Children and teenagers with autism spectrum disorder tend to struggle with sleep. They can experience trouble falling asleep and staying asleep or refuse to go to bed. The American Academy of Neurology (AAN) has issued a new guideline for sleep problems in children and teenagers with autism. The American Academy of Neurology carefully reviewed available scientific studies on autism and sleep problems in children and teenagers. With the guideline, families, neurologists and other health care providers will be better able make decisions on the best treatments to use. Health care providers are recommended to first identify if the sleep problems are caused by medications or other medical conditions, and if so, that those causes be addressed.
The guideline addressed four types of sleep problems:
• refusing to go to bed, stalling, or needing a parent or caregiver present until the child falls asleep;
• trouble falling asleep and staying asleep;
• sleeping for only short periods of time or not getting enough total sleep each night;
• daytime behavior problems associated with insufficient sleep at night.
“While up to 40% of children and teens in the general population will have sleep problems at some point during their childhood, such problems usually lessen with age,” said lead guideline author Ashura Williams Buckley, MD, of the National Institute of Mental Health in Bethesda, MD, and a member of the American Academy of Neurology. “For children and teens with autism, sleep problems are more common and more likely to persist, resulting in poor health and poor quality of life. Some sleep problems may be directly related to autism, but others are not. Regardless, autism symptoms may make sleep problems worse.”
A consistent sleep routine with regular bedtimes and wake times, choosing a bedtime close to when the child usually gets sleepy, and not allowing use of electronic close to bedtime are proven effective behavior treatments. If behavioral strategies alone do not work, the guideline recommends that health care providers also consider adding melatonin. However, more research is needed to determine how safe melatonin is over longer periods of time.
Studies show that an artificial form of melatonin is safe and effective for children and teenagers with autism in the short term, for a period of up to 3 months.
Possible side effects include headache, dizziness, diarrhea, and rash. The guideline also cautions that over the counter melatonin products may not be reliable in terms of how much melatonin they actually contain. The guideline recommends using products that are labeled pharmaceutical grade melatonin.
The guideline found melatonin use may be just as helpful in some patients as when melatonin is combined with behavioral strategies. The guideline did not find that behavior treatments combined with melatonin changed daytime behavior problems or symptoms of autism. There was also no evidence that routine use of weighted blankets or specialized mattress technologies improve sleep.
Peter McAllister, MD
Jakai D. Nolan, DO, MPH, and Jacqueline A. Nicholas, MD, MPH