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Addressing Autism and Sleep Problems

Updated on February 14, 2023

  • Although aggressive behavior is a common behavioral symptom in autism patients, it can be difficult to treat using conventional methods.
  • Research suggests that aggressive behavior might be rooted in sleep problems, making sleep behaviors a critical site of intervention.
  • Butyric acid supplements might offer an innovative way of improving sleep behaviors by supporting the health of the patient’s gut microbiome, which could in turn help alleviate aggression.

If you are the parent of a child with autism spectrum disorder (ASD) who displays aggressive behaviors, then you’re not alone: estimates indicate that one in four children diagnosed with autism fall within the clinical range on commonly-used aggressive behavior scales, and this symptom is the primary cause of residential placement for autism patients. Unfortunately, among the widely varying physical and behavioral symptoms associated with autism, aggressive behavior is one of the most challenging to address. This is largely because the etiology of behavioral problems is poorly understood: scientists hypothesize that aggressive behaviors in ASD patients are caused by a complex combination of biological, behavioral, and environmental factors but have yet to develop a fully comprehensive model for understanding the underpinnings of this common symptom.

Currently, the standard recommendation for autism patients who display aggressive behavior is antipsychotic medication. In 2006, risperidone (a second-generation antipsychotic) was approved for patients as young as five years old. Because several controlled studies indicate risperidone can be effective for addressing aggressive behavior in autism patients during childhood, it has become one of the most widely used medications in the field. The other FDA-approved option is aripiprazole, a similar antipsychotic drug. Although these medications have clear safety benefits over clozapine, which was the medication most commonly used in the past, they lack consistent efficacy and can produce unwanted side effects, like weight gain and daytime drowsiness. Therefore, scientists continue to explore pharmacological options that could be considered for future FDA approval, such as haloperidol, olanzapine, lurasidone, quetiapine, and sertraline. Preliminary small-scale, open-label studies suggest these drugs might offer benefits for some ASD patients.

Although lab-based and clinical research has historically focused on pharmacological therapeutics, many parents and practitioners are increasingly interested in alternative therapeutic options. Not only are there concerns about the side effects and overall efficacy of pharmaceutical therapies for addressing aggressive behavior in ASD patients, some parents simply want to avoid starting their child on a prescription medication so early in life. Still, the lack of understanding of the basis of aggressive behavior makes it difficult to address directly, so some researchers are exploring an innovative solution: targeting conditions statistically associated with the symptom. Specifically, scientists have recently observed significant correlations between aggressive behaviors and sleep problems in children with autism. This connection between autism and sleep problems has led to the hypothesis that it might be possible to provide an option for aggressive behavior with butyric acid supplementation.

The Connection Between Autism and Sleep Problems

Multiple studies suggest a relevant clinical connection between aggressive behaviors in autism patients and sleep problems. One particularly persuasive paper from 2015, published by researchers from Oregon Health and Science University, assessed the prevalence and correlation between aggressive behaviors and a variety of other co-varying conditions in a large clinical sample of 400 patients between the ages of 2 and 16 years. Recognizing that the roots of aggressive behavior are poorly understood in autism patients, their goal was to identify better-understood conditions that could be addressed more effectively in the expectation that the therapy would address both the aggressive behavior and the co-morbid condition. Chronic sleep problems was one of the conditions that immediately stood out as a feasible target.

Consistent with previous studies, the Oregon researchers found statistically significant associations between aggressive behavior and scores on a survey that measured eight different sleep domains among autism patients, including:

  • Bedtime resistance
  • Latency in sleep onset
  • Sleep duration
  • Mild anxiety related to sleep
  • Late-night wakeups
  • Disordered breathing during sleep
  • Parasomnias
  • Daytime sleepiness

Based on this data, the researchers concluded that sleep problems were a practicable target in future therapies designed to address aggressive behavior problems in children with ASD.

The Relationship Between Short-Chain Fatty Acids and the Circadian Clock

The next question, of course, is how best to address sleep problems in autism patients. Although traditional over-the-counter sleep aids like diphenhydramine HCl remain an option, drowsiness and dizziness are common side effects—the same side effects, in fact, that many parents are trying to avoid by seeking alternatives to antipsychotics. Also, because sleep problems in autism patients tend to be chronic, an over-the-counter sleep aid is not suitable because they are intended for periodic (not regular) usage, and children can develop a tolerance for them over time.

One promising solution is to address abnormalities in the gut microbiome. According to one recent study in mice, the presence of short-chain fatty acids in the gut has an important role in the regulation of the circadian clock, which influences sleep and wake cycles. In a 2018 study in mouse models, researchers from Waseda University in Tokyo found that the concentrations of short-chain fatty acids in the gut—including butyrate, acetate, and propionate—could directly modulate the functioning of the circadian clock. These short-chain fatty acids are produced by bacteria in the gut when they ferment fibers that humans cannot digest. Therefore, the researchers suggest that increasing the dietary intake of prebiotic fiber, either through whole foods or through supplementation, might enhance outcomes for individuals suffering from sleep problems.

Based on this finding, another option for autism patients would be to introduce short-chain fatty acids directly into the gut with a butyrate supplement. Although the Waseda University researchers who produced this paper did not focus on autism patients, some studies suggest that autism patients lack healthy concentrations of butyrate-producing gut bacteria. For these patients, directly supplementing with butyrate might be more effective for reducing sleep problems than taking prebiotic fiber and assuming the patient’s microbiome is healthy enough to ferment the fiber and produce the circadian-clock-regulating butyrate as expected. Supplementation is also ideal for ASD patients because sensory inputs surrounding food can often trigger symptoms, including aggressive behavior.

Of course, parents and practitioners must recognize that the Waseda University study was conducted in mice, so it is not entirely certain whether supplements like prebiotic fiber and butyrate will have similar effects on the circadian clock in humans. Nevertheless, for parents and practitioners who are looking to indirectly target aggressive behavior in an autism patient through a closely correlated condition—that is, sleep problems—trying a butyrate supplement and/or choosing a diet that is high in prebiotic fiber is a relevant strategy to undertake. Another option to consider is supplementing melatonin, a hormone that has been shown to help resolve sleep problems in children with autism in early studies. In the future, clinical studies can better resolve questions about how best to harness the correlation between sleep problems and aggressive behavior in autism patients for the development of optimal therapies.

The power of Tesseract supplements lies in the proprietary science of proven nutrients and unrivaled smart delivery, making them the most effective for supporting neurological health and gastrointestinal health.*

Works Cited

Cermak SA, Curtin C, Bandini LG. 2010. Journal of the American Dietetic Association. 110(2):238-246.

Chen C, Shen YD, Xun GL, et al.  2017. Autism Research. 10(6):1155-62.

DeFillipis M, Wagner KD. 2016. Psychopharmacology Bulletin. 46(2):18-41.

Farmer C, Butter E, Mazurek MO, et al. 2015. Autism. 19(3):281-91.

Felt BT, Chervin RD. 2014. Neurology Clinical Practice. 4(1):82-7.

Hill AP, Zuckerman KE, Hagen AD, et al. 2014. Research in Autism Spectrum Disorders. 8(9):1121-33.

LeClerc S, Easley D. 2015. 40(6):389-97.

Malow BA, Adkins KW, McGrew SG, et al. 2012. Journal of Autism and Developmental Disorders. 42(8):1729-37.

Pivovarciova A, Hnilcova S, Ostatnikova D, Mace FC. 2015. Bratislavske Lekarske Lisky. 116(12):702-6.

Strati F, Cavalieri D, Albanese D, et al. 3017. Microbiome. 5:24.

Tahara Y, Yamazaki M, Sukigara H, et al. 2018. Scientific Reports. 8:1395.

Al Czap, Founder | Tesseract

Al Czap has more than four decades of professional experience in preventative medicine. He founded Thorne Research in 1984 (sold in 2010) and he published Alternative Medicine Review for 17 years beginning in 1996. AMR was a highly acclaimed, peer-reviewed, and indexed medical journal. Al was the first to recognize the need for hypoallergenic ingredients and to devise methods of manufacture for and delivery of hypoallergenic products to underserved patient populations. His work has greatly impacted those with impaired immune and digestive systems and compromised health due to environmental exposures.

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