Peer-reviewed article
Sleep, executive functions, and repetitive behaviors in autism spectrum disorder: different patterns of association with lower- and higher-level repetitive behaviors
Elisa Fucà, Martina Parisi, Silvia Guerrera, Stefano Vicari ·
Summary
Written by AI, not yet AICS's view · claude-sonnet-5-5This study looked at 57 autistic children aged 6 to 14 and asked how executive functions (thinking skills such as shifting between tasks, controlling emotions and planning) relate to repetitive behaviors. It also tested whether these skills help explain the link between sleep problems and repetitive behaviors. Lower-level repetitive behaviors were linked only to difficulties with emotional control, while higher-level repetitive behaviors were linked to several executive function difficulties. Emotional control difficulties helped explain the link between sleep problems and lower-level repetitive behaviors. The authors describe the findings as preliminary.
Key points
- Lower-level repetitive behaviors were significantly associated only with emotional control difficulties.
- Higher-level repetitive behaviors were associated with inhibition, shifting, emotional control, planning and initiation difficulties.
- Shifting difficulties independently predicted higher-level repetitive behaviors in regression analyses.
- Lower-level repetitive behaviors were significantly associated with IQ and behavioral problems in regression analyses.
- Emotional control difficulties mediated the link between sleep disturbances and lower-level repetitive behaviors, but cognitive flexibility did not mediate the link between sleep disturbances and higher-level repetitive behaviors.
Limitations
The sample is small (57 children) and the analysis looks at associations at one point in time, so it cannot show that sleep or executive function difficulties cause repetitive behaviors. The authors call the findings preliminary, and the abstract does not say how the children were recruited or how the sample was divided between countries.
Abstract
Background Restricted and repetitive behaviors (RBs) are a core feature of autism spectrum disorder (ASD), although the mechanisms underlying different RB subtypes remain poorly understood. The present study investigated the differential contribution of executive functions (EFs) to lower- and higher-level RBs in autistic children and explored whether specific EF domains mediated the relationship between sleep disturbances and RBs. Methods Fifty-seven autistic children aged 6–14 years underwent neuropsychological and behavioral assessment. RBs were assessed using the Repetitive Behavior Scale–Revised, executive functions using the Behavior Rating Inventory of Executive Function–2, sleep disturbances through the Sleep Disturbance Scale for Children, and behavioral difficulties through the Child Behavior Checklist. Results Partial correlations, regression analyses, and mediation models were performed. Distinct association patterns emerged across RB subtypes. Lower-level RBs were significantly associated only with emotional control difficulties, whereas higher-level RBs were associated with several EF domains, including inhibition, shifting, emotional control, planning, and initiation. Regression analyses showed that higher-level RBs were independently predicted by shifting difficulties, whereas lower-level RBs were significantly associated with IQ and behavioral problems. Mediation analyses indicated that emotional control difficulties significantly explained the association between sleep disturbances and lower-level RBs. In contrast, cognitive flexibility did not mediate the relationship between sleep disturbances and higher-level RBs. Conclusion These findings provide preliminary evidence of different patterns of association across lower- and higher-level RBs in autistic children. Emotional regulation processes may be particularly relevant for lower-level RBs, whereas cognitive flexibility appears more strongly related to higher-level RBs. Findings also suggest that sleep disturbances may contribute to specific RB manifestations through different mechanisms.