From the Guidelines
Children with autism spectrum disorders (ASD) should be screened for insomnia, and therapeutic interventions should begin with parent education in the use of behavioral approaches as a first-line approach. Lack of sleep in children can cause irritability, difficulty concentrating, behavioral problems, poor academic performance, and weakened immune function 1. To improve children's sleep, establish a consistent bedtime routine, limit screen time before bed, create a comfortable sleep environment, and ensure regular physical activity during the day. For persistent sleep issues, consult a pediatrician who might recommend behavioral interventions before considering medications. Melatonin (typically 0.5-3mg taken 30-60 minutes before bedtime) may be suggested for some children with sleep onset difficulties, but should only be used under medical supervision 1.
Key Considerations
- Children who have ASD are at greater risk for developing sleep problems than typically developing children, with a prevalence of sleep disturbances ranging from 53% to 78% 1
- Insomnia in children who have ASD is multifactorial, including not only behavioral issues but also medical, neurologic, and psychiatric comorbidities; it is also an adverse effect of the medications used to treat symptoms of autism and these comorbidities 1
- Treating insomnia in children who have neurodevelopmental disorders may improve problematic daytime behaviors 1
- Current treatments for insomnia in children who have ASD show promise for behavioral/educational interventions and melatonin trials, but there is a paucity of evidence, supporting the need for additional research 1
Recommendations
- All children who have ASD should be screened for insomnia 1
- Screening should be done for potential contributing factors, including other medical problems 1
- Therapeutic interventions should begin with parent education in the use of behavioral approaches as a first-line approach 1
- Pharmacologic therapy may be indicated in certain situations, but should only be used under medical supervision 1
From the Research
Effects of Lack of Sleep on Children
- Lack of sleep can affect children's physical health, cognitive capacity, socioemotional processes, and behavioral functioning, with implications for children's development and well-being 2.
- Insufficient sleep, poor sleep quality, and irregular sleep schedules can have negative effects on children's development 2.
- Sleep deprivation may lead to physical and psychological disorders in the short and long term, and hospitalized children are particularly vulnerable to sleep disturbances due to external and internal factors 3.
Risk Factors for Sleep Problems in Children
- Several risk factors for sleep problems have been identified, including health literacy, TV in the room, feeding, close contact and arousing activities at bedtime, intolerance for infant crying, co-sleeping, maternal depression, and infant temperament 4.
- Cross-cultural differences have been noted both for infant sleep problems and parents' perceived distress by those problems 4.
Treatment and Intervention for Sleep Disorders in Children
- A number of interventions have been tried to ameliorate infant sleep problems, including consultations, teaching sessions on extinction and bedtime fading, internet-based interventions, and nighttime massages by parents 4.
- Melatonin supplementation has been shown to synchronize the circadian rhythms, and improve the onset, duration, and quality of sleep, and may offer an alternative treatment to currently available pharmaceutical therapies for sleep disorders with significantly less side effects 5.
- Proper clinical assessment and treatment of pediatric insomnia is crucial, given the importance of adequate sleep for proper brain development 6.