Objective: We sought to identify clinical discriminators between predominantly mood disordered and predominantly autism spectrum disordered research subjects that may reflect phenotypic state and treatment response characteristics. Method: Participants were 26 boys and 4 girls aged 2 to 18 years (Mean Age = 7.70). Subjects with DSM-IV diagnoses of Major depression (N = 2), Bipolar Disorder (N = 4) and Mood Disorder not otherwise specified (NOS) (N = 11) represented the mood disorder group (MD) (N = 17, Mean Age = 8.2) and those with diagnoses of Autistic Disorder (N = 1), Asperger ’ s Disorder (7) or Pervasive Developmental Disorder (NOS) (N = 3) comprised the autism spectrum disorder (ASD) group (N = 9, Mean Age = 6.8). Primary outcome measurements were continuous actigraphic measurements collected over one to three week periods. Secondary outcomes included personality and observational measurements. Personality characteristics reflected significant cross-group impairment s related to self-control and self-discipline and differed relative to intellectual measures. Observational measurements reflected greater general impairment s among the ASD group. Results: Predominantly mood disordered children demonstrated greater impairments related to sleep (P = 0 .000) and sleep onset latency (P = 0 .000) and were more active than ASD children during evening periods (P = 0 .000). ASD children had lower verbal functioning and greater deviations from the norm on measures of cognitive development (P = 0 .003) and psychosis (P = 0 .047). Conclusions: Sleep disturbances, evening activity levels and phase delayed sleep appear to differentiate predominant mood and autism spectrum disordered children suggesting future areas for further exploration of neurological and phenotypic treatment response characteristics .
G. Masi, M. Mucci, C. Pfanner, S. Berloffa, A. Magazù and G. Perugi, “Developmental Pathways for Different Subtypes of Early-Onset Bipolarity in Youths,” Journal of Clinical Psychiatry, Vol. 73, No. 10, 2012, pp. 1335-1341.
M. Maskey, F. Warnell, J. R. Parr, A. Le Couteur and H. McConachie, “Emotional and Behavioural Problems in Children with Autism Spectrum Disorder,” Journal of Autism and Developmental Disorders, Vol. 43, No. 4, 2013, pp. 851-859.
D. L. Coury, E. Anagnostou, P. Manning-Courtney, A. Reynolds, L. Cole, R. McCoy, A. Whitaker and J. M. Perrin, “Use of Psychotropic Medication in Children and Adolescents with Autism Spectrum Disorders,” Pediatrics, Vol. 130, Suppl. 2, 2012, pp. 69-76.
D. Staton, “The Impairment of Pediatric Bipolar Sleep: Hypotheses Regarding a Core Defect and Phenotype-Specific Sleep Disturbances,” Journal of Affective Disorders, Vol. 108, No. 3, 2008, pp. 199-206. http://dx.doi.org/10.1016/j.jad.2007.10.007
B. J. Duke, “Pathogenic Effects of Central Nervous System Hyperarousal,” Medical Hypotheses, Vol. 71, No. 2, 2008, pp. 212-217. http://dx.doi.org/10.1016/j.mehy.2008.03.037
E. Schopler, R. Reicher and B. Renner, “The Childhood Autism Rating Scale, s.l.,” Western Psychological Services, 1988.
K. A. Kaplan, L. S. Talbot, J. Gruber and A. G. Harvey, “Evaluating Sleep in Bipolar Disorder: Comparison between Actigraphy, Polysomnography, and Sleep Diary,” Bipolar Disorders, Vol. 14, No. 8, 2012, pp. 870-879. http://dx.doi.org/10.1111/bdi.12021
B. Duke, “Child Psychotherapy and the Scientific Method: The Systematic Observation Scale,” Proceedings of the Pacific Division, American Association for the Advancement of Science, Vol. 9, No. 1, 1990, p. 21.
A. S. Kaufman and N. L. Kaufman, “Kaufman Brief Intelligence Test,” 2nd Edition, NCS Pearson Inc., 2004.
R. D. Wirt, D. Lachar, J. K. Kleindin and P. D. Seat, “Multidimensional Description of Child Personality,” Western Psychological Services, Los Angeles, 1984.
B. Duke, “Child Psychopharmacology Institute,” 2012. http://www.childpsychopharmacologyinstitute.org/CPIObservationDefinitions.pdf
L. S. Talbot, S. Stone, J. Gruber, I. S. Hairston, P. Eidelman and A. G. Harvey, “A Test of the Bidirectional Association between Sleep and Mood in Bipolar Disorder and Insomnia,” Journal of Abnormal Psychology, Vol. 121, No. 1, 2012, pp. 39-50. http://dx.doi.org/10.1037/a0024946
T. R. Goldstein, J. A. Bridge and D. A. Brent, “Sleep Disturbance Preceding Completed Suicide in Adolescents,” Journal of Consulting and Clinical Psychology, Vol. 76, No. 1, 2008, pp. 84-91.
P. S. Ritter, C. Marx, N. Lewtschenko, S. Pfeiffer, K. Leopold, M. Bauer and A. Pfennig, “The Characteristics of Sleep in Patients with Manifest Bipolar Disorder, Subjects at High Risk of Developing the Disease and Healthy Controls,” Journal of Neural Transmission, Vol. 119, No. 10, 2012, pp. 1173-1184. http://dx.doi.org/10.1007/s00702-012-0883-y
L. Seugnet, Y. Suzuki, J. M. Donlea, L. Gottschalk and P. J. Shaw, “Sleep Deprivation during Early-Adult Development Results in Long-Lasting Learning Deficits in Adult Drosophilia,” Sleep, Vol. 34, No. 2, 2011, pp. 137-146.
A. Baroni, M. Hernandez, M. C. Grant and G. L. Faedda, “Sleep Disturbances in Pediatric Bipolar Disorder: A Comparison between Bipolar I and Bipolar NOS,” Frontiers in Psychiatry, Vol. 3, 2012, p. 22. http://dx.doi.org/10.3389/fpsyt.2012.00022
A. Millar, C. A. Espie and J. Scott, “The Sleep of Remitted Bipolar Outpatients: A Controlled Study Using Actigraphy,” Journal of Affective Disorders, Vol. 80, No. 2, 2004, pp. 145-153. http://dx.doi.org/10.1016/S0165-0327(03)00055-7
T. R. Goldstein, A. Gilbert, D. Axelson, B. Birmaher, R. Fersch, K. Monk and E. Frank, “Sleep Actigraphy among Adolescents at Risk for Bipolar Disorder,” Western Psychiatric Institute and Clinic University of Pittsburgh, Pittsburgh, 2012.
M. Matsuoka, S. Nagamitsu, A. Iwasaki, Y. Yamashita, M. Maeda, S. Kitani, T. Kakuma, N. Uchimura and Matsuishi, “High Incidence of Sleep Problems in Children with Developmental Disorders: Results of a Questionaire Survey in a Japanese Elementary School,” Brain & Development, 2013.
P. C. Zee, H. Attarian and Videnovic, “Circadian Rhythm Abnormalities,” Continuum (Minneap Minn), Vol. 19, No. 1, 2013, pp. 132-147.
I. Geijlswijk, H. Korzilius and M. G. Smits, “The Use of Exogenous Melatonin in Delayed Sleep Phase Disorder: A Meta-Analysis,” Sleep, Vol. 33, No. 12, 2010, pp. 1605-1614.
E. R. Norris, K. Burke, J. R. Correll, K. J. Zemanek, J. Lerman, R. A. Primelo and M. W. Kaufmann, “A Double-Blind, Randomized, Placebo-Controlled Trial of Adjunctive Ramelteon for the Treatment of Insomnia and Mood Stability in Patients with Euthymic Bipolar Disorder,” Journal of Affective Disorders, Vol. 144, No. 1, 2013, pp. 141-147. http://dx.doi.org/10.1016/j.jad.2012.06.023
M. Furuya, T. Miyaoka, H. Yasuda, S. Yamashita, I. Tanaka, S. Otsuka, R. Wake and J. Horiguchi, “Marked Improvement in Delirium with Ramelteon: Five Case Reports,” Psychogeriatrics, Vol. 12, No. 4, 2012, pp. 259-262. http://dx.doi.org/10.1111/j.1479-8301.2012.00422.x
P. Salvatore, S. Ghidini, G. Zita, C. De Panfilis, S. Lambertino and C. Maggini, “Circadian Activity Rhythm Abnormalities in Ill and Recovered Bipolar I Disorder,” Bipolar Disorders, Vol. 10, No. 2, 2008, pp. 256-265. http://dx.doi.org/10.1111/j.1399-5618.2007.00505.x
M. J. McCarthy and D. K. Welsh, “Cellular Circadian Clocks in Mood Disorders,” Journal of Biological Rhythms, Vol. 27, No. 5, 2012, pp. 339-352. http://dx.doi.org/10.1177/0748730412456367
C. J. Doyle and C. A. McDougle, “Pharmacologic Treatments for the Behavioral Symptoms Associated with Autism Spectrum Disorders across the Lifespan,” Dialogues in Clinical NeuroSciences, Vol. 14, No. 3, 2012, pp. 263-279.