of the America Academy of Child ad Adolescet Psychiatry 47(8): [7]. Hoda, H., Shimizu, Y. & Rutter, M. (2005). No Effect of MMR Withdrawal o the Icidece of Autism: A Total Populatio Study, Joural of Child Psychology ad Psychiatry 46(6): [8]. Krakowiak, P., Goodli-Joes, B., Hertz-Picciotto, I., et al. (2008). Sleep Problems i Childre with Autism Spectrum Disorders, Developmetal Delays, ad Typical Developmet: A Populatio-based Study, Joural of Sleep Research 17(2): [9]. Richdale, A.L. & Prior, M.R. (1995) The Sleep/Wake Rhythm i Childre with Autism, Europea Child ad Adolescet Psychiatry 4(3): [10]. Richdale, A.L. (1999). Sleep Problems i Autism: Prevalece, Cause, ad Itervetio, Developmetal Medicie ad Child Neurology 41(1): [11]. Schreck, K.A., Mulick, J.A. & Smith, A.F. (2004). Sleep Problems as Possible Predictors of Itesified Symptoms of Autism, Research i Developmetal Disabilities 25(1): [12]. Taylor, D.J., Lichstei, K.L., Durrece, H.H., et al. (2005). Epidemiology of Isomia, Depressio, ad Axiety, Sleep 28(11): [13]. Taylor, D.J., Mallory, L.J., Lichstei, K.L., et al. (2007). Comorbidity of Chroic Isomia with Medical Problems, Sleep 30(2): [14]. Wiggs, L. & Stores, G. (2004). Sleep Patters ad Sleep Disorders i Childre with Autistic Spectrum Disorders: Isights Usig Paret Report ad Actigraphy, Developmetal Medicie ad Child Neurology 46(6):