What could be causing non-restorative sleep in an individual with Autism Spectrum Disorder (ASD) and Attention Deficit Hyperactivity Disorder (ADHD) since childhood?

From the Guidelines

Non-restorative sleep in an individual with Autism Spectrum Disorder (ASD) and Attention Deficit Hyperactivity Disorder (ADHD) since childhood is likely caused by multifactorial issues, including behavioral, medical, neurologic, and psychiatric comorbidities, as well as adverse effects of medications used to treat symptoms of autism and these comorbidities 1.

Possible Causes

• Behavioral issues: difficulty initiating and/or maintaining sleep, including premature awakenings, leading to insufficient or poor-quality sleep 1
• Medical comorbidities: sleep disorders, such as sleep apnea, restless leg syndrome, and periodic leg movements 1
• Neurologic comorbidities: seizures, headaches, and other neurologic conditions that can disrupt sleep 1
• Psychiatric comorbidities: anxiety, depression, and other mental health conditions that can affect sleep 1
• Medication side effects: certain medications used to treat ASD and ADHD symptoms can interfere with sleep, such as stimulants and antipsychotics 1

Treatment Options

• Melatonin: a safe and effective treatment to reduce sleep problems in children with ASD, particularly for resistance, latency, duration, and sleep anxiety 1
• Multivitamin and iron supplementation: may have a positive impact on sleep latency and irritability, but more research is needed to confirm its effectiveness 1 It is essential to note that treating insomnia in children with ASD and ADHD may improve problematic daytime behaviors, such as attention and hyperactivity symptoms 1. A comprehensive evaluation and management plan should be developed to address the underlying causes of non-restorative sleep and improve overall sleep quality and daytime functioning.

From the Research

Potential Causes of Non-Restorative Sleep

The individual's Autism Spectrum Disorder (ASD) and Attention Deficit Hyperactivity Disorder (ADHD) may be contributing to their non-restorative sleep, as research suggests that these conditions are often associated with sleep disturbances 2, 3, 4, 5, 6.

• Sleep disturbances in individuals with ASD and ADHD can include insomnia, parasomnias, circadian rhythm disorders, and sleep-related movement disorders 3, 4, 6.
• The timing of one's most active hours can increase the likelihood of having both ASD and ADHD, and disturbed sleep in people with ADHD seems to be a result rather than the cause of the condition 2.
• Poor sleep quality can exacerbate problematic daytime behavior in individuals with ASD, and treating disordered sleep in ASD has great potential to improve daytime behavior and family functioning 5.
• Sleep problems in ASD and ADHD may not only worsen daytime behaviors and core symptoms but also contribute to parental stress levels, highlighting the need for prompt attention and management 6.

Factors Contributing to Sleep Disturbances

Multiple factors may contribute to the higher rates of sleep disturbances in individuals with ASD and ADHD, including:

• Circadian rhythm disorders 2, 3, 4
• Sleep-related movement disorders 3, 4
• Insomnia and parasomnias 3, 4, 6
• Periodic Limb Movements in Sleep, which is specific to ADHD adults 4
• Medication, intellectual disability, and concurrent psychiatric disorders, which can affect sleep patterns 4