Chandler-Mather N, Betts J, Donovan C, Shelton D, Dawe S. Understanding the impacts of childhood adversity on sleep problems in children with Fetal Alcohol Spectrum Disorder: A comparison of cumulative and dimensional approaches. Alcohol (Hanover, York County, Pa.). 2023 Jul. DOI: 10.1111/acer.15152. PMID: 37442612.
The developmental impacts of prenatal alcohol exposure (PAE) and post-natal exposure to adversity are typically considered in isolation. However, both contribute independently to sleep problems. Children with Fetal Alcohol Spectrum Disorder (FASD) have PAE and significant sleep disturbances. What is not clear is the relative contribution of exposure to early life adversity to these disturbances. The aim of this study was to examine how exposure to adversity impacts frequent insomnia symptoms and nightmares in children with FASD and “At Risk” designations.
This relationship was investigated in children who had undergone diagnostic assessment for FASD. Two approaches to modelling adversity were compared: a cumulative risk approach that sums adversities to create a total score and an approach that treats exposure to threat and deprivation as independent dimensions. Data on caregiver-reported exposure to adversity and sleep problems for sixty-three children (aged 3 years 4 months to 7 years 8 months) were extracted from clinical archives. Cumulative risk, threat exposure, and deprivation exposure scores were computed and were tested as potential predictors of insomnia symptoms and nightmares.
There were high rates of carer-reported sleep problems with 60% (n = 38) of children having nightmares and 44% (n = 28) with a frequent insomnia symptom. The cumulative risk analysis found that for every additional exposure to adversity, the odds of having a caregiver-reported insomnia symptom increased by 1.38. The dimensional analysis found no relationship between deprivation and sleep problems. However, every additional exposure to threat increased the likelihood of nightmares by 1.93. All analyses controlled for age and gender.
Exposure to postnatal adversity contributes to sleep disturbances in children with FASD, with unique roles for cumulative risk and the threat dimension of adversity. Implications for aetiology and treatment of sleep disturbances in children with FASD are discussed.