Behind Closed Eyes: Understanding Nightmares in Children and Adolescents with Autism Spectrum Disorder - A Systematic Review

Introduction: 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.

Methods: 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.

Results: 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.

Discussion: 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.