Work

Sleep, executive functions, and repetitive behaviors in autism spectrum disorder: different patterns of association with lower- and higher-level repetitive behaviors

Year: 2026

Type: article

Abstract: Background: Restricted and repetitive behaviors (RBs) are a core feature of autism spectrum disorder (ASD), although the mechanisms underlying different RB subtypes remain poorly understood. The present study investigated the differential contribution of executive functions (EFs) to lower- and higher-level RBs in autistic children and explored whether specific EF domains mediated the relationship between sleep disturbances and RBs. Methods: Fifty-seven autistic children aged 6-14 years underwent neuropsychological and behavioral assessment. RBs were assessed using the Repetitive Behavior Scale-Revised, executive functions using the Behavior Rating Inventory of Executive Function-2, sleep disturbances through the Sleep Disturbance Scale for Children, and behavioral difficulties through the Child Behavior Checklist. Results: Partial correlations, regression analyses, and mediation models were performed. Distinct association patterns emerged across RB subtypes. Lower-level RBs were significantly associated only with emotional control difficulties, whereas higher-level RBs were associated with several EF domains, including inhibition, shifting, emotional control, planning, and initiation. Regression analyses showed that higher-level RBs were independently predicted by shifting difficulties, whereas lower-level RBs were significantly associated with IQ and behavioral problems. Mediation analyses indicated that emotional control difficulties significantly explained the association between sleep disturbances and lower-level RBs. In contrast, cognitive flexibility did not mediate the relationship between sleep disturbances and higher-level RBs. Conclusion: These findings provide preliminary evidence of different patterns of association across lower- and higher-level RBs in autistic children. Emotional regulation processes may be particularly relevant for lower-level RBs, whereas cognitive flexibility appears more strongly related to higher-level RBs. Findings also suggest that sleep disturbances may contribute to specific RB manifestations through different mechanisms.

Source: Frontiers in Psychology

DOI: 10.3389/fpsyg.2026.1903369

Authors: Elisa Fucà, Martina Parisi, Silvia Guerrera, Stefano Vicari

Institutions: Bambino Gesù Children's Hospital, Pontifícia Universidade Católica de São Paulo

Language: English

Topic: Autism Spectrum Disorder Research

Subfield: Cognitive Neuroscience

Field: Neuroscience

Domain: Life Sciences

SDG: Good health and well-being

Open Access status: gold

Estimated APC paid: $3,801