Ashura Williams Buckley1, Deborah Hirtz1, Maryam Oskoui1, Melissa J Armstrong1, Anshu Batra1, Carolyn Bridgemohan1, Daniel Coury1, Geraldine Dawson1, Diane Donley1, Robert L Findling1, Thomas Gaughan1, David Gloss1, Gary Gronseth1, Riley Kessler1, Shannon Merillat1, David Michelson1, Judith Owens1, Tamara Pringsheim1, Linmarie Sikich1, Aubyn Stahmer1, Audrey Thurm1, Roberto Tuchman1, Zachary Warren1, Amy Wetherby1, Max Wiznitzer1, Stephen Ashwal1. 1. From the Pediatrics and Developmental Neuroscience Branch (A.W.B., T.G., R.K., A.T.), National Institute of Mental Health, NIH, Bethesda, MD; Department of Neurological Sciences (D.H.), University of Vermont Medical Center, Burlington; Department of Pediatric Neurology (M.O.), McGill University Health Centre, Montréal, Canada; Department of Neurology (M.J.A.), University of Florida College of Medicine, Gainesville; Developmental Pediatrics (A.B.), Our Special Kids Pediatric Care, Los Angeles, CA; Division of Developmental Medicine (C.B.) and Center for Pediatric Sleep Disorders (J.O.), Boston Children's Hospital, MA; Departments of Pediatrics and Psychiatry (D.C.), The Ohio State University College of Medicine, Columbus; Duke Center for Autism and Brain Development (G.D., L.S.), Duke University School of Medicine, Durham, NC; Northern Michigan Neurology (D.D.), Traverse City; Department of Child and Behavioral Sciences (R.L.F.), Johns Hopkins University, Baltimore, MD; Department of Neurology (D.G.), Charleston Area Medical Center, WV; Department of Neurology (G.G.), Kansas University Medical Center, Kansas City; American Academy of Neurology (S.M.), Minneapolis, MN; Division of Pediatric Neurology, Department of Pediatrics (D.M., S.A.), Loma Linda University School of Medicine, CA; Department of Clinical Neurosciences (T.P.), University of Calgary, Alberta, Canada; Department of Psychiatry and Behavioral Science and MIND Institute (A.S.), University of California, Davis; Division of Neurology (R.T.), Nicklaus Children's Hospital and Miami Children's Hospital, FL; Treatment and Research Institute for Autism Spectrum Disorders (Z.W.), Vanderbilt Kennedy Center, Nashville, TN; Autism Institute, College of Medicine (A.W.), Florida State University, Tallahassee; and Division of Neurology (M.W.), Rainbow Babies & Children's Hospital, Cleveland, OH.
Abstract
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.
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.
Authors: Thomas W Frazier; Jyoti Krishna; Eric Klingemier; Mary Beukemann; Rawan Nawabit; Sally Ibrahim Journal: J Clin Sleep Med Date: 2017-01-15 Impact factor: 4.062
Authors: Michel Hoebert; Kristiaan B van der Heijden; Ingeborg M van Geijlswijk; Marcel G Smits Journal: J Pineal Res Date: 2009-05-27 Impact factor: 13.007
Authors: Karen W Adkins; Cindy Molloy; Shelly K Weiss; Ann Reynolds; Suzanne E Goldman; Courtney Burnette; Traci Clemons; Diane Fawkes; Beth A Malow Journal: Pediatrics Date: 2012-11 Impact factor: 7.124
Authors: Carol L Rosen; R Nisha Aurora; Vishesh K Kapur; Alberto R Ramos; James A Rowley; Matthew M Troester; Rochelle S Zak Journal: J Clin Sleep Med Date: 2020-06-15 Impact factor: 4.062
Authors: Lydia L MacDonald; Laura Gray; Whitney Loring; Amanda Wyatt; Kemberlee Bonnet; David Schlund; Mary Landis Gaston; Beth A Malow Journal: Res Autism Spectr Disord Date: 2021-01-11
Authors: Lisa D Wiggins; Cy Nadler; Steven Rosenberg; Eric Moody; Nuri Reyes; Ann Reynolds; Aimee Alexander; Julie Daniels; Kathleen Thomas; Ellen Giarelli; Susan E Levy Journal: J Pediatr Date: 2021-01-22 Impact factor: 6.314