Sleep, executive functions, and repetitive behaviors in autism spectrum disorder: different patterns of association with lower- and higher-level repetitive behaviors.
- 1Child and Adolescent Neuropsychiatry Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy.
- 2Life Sciences and Public Health Department, Catholic University, Rome, Italy.
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.
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BibTeX
@article{fuca2026sleep,
title = {{Sleep, executive functions, and repetitive behaviors in autism spectrum disorder: different patterns of association with lower- and higher-level repetitive behaviors.}},
author = {Elisa Fucà and Martina Parisi and Silvia Guerrera and Stefano Vicari},
journal = {Frontiers in psychology},
year = {2026},
month = oct,
doi = {10.3389/fpsyg.2026.1903369},
url = {https://europepmc.org/article/MED/42909105},
note = {CC BY},
}
RIS
TY - JOUR
TI - Sleep, executive functions, and repetitive behaviors in autism spectrum disorder: different patterns of association with lower- and higher-level repetitive behaviors.
AU - Elisa Fucà
AU - Martina Parisi
AU - Silvia Guerrera
AU - Stefano Vicari
PY - 2026
DA - 2026/10/07
JO - Frontiers in psychology
DO - 10.3389/fpsyg.2026.1903369
UR - https://europepmc.org/article/MED/42909105
AB - 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.
SN - 1664-1078
ER -