For some children and teens with autism spectrum disorder, sleep can sometimes be a struggle. But good sleep is essential to good health and a good quality of life.
“While up to 40 percent of all children and teens will have sleep problems at some point during childhood, such problems usually lessen with age,” says lead guideline author Ashura Williams Buckley, MD, of the National Institute of Mental Health and a member of American Academy of Neurology (AAN). “However, for children and teens with autism, sleep problems are more common and more likely to persist.”
To help families, neurologists and other healthcare providers make treatment decisions, the AAN has issued a new guideline based on careful review of available scientific studies to address four types of sleep problems: refusing to go to bed, stalling, or needing a parent or caregiver present until falling asleep; trouble falling asleep and staying asleep; sleeping for only short periods of time or not getting enough total sleep each night; as well as associated daytime behavior problems.
Published recently in Neurology, the medical journal of the AAN, the guideline is endorsed by the American Academy of Sleep Medicine, Autism Speaks, the Child Neurology Society, and the Society for Developmental and Behavioral Pediatrics. The American Epilepsy Society has affirmed its value to epileptologists.
Recommendations and insights from the new guideline include:
• There are many factors that may contribute to sleep challenges, including medicines, other health conditions, emotional disorders, and family and social factors. A knowledgeable clinician should do a thorough evaluation and address problems caused by medications or other medical conditions first.
• After other potential treatable causes of the sleep problems have been ruled out, children with autism spectrum disorder may benefit from behavioral treatments, such as setting up a consistent sleep routine with regular bedtimes and wake times, choosing a bedtime close to when the child usually gets sleepy, and prohibiting use of electronic devices close to bedtime.
“Behavior-modification strategies are a good place to start because they don’t cost anything, there are no side effects and they’ve been shown to work for some people,” says Dr. Williams Buckley.
• If behavioral strategies alone don’t work, healthcare providers should consider prescribing melatonin, a hormone that tells the brain when and how long to sleep. Look for “pharmaceutical grade,” and discuss with your practitioner, as some over-the-counter products may not be reliable in terms of how much melatonin they actually contain. Studies suggest that the artificial form of melatonin is safe and effective for children and teens with autism for a period of up to three months. However, more research is needed to determine safety over longer periods. Possible side effects include headache, dizziness, diarrhea and rash. Melatonin alone may be just as helpful in some patients as when combined with behavioral strategies. The guideline says that current studies that looked at behavior treatments combined with melatonin were not found to change daytime behavior problems or symptoms of autism.
• No evidence was found that routine use of weighted blankets or specialized mattress technologies improve sleep.