Sleep problems are common in infants who later develop autism spectrum disorders (ASD) and are associated with an abnormal growth trajectory of the hippocampus, a new study reports.

Katherine MacDuffie and colleagues analyzed MRI brain scans performed on 432 infants at 6, 12, and 24 months of age. In addition, they collected data on the children’s sleep patterns. Of the infants, 127 were classified as low-risk because they did not have an older sibling with ASD, while the remainder were classified as high-risk. Seventy-one high-risk infants eventually received an ASD diagnosis.

sleep issues autism

The researchers found that sleep onset problems were more common in 6- to 12-month-old infants who later developed ASD than in other children. Additionally, infant sleep onset problems were related to hippocampal volume trajectories from 6 to 24 months for high-risk infants who developed ASD. Changes in hippocampal size have been associated with poor sleep in adults and older children, but MacDuffie says, “This is the first study we are aware of to find an association in infants as young as six months of age.”

Study coauthor Annette Estes says, “It could be that altered sleep is part-and-parcel of autism for some children. One clue is that behavioral interventions to improve sleep don’t work for all children with autism, even when their parents are doing everything just right. This suggests that there may be a biological component to sleep problems for some children with autism.”

The researchers conclude, “These findings provide initial evidence that sleep onset problems in the first year of life precede ASD
diagnosis and are associated with altered neurodevelopmental trajectories in infants at high familial risk who go on to develop ASD. If replicated, these findings could provide new insights into a potential role of sleep difficulties in the development of ASD.”

“Sleep onset problems and subcortical development in infants later diagnosed with autism spectrum disorder,” Katherine MacDuffie, Mark Shen, Stephen Dager, Martin Styner, Sun Hyung Kim, Sarah Paterson, Juhi Pandey, Tanya St. John, Jed Elison, Jason Wolff, Meghan Swanson, Kelly Botteron, Lonnie Zwaigenbaum, Joseph Piven, and Annette Estes, American Journal of Psychiatry, May 7, 2020 (online). Address: Katherine MacDuffie, UW Autism Center, CHDD, Box 357920, University of Washington, Seattle, WA 98195, [email protected].


“Sleep difficulties linked to altered brain development in infants later diagnosed with autism,” news release, University of Washington, May 7, 2020.

This article also appears in Vol. 34, No. 2, 2020, of Autism Research Review International

Past issues of Autism Research Review International are available online at 

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