Study Shows the Impact of Adversity on Sleep Problems in Fetal Alcohol Spectrum Disorder

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Results show 60% of the children with FASD experienced nightmares, while 44% exhibited frequent insomnia symptoms.

Recent research demonstrated the critical role of exposure to postnatal adversity in contributing to sleep disturbances among children with fetal alcohol spectrum disorder (FASD). In addition, it illuminated the distinct impacts of cumulative risk and the threat dimension of adversity on sleep problems.1

Previous efforts have been made to better understand the developmental impacts of prenatal alcohol exposure (PAE) and postnatal exposure to adversity. In this study, investigators focused on children with Fetal Alcohol Spectrum Disorder (FASD), who are known to experience significant sleep disturbances.

Ned Chandler-Mather, School of Applied Psychology, Griffith University, Brisbane, and investigators aimed to unravel the relative influence of early life adversity on insomnia symptoms and nightmares in these children with FASD and "At Risk" designations.

The study examined a cohort of children who had undergone diagnostic assessment for FASD and 2 distinct approaches to model adversity were employed: a cumulative risk approach that computed a total score by summing adversities; and an approach that treated exposure to threat and deprivation as separate dimensions. All the analyses accounted for potential confounding variables, such as age and gender.

Results revealed alarmingly high rates of carer-reported sleep problems among the children studied. Notably, 60% (n = 38) of the children experienced nightmares, while 44% (n = 28) exhibited frequent insomnia symptoms.

Data on exposure to adversity and sleep problems were collected from caregiver reports for 63 children, ranging from 3 years 4 months to 7 years 8 months old. Investigators computed cumulative risk, threat exposure, and deprivation exposure scores, which were then evaluated as potential predictors of insomnia symptoms and nightmares.

According to the cumulative risk approach, with every additional exposure to adversity, the odds of a caregiver reporting insomnia symptoms increased significantly, with an odds ratio of 1.38. This finding suggested the compounding effect of multiple adversities on sleep disturbances in these children.

In contrast, the dimensional analysis found no direct relationship between exposure to deprivation and sleep problems. However, it did uncover a crucial connection between exposure to threat and nightmares.

The study revealed that for each additional exposure to threat, the likelihood of experiencing nightmares increased by a significant factor of 1.93.

The findings indicated implications for understanding the etiology and treatment of sleep disturbances in this population. By identifying specific dimensions of adversity that significantly impact sleep, investigators and healthcare practitioners can aim to utilize interventions and treatments to address these issues effectively, and the team urged for increased awareness and targeted support for children with FASD.


  1. 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 [published online ahead of print, 2023 Jul 13]. Alcohol (Hanover). 2023;10.1111/acer.15152. doi:10.1111/acer.15152