Relationships between autistic traits, insufficient sleep, and real-world executive functions in children: a mediation analysis of a national epidemiological survey

• Published in: Psychological medicine Vol. 51; no. 4; pp. 579 - 586
• Main Authors: Tsai, Tsung-Han, Chen, Yi-Lung, Gau, Susan Shur-Fen
• Format: Journal Article
• Language: English
• Published: Cambridge, UK Cambridge University Press 01.03.2021
• Subjects: Age; Autism; Behavior; Child development; Children; Children & youth; Epidemiology; Executive function; Indirect effects; Memory; Mental disorders; Nocturnal; Original Article; Polls & surveys; Population studies; Quality of life; Questionnaires; Repetitive behaviour; Responsiveness; Secondary schools; Sleep; Students; Taiwan; autistic traits; mediation; insufficient sleep; Autism spectrum disorder; executive function
• ISSN: 0033-2917; 1469-8978
• DOI: 10.1017/S0033291719003271

Although the literature documents low executive functions and sleep deficits in individuals with autism spectrum disorder or subclinical autistic traits, no study has simultaneously examined their relationships in the general child population. This study aimed to examine whether autistic traits impacted real-world executive functions through insufficient sleep in a nationally representative sample of children. This was a national survey of 6832 primary and secondary school students, aged 8-14 years old, with equal sex distribution (3479 boys, 50.8%). Parents reported their child's nocturnal sleep duration and the need for sleep to maintain their daytime function and the Social Responsiveness Scale and the Behavior Rating Inventory of Executive Function (BRIEF) for their children's autistic traits and real-world executive functions, respectively. We found that autistic traits exerted indirect effects on real-world executive functions through sleep deficits, independent of sex, and age. Moreover, such an indirect effect was observed only from restricted and repetitive behaviors to executive functions through sleep deficits, but not in the other components of autistic traits (i.e. social communication and interaction). Our novel findings underscore the importance of sleep and autistic traits in executive functions and suggest potential mechanisms that may underlie the observed correlational structure among autistic behaviors, sleep deficits, and low executive function performance.