Nightmares in Children with Foetal Alcohol Spectrum Disorders, Autism Spectrum Disorders, and Their Typically Developing Peers
Abstract
:1. Introduction
2. Materials and Methods
2.1. Ethical Approval
2.2. Questionnaires
2.3. Participants
2.4. Statistical Analysis
3. Results
3.1. Thematic Analysis of Nightmare Themes
3.2. Group Comparison on Nightmare Frequency and All Clinical Outcome Measures
3.3. The Relation between Nightmare Frequency and Clinical Outcome Measures
4. Discussion
4.1. Nightmare Content
4.2. Nightmare Frequency and Psychometric Associations
4.3. CSHQ/Nightmare Frequency
4.4. CBCL/Nightmare Frequency
4.5. SCAS/Nightmare Frequency
4.6. BRIEF/Nightmare Frequency
5. Strengths and Limitations
6. Summary
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
Appendix A
Group | Does Your Child Have Nightmares? If So, Please Describe the Content and Frequency. |
---|---|
TD | Random content. Could be me leaving could be monsters. Could be about going to school. Usually weekly. |
TD | Very rarely, last time she dreamed our puppy had died. |
TD | At least once a week, they tend to involve wolves, aliens or family members going away/being hurt. |
TD | Rarely at the minute and usually he will get up out of bed but not fully awake, needs consoling but will go back to bed easily and fall back to sleep. |
TD | May call out for Mummy or Daddy once every couple of weeks. Will sometimes talk in sleep but make no sense. |
TD | Occasionally about 1 a month. She can’t remember the content. |
TD | Yes, he is just been able to tell us that he dreams that monsters are eating people. More often he wakes crying repeatedly (up to 10 times a night) calling for me and tells us that he feels sad. |
TD | Nothing I would call a nightmare, but she calls them nightmares. They sound like random dreams, with some running away. |
TD | Separation monthly. |
TD | Dead people, ghosts, it can happen a couple of times per month. |
TD | Every now and then. Normally about something happening to close family or the pets. |
TD | The content can vary, and he doesn’t always remember. Depending on our routine they are infrequent as he suffers from night terrors, so we monitor things closely. |
TD | Very often most nights speak about being chased by a dog. |
TD | School worries. |
TD | Sporadic. Maybe every 3 -5 weeks. No regular pattern. Sometimes link to tv. |
TD | Once a year maybe. Sometimes involving monsters. |
TD | He has nightmares very sporadically, but he doesn’t want to talk about them. |
TD | Occasional due to anxiety, issues at school and stress of preparing for GCSE’s. |
FASD | Crying screaming thrashing about not often. |
FASD | Sometimes, alone, Vikings. |
FASD | He sometimes has nightmares. Maybe once a week. |
FASD | Yes. Every night. She wakes up screaming and sweating at least once. She seems phased out and will not talk she will however follow instructions. She can’t remember what her nightmares are about and will not talk about them the next day. |
FASD | Few times a month for a few consecutive nights then none for a while. Content is not clear. |
FASD | Occasional nightmares, something that may be worrying him. |
FASD | Occasionally. |
FASD | Yes. Always monsters chasing him. Usually once or twice a week. |
FASD | Yes, related to past experiences, about 2–4 times per week. |
FASD | He tells me he has nightmares most nights. He dreams people die or he dies. He dreams he is alone and can’t find anyone. He feels he can’t come and get me or call out for help as he thinks there are people in the house who will come and kill him. |
FASD | Occasionally about monsters and zombies. |
FASD | Regularly. Scary witches. Ghosts. |
FASD | One every 2 or so weeks. Dreams of being taken by a stranger. |
FASD | Once twice a month, she can never remember but she’s shouting at somebody in her sleep. |
FASD | Being chased, maybe twice a week. |
FASD | Sometimes, being chased or chasing, fighting others, knives or clowns. Less frequent in last year and a half. |
FASD | She will shout out in her sleep and talks a lot. |
FASD | Usually involving boys fighting over her, once a week. |
FASD | Has nocturnal epilepsy. Used to have when younger. Now has waking fear palpitation. |
FASD | Yes, more than 2 to 3 times a week. |
FASD | None that he talks about. |
FASD | Yes-vivid dreams about zombies and monsters are common. |
FASD | She can’t tell me the content. 5 times a week approx. |
FASD | Maybe, but she cannot tell us. |
FASD | House break in. |
FASD | Not sure, will sometimes wake up very upset. |
FASD | Being ‘robbed’ from me. |
FASD | Not often. Once a month perhaps. Often dreams foxes have eaten our chickens. Or a fox jumps into his bedroom window. Or fox staring at him through his 2nd floor bedroom window. Sometimes dreams of giants smashing things up in his bedroom. Or dreams of thieves breaking in and stealing his toys and precious cuddly toys. Sometimes monsters or dinosaurs. |
FASD | Rarely but if does being chased. |
FASD | Yes, but she is unable to explain the content. |
FASD | Yes, and wets bed at same time. Content is varied but can be being chased, about once a month it wakes her up. |
FASD | Yes, about twice a week he will have bad dream. He is usually shouting ‘get off me’ and pleading. We go and stroke his head and tell he’s at home in bed and is safe. |
FASD | Yes 1-week approx. The past. |
FASD | Sometimes not as frequent at the moment but talks a lot in his sleep. |
FASD | Not as bad recently. Used to wake and be inconsolable, sometimes self-harming. |
FASD | Approx. Twice a week. Usually about bad guys or monsters. |
FASD | Occasionally no idea what they are about she says bad guys. |
FASD | Occasionally....Mum dying. |
FASD | Yes, big presence in his room, disturbed by noise. |
FASD | Not being able to get something. |
FASD | 2–3 per month he tells me he has had a nightmare, maybe has them more but doesn’t say. They always seem to be about him, his brother and his mum but he can’t explain anymore. Suffered neglect while living with mother because of drug and alcohol misuse. |
FASD | Sometimes but not clear what the nightmare was about as she doesn’t remember, or she can’t describe it. |
FASD | Sometimes he will say I had a bad dream last night. |
FASD | Monsters people in his head telling him to do bad things. At least once a week. |
FASD | They have reduced following two and a half years of psychotherapy, but they are nightmares of red buttons, trolls, robots. |
FASD | Yes, less frequently now, but approx. Every 3 weeks or so. He is unable to tell us the content. |
FASD | Not that he says, he’s only mentioned a few in the past but can’t remember them |
FASD | Yes. Very abstract not very specific. |
FASD | Possibly 3–4 times a month Usually someone chasing him or catching him. |
FASD | Yes, quite regular, about his siblings, the dog, his toys dying. |
FASD | Usually twice a week shouting n muttering in sleep is noted but child will not recall a nightmare. Once a fortnight usually a nightmare about her safety or my safety. |
FASD | Yes, he does. Can be very large insects chasing him. Being killed, shot. |
FASD | Every night. |
FASD | Every night. Mostly about me dying or there being people in the house that will kill him. Lots of his nightmares don’t make sense. |
FASD | Most night. Dreams about skeletons or the monster that eats babies that lives at school. |
FASD | Most nights. Used to be an insomniac before going on risperidone. |
FASD | Every night not recalled. |
FASD | Monsters 2 times a week. |
FASD | Yes at least once a week often every night. People or monsters chasing him. |
AUTISM | Not sure if he has nightmares but he shouts out throughout the night and tosses and turns. |
AUTISM | 1 per week but has gone through phases of having lots. V scared of dark so often needs lights on or gets the fear when wakes at night. When he wakes after midnight, he rarely seems that sleepy and I’m not sure he’s going to go back to sleep. He seems v alert. |
AUTISM | Rarely, cannot recall content. |
AUTISM | Yes often. He doesn’t usually want to say but he often dreams of someone in the family or him dying. He goes through phases where he will have nightmares and night terrors every night and other phase where he doesn’t have them for a while. He doesn’t like closing his eyes or want to go to sleep for fear of nightmares and if he has one in the night, he won’t go back to sleep for fear of it happening again. |
AUTISM | Yes-almost every night. He doesn’t want to describe it when he wakes. Later he may say it’s about something from TV or event that’s happened. He struggles to switch off the fear and so needs us to sleep with him to get back and stay asleep. |
AUTISM | Yes, about once a week, they are always linked to abandonment- being left at a railway station or about waking and no one else being at home. |
AUTISM | Yes. And infrequent once a week if that. |
AUTISM | Aliens are coming to get him! |
AUTISM | She says she has usually if someone has shown her something or she has seen something by accident. Can be 3–4 times a week or none. No pattern. Gets scared by noises. |
AUTISM | Approx. Once every 2–3 weeks. |
AUTISM | Always. Car crashes. Death. Torture. Being left alone. |
AUTISM | Yes, recurring after suffering trauma. Can be up to 4 times a week. |
AUTISM | 2/3 times a night. |
AUTISM | Yes, sometimes, but content almost never disclosed, just ‘scary’. |
AUTISM | Patches of nightmares, subject not always disclosed. A couple of times a man who followed son and friend in school and in wood and clearing and had fireballs for hands. |
AUTISM | I think he sometimes has nightmares, but he is unable to explain the content of his dreams. This occurs probably 2 or 3 times a week. |
AUTISM | Sometimes he does; he rarely remembers but they seem to involve him being chased. He went through a rough patch when someone at school told him about ‘Five Nights at Freddie’s’, he was anxious and had nightmares about that for a while. |
AUTISM | Nightmares 2–3 times a week usually of some form of harm happening to family member. |
AUTISM | Sometimes-only a few times a month. He does talk in his sleep though and sleep walk more frequently. |
AUTISM | Over past few months since starting high school has been happening about 10 times a month. |
AUTISM | Yes, probably 2 to 3 times a week. Sometimes night terrors but this is lessening with age. |
AUTISM | Apparently most nights but he can’t describe them. |
AUTISM | Occasional nightmare about being lost and unable to find people or being chased by wolves. |
AUTISM | Wakes crying saying had bad dream a hand full of times a year. |
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ASD | FASD | TD | |
---|---|---|---|
n | 61 | 112 | 104 |
Male/Female | 46/15 | 62/50 | 55/48 |
Age (M(SD)) | 10.03(2.54) | 9.54(2.86) | 9.43(2.55) |
Age Range | 6.07–15.56 | 6.09–15.98 | 6.47–15.90 |
SES ½/3 | 17/35/9 | 14/74/26 | 23/67/15 |
ASD | FASD | TD | ||||
---|---|---|---|---|---|---|
n = 67 | n = 91 | n = 103 | ||||
Typical nightmare themes | ||||||
Being chased | 2/27 | 7% | 10/67 | 15% | 1/22 | 5% |
Injured/dying | 3/27 | 11% | 4/67 | 6% | 2/22 | 9% |
Sensing scary | 1/27 | 4% | 1/67 | 1% | 0/22 | 0% |
Being Chased | Injured/Dying | Sensing Scary | |
---|---|---|---|
ASD | Aliens | Wolves, Aliens, family members, themselves | |
FASD | Wolves, monsters, strangers, someone, large insects | People, mum, toys, dogs | Witches, ghosts |
TD | Dog | People, puppy |
Separation | Fantasy | Persecuted/Being Chased | Real Life | Death/Injury/Violence | Robbery/Theft/Crime | |
---|---|---|---|---|---|---|
TD (n) | 3 | 3 | 2 | 3 | 2 | 0 |
TD (%) | 23% | 23% | 15% | 23% | 15% | 0% |
FASD (n) | 11 | 17 | 10 | 5 | 11 | 5 |
FASD (%) | 24% | 30% | 22% | 9% | 24% | 9% |
ASD (n) | 4 | 4 | 2 | 4 | 4 | 0 |
ASD (%) | 22% | 22% | 11% | 22% | 22% | 0% |
ASD | FASD | TD | TD vs. ASD | TD vs. FASD | ASD vs. FASD | ||
---|---|---|---|---|---|---|---|
Mean (SD) | Mean (SD) | Mean (SD) | F | Sig. | |||
CSHQ | |||||||
Total | 55.59 (9.22) | 56.01 (8.53) | 48.27 (8.65) | 6.842 ** | 0.012 | 0.001 | 0.995 |
Bedtime resistance | 9.63 (3.10) | 9.19 (2.74) | 9.27 (2.66) | 0.233 | 0.960 | 0.999 | 0.865 |
Sleep onset delay | 4.74 (2.46) | 5.15 (2.73) | 3.86 (2.08) | 2.108 | 0.548 | 0.104 | 0.853 |
Sleep duration | 7.74 (1.35) | 7.43 (1.52) | 7.73 (1.12) | 0.645 | 1.000 | 0.762 | 0.697 |
Sleep anxiety | 8.93 (2.77) | 8.91 (3.24) | 5.73 (2.33) | 10.157 *** | 0.001 | 0.001 | 1.000 |
Night wakings | 7.74 (3.27) | 7.64 (2.80) | 4.95 (2.44) | 8.090 ** | 0.003 | 0.001 | 0.998 |
Parasomnias | 7.74 (3.19) | 8.01 (3.29) | 8.05 (4.10) | 0.070 | 0.986 | 1.000 | 0.978 |
Sleep disordered breathing | 2.78 (1.31) | 2.79 (1.11) | 2.50 (1.37) | 0.504 | 0.808 | 0.673 | 1.000 |
Daytime sleepiness | 7.70 (3.21) | 7.85 (3.77) | 7.68 (4.19) | 0.025 | 1.000 | 0.997 | 0.997 |
SCAS | |||||||
Total | 43.04 (16.15) | 43.58 (17.34) | 29.36 (17.93) | 5.977 ** | 0.019 | 0.002 | 0.999 |
Panic Attack | 6.11 (5.57) | 6.45 (4.30) | 2.73 (3.49) | 5.841 ** | 0.029 | 0.002 | 0.982 |
Separation Anxiety | 9.30 (3.71) | 9.75 (3.98) | 6.50 (4.10) | 5.693 ** | 0.044 | 0.002 | 0.940 |
Physical Injury | 6.04 (3.20) | 6.24 (3.02) | 4.59 (2.72) | 2.529 | 0.262 | 0.067 | 0.987 |
Social Phobia | 7.33 (3.08) | 8.60 (4.63) | 7.05 (4.59) | 1.504 | 0.994 | 0.344 | 0.467 |
Obsessive Compulsive | 5.81 (3.73) | 4.81 (3.49) | 2.86 (3.09) | 4.480 * | 0.011 | 0.059 | 0.476 |
Generalised Anxiety | 8.44 (3.83) | 7.75 (3.53) | 5.64 (3.80) | 3.916 * | 0.025 | 0.048 | 0.774 |
T Score | 65.37 (4.11) | 65.12 (5.06) | 57.41 (15.11) | 8.759 *** | 0.002 | 0.001 | 0.999 |
CBCL | |||||||
Total | 64.41 (21.88) | 77.82 (25.71) | 39.27 (26.96) | 19.735 *** | 0.002 | 0.000 | 0.053 |
Withdrawn | 5.19 (2.90) | 6.18 (3.82) | 4.00 (4.23) | 3.012 | 0.605 | 0.043 | 0.543 |
Somatic Complaints | 4.33 (3.79) | 4.19 (3.06) | (2.32) **** | 7.526 ** | 0.004 | 0.001 | 0.996 |
Anxious Depressed | 11.89 (6.14) | 11.97 (6.55) | 7.73 (7.12) | 3.680 * | 0.085 | 0.022 | 1.000 |
Social Problems | 6.22 (2.61) | 8.12 (2.86) | 3.55 (2.94) | 22.587 *** | 0.004 | 0.001 | 0.009 |
Thought Problems | 5.37 (3.15) | 5.27 (2.74) | 2.55 (2.48) | 8.655 *** | 0.002 | 0.001 | 0.998 |
Attention Problems | 10.93 (3.74) | 12.97 (3.68) | 5.82 (4.34) | 29.009 *** | 0.001 | 0.001 | 0.053 |
Delinquency Externalising | 3.52 (3.17) | 6.31 (3.89) | 2.50 (2.41) | 12.746 *** | 0.673 | 0.001 | 0.001 |
Aggression Externalising | 16.96 (7.94) | 22.81 (8.51) | 11.77 (8.01) | 16.136 *** | 0.090 | 0.001 | 0.006 |
BRIEF | |||||||
Total | 175.07 (25.32) | 181.43 (21.52) | 128.32 (35.14) | 36.817 *** | 0.001 | 0.001 | 0.599 |
Working Memory | 71.70 (11.37) | 74.22 (10.71) | 56.57 (12.95) | 19.528 *** | 0.001 | 0.001 | 0.689 |
Shifting | 76.44 (13.15) | 78.59 (12.57) | 56.81 (14.88) | 22.279 *** | 0.001 | 0.001 | 0.848 |
Planning and Organising | 68.41 (10.46) | 72.17 (10.18) | 55.29 (14.60) | 18.038 *** | 0.000 | 0.000 | 0.355 |
Organisation of Materials | 60.07 (8.46) | 61.25 (11.34) | 49.00 (12.76) | 10.068 *** | 0.002 | 0.000 | 0.951 |
Monitoring | 67.74 (9.51) | 69.70 (9.93) | 51.52 (14.22) | 23.152 *** | 0.000 | 0.000 | 0.801 |
Inhibition | 70.44 (11.09) | 70.53 (11.09) | 55.76 (15.07) | 13.058 *** | 0.000 | 0.000 | 1.000 |
Initiate | 69.44 (9.85) | 68.66 (13.25) | 52.57 (12.77) | 14.734 *** | 0.000 | 0.000 | 0.989 |
Emotional Control | 71.89 (11.14) | 70.17 (13.32) | 56.24 (14.41) | 10.620 *** | 0.000 | 0.913 |
TD | |||||||||
CBCL | Total | Withdrawn | Somatic Complaints | Anxious Depressed | Social Problems | Thought Problems | Attention Problems | Delinquency | Aggression |
0.799 ** | 0.468 | 0.594 * | 0.768 ** | 0.306 | 0.668 * | 0.807 ** | 0.344 | 0.698 | |
BRIEF | Total | Working Memory | Shifting | Planning Organise | Organise Materials | Monitor | Inhibition | Initiate | Emotional Control |
0.638 * | 0.648 * | 0.624 * | 0.615 * | 0.101 | 0.575 | 0.405 | 0.836 ** | 0.683 * | |
FASD | |||||||||
CBCL | Total | Withdrawn | Somatic Complaints | Anxious Depressed | Social Problems | Thought Problems | Attention Problems | Delinquency | Aggression |
0.444 * | 0.502 ** | 0.358 * | 0.405 * | 0.318 | 0.453 ** | 0.353 * | 0.238 | 0.171 | |
SCAS | Total | Panic Attack | Separation Anxiety | Physical Injury | Social Phobia | Obsess/ Compulsive | Generalised Anxiety | T Score | |
0.353 | 0.413 * | 0.138 | 0.232 | 0.128 | 0.289 | 0.342 | 0.352 * |
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Mughal, R.; Wong, S.S.; Dimitriou, D.; Halstead, E. Nightmares in Children with Foetal Alcohol Spectrum Disorders, Autism Spectrum Disorders, and Their Typically Developing Peers. Clocks & Sleep 2021, 3, 465-481. https://doi.org/10.3390/clockssleep3030033
Mughal R, Wong SS, Dimitriou D, Halstead E. Nightmares in Children with Foetal Alcohol Spectrum Disorders, Autism Spectrum Disorders, and Their Typically Developing Peers. Clocks & Sleep. 2021; 3(3):465-481. https://doi.org/10.3390/clockssleep3030033
Chicago/Turabian StyleMughal, Rabya, Siu Sing Wong, Dagmara Dimitriou, and Elizabeth Halstead. 2021. "Nightmares in Children with Foetal Alcohol Spectrum Disorders, Autism Spectrum Disorders, and Their Typically Developing Peers" Clocks & Sleep 3, no. 3: 465-481. https://doi.org/10.3390/clockssleep3030033