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The reported prevalence rates of regulatory problems (RP) in infants and young children, mostly expressed as excessive crying, feeding and sleeping problems, vary widely [1, 2]. Reasons for discrepant findings could be attributed to lack of standardized definitions, type of populations under study, and different methods used to measure and document the problems.
In the large ‘Copenhagen Child Cohort’ study of one- and half-year-old children, the prevalence of mental health problems was studied in the general child population – prospectively from birth. The authors found that the most common infant mental health problem was ‘regulatory disorder’, present in 7.1% of the general population .
Regulatory problems (RP)/regulatory disorders may be associated with adverse behavioural outcomes  – particularly externalizing and ADHD-problems. Persistent RP in general and infancy feeding problems in particular have been found to predict deficits in social skills and in adaptive behaviour in preschool age . Moreover, infant RP is associated with high infant and parental burden and is a common reason for seeking help from health services .
Excessive crying during the first months in life has not generally been found to be associated with any long-term behavioural consequences. However, in a substantial proportion of children with persistent crying, this may be associated with multiple RP . Persistent excessive crying after three months of age has been reported to be predictive of hyperactivity, discipline and cognitive problems [6, 7].
Typical feeding problems comprise for instance long mealtimes, short intervals between meals, excessive vomiting, food refusal or failure to thrive (FTT). Feeding problems are common in childhood and occur in as many as 25–35% of normally developing children and in up to 80% of those with developmental delay . Feeding problems in children with autism spectrum disorder (ASD) are complex with biological vulnerability interacting with attachment and behavioural problems [6, 7]. The presence of severe or atypical feeding problems and FTT in infancy should alert professionals to a possible underlying autism spectrum disorder [9, 10].
Sleeping problems in infants and young children are prevalent, varying between 15 and 35% in children aged between 6 months and 5 year  and include difficulty falling asleep without parental help and/or frequent awakenings . Severe sleep problems in infancy have been associated with subsequent development of ADHD . In another study, family adversity was reported  instead of RP, as predictor for later hyperkinetic symptoms. Different types of sleep problems are reported in children with autism, sleep onset insomnia, sleep maintenance insomnia and irregularities of the sleep–wake cycle . It has been reported that most cry–fuss and sleep problems in the first 2 years of life are transient. Persistent problems were found to contribute to maternal depression, parenting stress and subsequent child behaviour problems .
There are relatively few studies that specifically focus on the link between RP in infancy and later autism or ASD. The aim of this study was therefore to analyse different domains of early RP in a representative group of young children with ASD and to contrast these early regulatory problem signs with an age- and sex-matched comparison group.
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This study focused on three domains of early RP: excessive crying, eating/feeding and sleeping problems in a representative group of children with ASD and in a comparison group. The measure used to assess these problems was the number of registered consultations at the CHC concerning these domains during the child's first two years. No analyses other than regarding RP have been performed.
Children with ASD had had significantly more consultations for crying, feeding or sleeping problems at the CHC than the children in the comparison group. This applied both when individual domains were compared and when the domains were collapsed.
An important finding was that the odds for an ASD child to have many (2 or more) consultations related to a regulatory problem were about four times as high as for a child in the comparison group (OR = 4.11). Few (0–1) consultations had occurred significantly more often in the comparison group.
We could not demonstrate any correlation between number of consultations and age for referral to the habilitation centre, gender, type of ASD, intellectual level or reported hyperactivity in the total group of ASD or in the group with the highest number of consultations.
Data from CHC records and from the DISCO interview, performed with parents of children with ASD at the two-year follow-up, revealed a significant correlation for feeding and sleeping problems. A significant correlation between the two measures (CHC records and DISCO interview) was also found when the three domains were merged into one. Thus, parental information given later during the child's preschool age was consistent with early reports in the CHC record.
As children at this early age have not yet developed a spoken language, crying is usually the way in which they express fatigue, hunger, anxiety or any other means of discomfort. Possibly many children with developmental abnormalities are, already at an early stage, extra sensitive regarding their perceptual and sensory functioning .
This could in turn augment reactions in terms of more frequent or severe RP. In older children with ASD, it is well known that many have difficulties with eating (regulation of food amount, insistance of sameness etc.), demonstrate different kinds of sleep problems as well as disruptive behaviour (e.g. in transitions).
The study has certain limitations mainly related to that only one source for data collection was used (CHC records) and that data were not assessed with parental diaries. Besides this, we lack information on psychosocial risk factors. There might also be a general tendency of underrating problems in the children's records, to avoid pointing out deviances. However, if any of this is the case, the same policy should have been undertaken in the two groups. Overrating because of a known diagnosis is not probable because the children had not yet been assessed with regard to ASD at this early age, and there were no such indications in the records.
However, the sample is relatively large and representative, and, instead of parental diaries, documentation had been made in a consistent way by the child's nurse at every visit.
In conclusion, we found that the children who later had received a diagnosis of ASD had had more consultations at the CHC than children without ASD.
It is of great importance to all parents of infant children to have a good relation to the CHC and confidence in that their worries are taken seriously and handled with care. Even though these early findings cannot be seen as precursors of autism spectrum disorders or any other specific neurodevelopmental disorder, results from this study suggest that children with a great deal of RP in infancy, and many consultations at the CHC, should be closely followed, both with regard to the child's development in general but also to help with early interventions for the well-being of the whole family.