Behind closed eyes: Understanding nightmares in children and adolescents with autism spectrum disorder - A systematic review.

This review looked at nightmares in autistic children and teens. Researchers found that frequent nightmares happen in less than 5% of autistic children - about the same rate as other children. Nightmares seem connected to other sleep problems in autism, but they don't appear to be a main feature of autism itself. The difficulty autistic children have with communication might make it harder for them to report their dreams and nightmares.

This systematic review examined nightmares in children and adolescents with autism spectrum disorder (ASD) by analyzing 29 studies. The research found that frequent nightmares occurred in less than 5% of children with ASD, with no significant difference in nightmare prevalence compared to typically developing peers. The review identified relationships between nightmares and other sleep disturbances in individuals with ASD. Results suggest nightmares may not be a distinctive feature of ASD itself, though communication and introspection difficulties may affect dream reporting abilities.

The authors note that while comorbid sleep disorders can influence nightmare frequency, current research remains preliminary and requires further investigation.

Clinicians should not expect nightmares to be more common in autistic children compared to their peers. When nightmares do occur, they may be related to broader sleep disturbances that warrant comprehensive sleep assessment. Communication challenges may require adapted approaches to assess dream experiences in autistic individuals.

The review notes that current research on nightmares in ASD is preliminary in nature. Communication and introspection difficulties in individuals with ASD may affect the accuracy of dream and nightmare reporting, potentially impacting study findings.

Brain and sleep development in childhood shapes emotional and cognitive growth, including the ability to recall dreams. In line with the continuity hypothesis of dreaming, several findings suggest a link between clinical symptoms and nightmare frequency. Sleep disorders and anxiety are among the most frequently co-occurring conditions in children and adolescents with autism spectrum disorder (ASD). However, their impact on nightmares has not yet been systematically explored.

This review aims to address this research gap by investigating nightmares in autism and their influence on clinical symptoms and cognitive functioning. The literature was searched utilizing the databases PubMed, PsycINFO, Web of Science, and Scopus, following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The included studies were assessed for methodological quality. Twenty-nine papers were reviewed.

The prevalence of nightmares occurring very frequently was below 5 %, with no significant difference in nightmare prevalence between children with ASD and their healthy peers. Furthermore, several findings reported a relationship between nightmares and other sleep disturbances among individuals with ASD. The study of dreaming in ASD may provide valuable insights into the disorder. Although comorbid sleep disorders can influence nightmare frequency, the results of this review suggest that nightmares may not represent a distinctive feature of ASD.

However, poor communication and introspection skills may explain the difficulties in reporting dream experiences. Given the preliminary nature of current research on nightmares in ASD, further studies are essential to overcome existing limitations and deepen our understanding.