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

多达2/3的自闭症谱系障碍（ASD）青少年表现出具有挑战性和危险的行为， 包括侵略和自我伤害，这严重限制了他们进入社区，教育， 治疗资源。挑战行为的风险及其后果（例如，精神病住院治疗; 多药）在青春期增加，特别是对严重影响的青少年与ASD（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 使用非药物和非侵入性方法可以改变的行为是高度优先的， 临床医生、研究人员和家庭护理人员。然而，SA-ASD青年在研究中的代表性不足， 限制了那些最需要改善的人的潜力。睡眠和睡眠的昼夜节律调节 是可以通过行为和生理干预来改变的。在典型的发育中的青年， 睡眠的稳态和昼夜节律调节在青春期期间表现出显著的变化（例如，昼夜 相位延迟）。这些变化会导致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 SA-ASD青少年的昼夜节律相位延迟与睡眠问题和挑战行为有关。的 研究将在精神科住院部进行，以促进SA-ASD的培训和入组 青年是一个很难在社会上研究的群体。这项研究将作为一个培训平台， (1)支持技术和非侵入性睡眠测量方法，以增加SA-ASD的参与 青年在客观睡眠和昼夜节律科学，（2）观察到的挑战性行为的系统编码， 生态瞬时评价方法，（3）先进的分析方法，以模拟前景 协会和个体差异，以及（4）支持未来的干预发展过程 干预研究辅导阶段的培训和经验教训将为 一项关于昼夜节律、睡眠和挑战之间关系的独立前瞻性研究（R 00） 行为在一个独立的样本SA-ASD青少年。拟议的研究将遵循SA-ASD青年， 他们从精神病住院设施出院并返回家中。出院前基线后 在医院进行评估，在家中进行昼夜节律和睡眠的评估， 将在出院后6个月和12个月进行挑战行为评估。的目标 这项研究是为了确定昼夜节律相位延迟是否先于睡眠问题的出现/升级， 挑战行为。这项工作将为未来的研究奠定基础，比较前瞻性的协会 在多个比较组之间的昼夜节律相位、睡眠和挑战行为之间（例如，更高的 功能性ASD和典型发育），并评估干预昼夜节律时相的临床效用 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.