Practice guideline: Treatment for insomnia and disrupted sleep behavior in children and adolescents with autism spectrum disorder: Report of the Guideline Development, Dissemination, and Implementation Subcommittee of the American Academy of Neurology.
Study Goal
To evaluate pharmacologic and nonpharmacologic strategies, including melatonin, for treating sleep disturbances in children and adolescents with autism spectrum disorder (ASD).
Results Summary
Melatonin was recommended as a treatment option when behavioral strategies were insufficient, starting with a low dose. The study noted potential adverse effects and lack of long-term safety data but reported no serious adverse events.
Population
Children and adolescents with autism spectrum disorder (ASD) and sleep disturbances.
Effective Dosage
Low dose (specific amount not provided).
Duration
Not specified.
Interactions
None mentioned.
| Intervention | Direction | Endpoint | Population | Dosage | Impact | Claim # |
|---|---|---|---|---|---|---|
behavioral strategies | decrease | sleep disturbance | children and adolescents with ASD | - | should be used as a first-line treatment approach | #1 |
melatonin | decrease | sleep disturbance | children and adolescents with ASD | - | should be offered if behavioral strategies have not been helpful | #2 |
weighted blankets | no change | disrupted sleep | children and adolescents with ASD | - | no evidence to support the routine use | #3 |
specialized mattress technology | no change | disrupted sleep | children and adolescents with ASD | - | no evidence to support the routine use | #4 |
weighted blankets | decrease | sleep disturbance | some individuals | - | could be a reasonable nonpharmacologic approach for some individuals | #5 |
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.