A practice pathway for the identification, evaluation, and management of insomnia in children and adolescents with autism spectrum disorders.
Study Goal
The researchers aimed to evaluate the effectiveness of melatonin as a treatment for insomnia in children and adolescents with autism spectrum disorders (ASDs).
Results Summary
The study found that melatonin trials show promise for treating insomnia in children with ASD, though evidence is limited, highlighting the need for further research. Behavioral/educational interventions were recommended as first-line approaches, with pharmacologic therapy considered in certain situations.
Population
Children and adolescents with autism spectrum disorders (ASDs).
Effective Dosage
Not specified
Duration
Not specified
Interactions
None mentioned
| Intervention | Direction | Endpoint | Population | Dosage | Impact | Claim # |
|---|---|---|---|---|---|---|
behavioral/educational interventions | decrease | insomnia | children who have ASD | - | show promise | #1 |
melatonin trials | decrease | insomnia | children who have ASD | - | show promise | #2 |
parent education in the use of behavioral approaches | neutral | therapeutic interventions | children who have ASD | - | should begin with | #3 |
pharmacologic therapy | decrease | insomnia | children who have ASD | - | may be indicated | #4 |
follow-up after any intervention | neutral | effectiveness and tolerance of the therapy | children who have ASD | - | should be | #5 |
insomnia practice pathway | neutral | identify and manage insomnia symptoms | children and adolescents who have ASD | - | may help | #6 |
insomnia practice pathway | neutral | a framework to evaluate the impact of contributing factors on insomnia | children and adolescents who have ASD | - | may provide | #7 |
insomnia practice pathway | neutral | a framework to test the effectiveness of nonpharmacologic and pharmacologic treatment strategies | children and adolescents who have ASD | - | may provide | #8 |
OBJECTIVE: This report describes the development of a practice pathway for the identification, evaluation, and management of insomnia in children and adolescents who have autism spectrum disorders (ASDs). METHODS: The Sleep Committee of the Autism Treatment Network (ATN) developed a practice pathway, based on expert consensus, to capture best practices for an overarching approach to insomnia by a general pediatrician, primary care provider, or autism medical specialist, including identification, evaluation, and management. A field test at 4 ATN sites was used to evaluate the pathway. In addition, a systematic literature review and grading of evidence provided data regarding treatments of insomnia in children who have neurodevelopmental disabilities. RESULTS: The literature review revealed that current treatments for insomnia in children who have ASD show promise for behavioral/educational interventions and melatonin trials. However, there is a paucity of evidence, supporting the need for additional research. Consensus among the ATN sleep medicine committee experts included: (1) all children who have ASD should be screened for insomnia; (2) screening should be done for potential contributing factors, including other medical problems; (3) the need for therapeutic intervention should be determined; (4) therapeutic interventions should begin with parent education in the use of behavioral approaches as a first-line approach; (5) pharmacologic therapy may be indicated in certain situations; and (6) there should be follow-up after any intervention to evaluate effectiveness and tolerance of the therapy. Field testing of the practice pathway by autism medical specialists allowed for refinement of the practice pathway. CONCLUSIONS: The insomnia practice pathway may help health care providers to identify and manage insomnia symptoms in children and adolescents who have ASD. It may also provide a framework to evaluate the impact of contributing factors on insomnia and to test the effectiveness of nonpharmacologic and pharmacologic treatment strategies for the nighttime symptoms and daytime functioning and quality of life in ASD.