Journal of Childhood

Introduction
Autism Spectrum Disorder (ASD) is a complex, lifelong neurodevelopmental condition characterized by deficits in social interaction and communication, alongside restricted and repetitive patterns of behavior. Among the most significant challenges faced by children with ASD are aggressive behaviors, which not only hinder social integration and school participation but also impose substantial psychological, financial, and emotional burdens on their parents and caregivers. Over time, these behaviors can lead to social isolation, exacerbated behavioral problems, and reduced quality of life for children and their families. Sleep problems are one of the most prevalent comorbidities in children with ASD, manifesting as difficulties initiating sleep, frequent night-time awakenings, and reduced sleep quality. These problems often emerge in early childhood and persist into later years. Disrupted sleep compromises cognitive control and emotional regulation, increasing irritability, hostility, and aggression in these individuals. Research indicates that children with ASD who also suffer from sleep problems are at a significantly higher risk for aggressive behaviors compared to their peers without sleep disturbances. Executive functions—such as planning, response inhibition, cognitive flexibility, and organization—play a pivotal role in behavioral and emotional self-regulation. Deficits in these abilities, which are highly prevalent among children with ASD, impair their capacity to accurately process social contexts, inhibit inappropriate responses, and select adaptive behavioral strategies, ultimately leading to increased maladaptive and aggressive behaviors. The present study aims to investigate and predict aggression based on sleep problems and executive function deficits in children with ASD residing in Tehran, Iran.

Research Methods
This descriptive-correlational study was conducted on 118 children diagnosed with ASD selected from the Autism Association center, Paya Clinic, and West Tehran Clinic, 2021–2022, using a convenience sampling method, adhering to strict inclusion and exclusion criteria. Data collection was done using three standardized questionnaires: the Child Aggression Questionnaire developed by Vahedi et al. (2008) with 43 items assessing verbal aggression, physical aggression, relational aggression, and impulsive aggression; the Children’s Sleep Habits Questionnaire (CSHQ) designed by Owens, Spirito, and McGuinn (2000), with 45 items to evaluate sleep quality in children aged 4–12; and the Behavior-Rating Inventory of Executive Function (BRIEF) questionnaire developed by Gioia et al. (2000), with 86 items to assess eight executive function domains in children aged 5–18. The collected data were analyzed in SPSS software, version 23, employing correlation test and multiple regression analysis.

Results
The analysis revealed a significant positive correlation between aggression and sleep problems (resistance to bedtime, sleep anxiety, nighttime awakenings, and parasomnia), as well as a significant negative correlation between aggression and executive functions (such as inhibition, emotional control, and working memory). Specifically, higher severity of sleep problems and weaker executive functions were associated with increased levels of aggression. Multiple regression analysis confirmed that approximately 87% of the variance in aggression was explained by these variables. The most significant predictors of aggression were parasomnia, sleep anxiety, nighttime awakenings, and inhibition, emotional control, and working memory. 

Conclusion
The results demonstrated a significant positive relationship between aggression and sleep problems, and a significant negative relationship between aggression and executive functions in children diagnosed with ASD. Parasomnia, sleep anxiety, nighttime awakenings, inhibition, emotional control, and working memory are the key predictors of aggression in these children. These outcomes can be explained by neurochemical abnormalities (such as dysregulation of dopamine and norepinephrine) and reduced melatonin levels in children with ASD, which impair inhibitory control and increase impulsive and aggressive behaviors. Future studies are recommended to examine these relationships in other cities of Iran and in other countries and/or to include gender-based comparisons. The findings suggest that targeted interventions addressing sleep quality and executive function enhancement can directly contribute to reducing aggressive behaviors in children with ASD. Clinically, it is recommended to improve sleep environments and utilize psychological interventions and sensory-motor integration therapies to strengthen executive functions and mitigate aggression in children with ASD. 

Ethical Considerations
Compliance with ethical guidelines
The procedures in this study were in accordance with the ethical principles outlined in the Declaration of Helsinki and the ethical guidelines of the Islamic Azad University, Sciences and Research Branch  (Code: IR.IAU.SRB.REC.1401.146). The study objectives and methods were explained to the participants, and the confidentiality of their information was maintained. 

Funding
This article was extracted from the thesis of Sajjad Dehghan Benadaki in the field of Psychology and Special Education at the Islamic Azad University, Science and Research Branch, Tehran. The research has not received any financial support from governmental, private, or non-profit organizations.

Authors contributions
The authors contributed equally to the preparation of the manuscript. All authors read and approved the final version of the manuscript for submission.

Conflicts of interest
The authors declare no conflicts of interest.

Acknowledgments
 The authors would like to thank all participants for their cooperation and time.



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