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AJP CME: June 2020 - Sleep Onset Problems and Subcortical Development in Infants Later Diagnosed With Autism Spectrum Disorder

Activity Type:

  • Journal CME

Release Date: 6/1/2020

Expiration Date: 5/31/2022

  • AMA PRA Category 1: 1
  • Participation: 1



Objective: Sleep patterns in children with autism spectrum disorder (ASD) appear to diverge from typical development in the second or third year of life. Little is known, however, about the occurrence of sleep problems in infants who later develop ASD and possible effects on early brain development. In a longitudinal neuroimaging study of infants at familial high or low risk for ASD, parent-reported sleep onset problems were examined in relation to subcortical brain volumes in the first 2 years of life.

Methods: A total of 432 infants were included across three study groups: infants at high risk who developed ASD (N=71), infants at high risk who did not develop ASD (N=234), and infants at low risk (N=127). Sleep onset problem scores (derived from an infant temperament measure) were evaluated in relation to longitudinal high-resolution T1 and T2 structural imaging data acquired at 6, 12, and 24 months of age.


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Educational Objective

The participant will recognize altered patterns of brain development associated with sleep onset difficulties and risk for autism in infancy.

Target Audience

This program is designed for all psychiatrists in clinical practice, residents in Graduate Medical Education programs, medical students interested in psychiatry, and other physicians who wish to advance their current knowledge of clinical medicine.

Estimated Time to Complete

Duration: 1 hour
Begin Date: June 1, 2020
End Date: May 31, 2022

How to Earn Credit

In order to earn CME credit, subscribers should read through the material presented in the article. After reading the article, complete the quiz and submit your evaluation and study hours (up to 1 AMA PRA Category 1 Credit™).  A score of 60% or higher is required to receive credit.


The American Psychiatric Association (APA) is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.

The APA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 Credit™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Faculty and Planner Disclosures

Title: Sleep Onset Problems and Subcortical Development in Infants Later Diagnosed With Autism Spectrum Disorder

Authors: Katherine E. MacDuffie, Ph.D., Mark D. Shen, Ph.D., Stephen R. Dager, M.D., Martin A. Styner, Ph.D., Sun Hyung Kim, Ph.D., Sarah Paterson, Ph.D., Juhi Pandey, Ph.D., Tanya St. John, Ph.D., Jed T. Elison, Ph.D., Jason J. Wolff, Ph.D., Meghan R. Swanson, Ph.D., Kelly N. Botteron, M.D., Lonnie Zwaigenbaum, Ph.D., Joseph Piven, M.D., Annette M. Estes, Ph.D.

Affiliations: Department of Speech and Hearing Sciences (K.E.M.D., T.S.J., A.M.E.), and Department of Radiology (S.R.D.), University of Washington, Seattle; Department of Psychiatry (M.D.S., M.A.S., S.H.K.), Biomedical Research Imaging Center (M.A.S.), and Neurodevelopmental Research Center (Jo.Pi.), University of North Carolina Chapel Hill; Department of Psychology, Temple University, Philadelphia (S.P.); Department of Child Psychiatry and Behavioral Sciences, Children’s Hospital of Philadelphia (Ju.Pa.); Institute of Child Development (J.T.E.), Department of Educational Psychology (J.J.W.), University of Minnesota, Minneapolis); Department of Behavioral and Brain Sciences, University of Texas at Dallas (M.R.S.); Department of Child Psychiatry, Washington University School of Medicine in St. Louis (K.N.B.); and Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada (L.Z.).

Disclosures: Dr. Zwaigenbaum has served as a member of an independent data monitoring committee for a clinical trial funded by Roche. The other authors report no financial relationships with commercial interests.

Discussion of unapproved or investigational use of products*: No.

 *APA policy requires disclosure by CME authors of unapproved or investigational use of products discussed in CME programs. Off-label use of medications by individual physicians is permitted and common. Decisions about off-label use can be guided by scientific literature and clinical experience.

Program Planners

Ned H. Kalin, M.D. (Editor-in-Chief, AJP); Carolyn Rodriguez, M.D., Ph.D. (Deputy Editor, AJP); Michael D. Roy (Editorial Director, AJP); Michael A. Pogachar (Online Content Manager, Journals). Dr. Kalin has served as a consultant to the Board of Scientific Advisors, the Pritzker Neuropsychiatric Disorders Research Consortium, and the Skyland Trail Advisory Board and as Councilor, Society of Biological Psychiatry. Dr. Rodriguez has served as a consultant to Allergan, Blackthorn, Epiodyne, and Rugen. Mr. Roy and Mr. Pogachar report no financial relationships with commercial interests.


Hardware/Software Requirements

This internet-based CME activity is best experienced using Internet Explorer 8+, Mozilla Firefox 3+, Safari 4+. This Web site requires that JavaScript and session cookies be enabled. Certain activities may require additional software to view multimedia, presentation, or printable versions of the content. These activities will be marked as such and will provide links to the required software. That software may be: Adobe Flash, Adobe Acrobat, Microsoft PowerPoint, and Windows Media Player.


Optimal System Configuration:

  • Flash Player: Adobe Flash Player 10.1+ 
  • Browser: Firefox 3+, Internet Explorer 8.0+, Safari 4.0+, or Google Chrome 7.0+ 
  • Operating System: Windows XP+ or Mac OS X 10.4+ 
  • Internet Connection: 1 Mbps or higher
  • Screen Resolution: 1024 x 768 pixels.

Minimum Requirements:

  • Windows PC:500-MHz Pentium II; Windows XP or higher; 128 MB RAM; Video Card at least 64MB of video memory; Sound Card at least 16-bit; Macromedia Flash Player 10 or higher, audio playback with speakers for programs with video content; Firefox 1.1+, Internet Explorer 7.0+, Safari 1.0+, Google Chrome, or Opera
  • Macintosh: Mac OS X 10.3 or higher with latest updates installed; 1.83MHz Intel Core Duo or faster; RAM: 128MB or more; Video Card: at least 64MB of video memory; Sound Card: at least 16-bit

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