Practice guideline: Treatment for insomnia and disrupted sleep behavior in children and adolescents with autism spectrum disorder

Abstract

Objective To review pharmacologic and nonpharmacologic strategies for treating sleep disturbances in children and adolescents with autism spectrum disorder (ASD) and to develop recommendations for addressing sleep disturbance in this population. Methods The guideline panel followed the American Academy of Neurology 2011 guideline development process, as amended. The systematic review included studies through December 2017. Recommendations were based on evidence, related evidence, principles of care, and inferences. Major recommendations (Level B) For children and adolescents with ASD and sleep disturbance, clinicians should assess for medications and coexisting conditions that could contribute to the sleep disturbance and should address identified issues. Clinicians should counsel parents regarding strategies for improved sleep habits with behavioral strategies as a first-line treatment approach for sleep disturbance either alone or in combination with pharmacologic or nutraceutical approaches. Clinicians should offer melatonin if behavioral strategies have not been helpful and contributing coexisting conditions and use of concomitant medications have been addressed, starting with a low dose. Clinicians should recommend using pharmaceutical-grade melatonin if available. Clinicians should counsel children, adolescents, and parents regarding potential adverse effects of melatonin use and the lack of long-term safety data. Clinicians should counsel that there is currently no evidence to support the routine use of weighted blankets or specialized mattress technology for improving disrupted sleep. If asked about weighted blankets, clinicians should counsel that the trial reported no serious adverse events with blanket use and that blankets could be a reasonable nonpharmacologic approach for some individuals. AAN= : American Academy of Neurology; ABC= : Aberrant Behavior Checklist; ADHD= : attention-deficit/hyperactivity disorder; AE= : adverse event; ASD= : autism spectrum disorders; CAM= : complementary and alternative medicine; CBT= : cognitive-behavioral therapy; CI= : confidence interval; COI= : conflict of interest; CSHQ= : Children’s Sleep Habits Questionnaire; CSHQ-NW= : CSHQ–Night Wakings; CSHQ-SD= : CSHQ–Sleep Duration; CSHQ-SOD= : Children’s Sleep Habits Questionnaire–Sleep Onset Delay; DBC= : Developmental Behavior Checklist; DSM-5= : Diagnostic and Statistical Manual of Mental Disorders, 5th edition ; FDA= : Food and Drug Administration; GDDI= : American Academy of Neurology Guideline Development, Dissemination, and Implementation Subcommittee; GERD= : gastroesophageal reflux disorder; OSA= : obstructive sleep apnea; OTC= : over-the-counter; RMD= : raw mean difference; SE= : sleep efficiency; SOL= : sleep onset latency; SR= : systematic review; STS= : Sound-to-Sleep; TST= : total sleep time; WASO= : wake after sleep onset