Circadian phase, sleep, and challenging behavior in autism spectrum disorder

多达三分之二的患有自闭症谱系障碍(ASD)的年轻人表现出具有挑战性的、往往是危险的行为， 包括攻击性和自伤，这深刻地限制了他们获得社区、教育和 治疗资源。挑战性行为及其后果的风险(例如，精神病院； 多药联用)在青春期增加，特别是对患有自闭症的严重影响的年轻人(SA-ASD； 以智力残疾或最低语言能力为特征)。确定挑战的贡献者 可以使用非药物和非侵入性方法改变的行为是 临床医生、研究人员和家庭照顾者。然而，SA-ASD青年在研究中的代表性不足，这 限制了那些最需要改进的人的潜力。睡眠与睡眠的昼夜节律 可以通过行为和时间治疗干预来改变。在典型的青少年发展中， 睡眠的动态平衡和昼夜节律在青春期表现出显著的变化(例如，昼夜节律 相位延迟)。这些变化增加了睡眠问题和挑战性行为的风险，部分原因是 警觉性、情绪和认知的变化。拟议的横断面指导研究(K99)将评估是否 在SA-ASD青少年中，昼夜节律延迟与睡眠问题和挑战性行为有关。这个 研究将在住院精神病室进行，以促进SA-ASD的培训和登记 青年，一个很难在社区学习的人群。这项研究将作为培训的平台 (1)支持技术和非侵入性睡眠测量方法，以增加SA-ASD的参与度 客观睡眠和昼夜节律科学中的青年，(2)对观察到的挑战行为和 生态瞬时评估方法，(3)先进的分析方法，对前景进行建模 联系和个体差异，以及(4)支持未来的干预发展过程 干预研究。在指导阶段学到的培训和经验教训将为 关于昼夜节律、睡眠和挑战之间关系的独立前瞻性研究(R00) SA-ASD青少年的独立样本中的行为。拟议的研究将对SA-ASD青年进行如下跟踪 他们从精神病院出院，然后回家。遵循出院前基线 在医院进行的评估、对昼夜节律、睡眠和生态瞬间的家庭评估 对挑战行为的评估将在出院后6个月和12个月进行。的目标是 这项研究旨在确定昼夜节律延迟是否先于睡眠问题的出现/升级 具有挑战性的行为。这项工作将为未来比较未来联系的研究奠定基础 在多个比较组的昼夜节律、睡眠和挑战性行为之间(例如，较高的 功能性ASD和典型发育)，并评估对昼夜节律期进行干预的临床效用 改善ASD青少年的睡眠和挑战行为。

Up to 2/3 of youth with autism spectrum disorder (ASD) exhibit challenging and often dangerous behaviors, including aggression and self-injury, that profoundly limits their access to community, educational, and therapeutic resources. Risk for challenging behavior and its consequences (e.g., psychiatric hospitalization; polypharmacy) increases during adolescence, particularly for severely affected youth with ASD (SA-ASD; characterized by intellectual disability or minimal verbal ability). Identifying contributors to challenging behaviors that can be modified using non-pharmacological and non-invasive approaches is a high priority for clinicians, researchers, and family caregivers. Yet, SA-ASD youth are under-represented in research, which restricts the potential for improvements for those who need it most. Sleep and the circadian regulation of sleep are modifiable through behavioral and chronotherapeutic interventions. In typically developing youth, the homeostatic and circadian regulation of sleep exhibits marked changes during adolescence (e.g., circadian phase delay). These changes confer risk for sleep problems and challenging behaviors mediated in part by changes in alertness, mood, and cognition. The proposed cross-sectional mentored study (K99) will evaluate if circadian phase delay is associated with sleep problems and challenging behaviors in SA-ASD youth. The study will be conducted in an inpatient psychiatric unit to facilitate training with, and enrollment of, SA-ASD youth, a population that is difficult to study in the community. The study will serve as a platform for training in (1) supportive techniques and non-invasive sleep measurement methods to increase participation of SA-ASD youth in objective sleep and circadian science, (2) systematic coding of observed challenging behavior and ecological momentary assessment methodology, (3) advanced analytic methods to model prospective associations and individual differences, and (4) the process of intervention development to support future intervention research. Training and lessons learned during the mentored phase will inform and support an independent prospective study (R00) of associations between circadian phase, sleep, and challenging behaviors in an independent sample of SA-ASD adolescents. The proposed study will follow SA-ASD youth as they are discharged from a psychiatric inpatient facility and return home. Following a pre-discharge baseline assessment in the hospital, in-home assessments of circadian phase and sleep and ecological momentary assessments of challenging behavior will be conducted at 6 and 12 months post-discharge. The objective of this study is to determine if circadian phase delay precedes the emergence/escalation of sleep problems and challenging behavior. This work will set the foundation for future studies to compare prospective associations between circadian phase, sleep, and challenging behavior across multiple comparison groups (e.g., higher- functioning ASD and typical development) and evaluate the clinical utility of intervening upon circadian phase to improve sleep and challenging behavior in ASD youth.