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Reuters Health: New guideline targets sleep problems in youth with autism

By Marilynn Larkin

Bedtime resistance, sleep onset latency, sleep continuity and behavior problems tied to insufficient sleep are among the issues experienced by young people with autism that are addressed in a new American Academy of Neurology practice guideline.

As reported in Neurology, the main recommendations, with Level B evidence, focused on refusal to go to bed, stalling, or needing a parent or caregiver present until sleep occurs; trouble falling asleep and staying asleep; sleeping for only short periods of time or not getting enough total sleep each night; and daytime behavior problems associated with insufficient sleep at night. The guideline states that clinicians should:

- Assess for medications and coexisting conditions that could contribute to the sleep disturbance and address identified issues.

- 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.

- Offer pharmaceutical-grade melatonin, if available, if behavioral strategies have not been helpful and contributing coexisting conditions and use of concomitant medications have been addressed. Start with a low dose.

- Counsel children, adolescents, and parents regarding potential adverse effects of melatonin use and the lack of long-term safety data.

- 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 say that the study reported no serious adverse events with blanket use and that blankets could be a reasonable nonpharmacologic approach for some individuals.

Clinical psychologist Dr. Cy Nadler, Director of the Children's Mercy Kansas City Autism Clinic, commented in an email to Reuters Health, "Consistent with the recently updated autism guidelines from the American Academy of Pediatrics, this review emphasizes that sleep problems for youth with autism spectrum disorder don't occur in a vacuum."

"A child's co-occurring conditions and current medications need to be considered as potential contributing factors, and when it comes to treatment, behavioral strategies should be considered the first-line of defense," said Dr. Nadler, who was not involved in developing the guideline. "There is also good evidence that melatonin can be a helpful adjunct to behavioral approaches."

"Sleep-specific guidelines highlight how incredibly common sleep problems are for youth with autism, and the need for more rigorous studies investigating both behavioral and pharmacological approaches to intervention," he said.


Read the full article via M.D. alert

Learn more about the Autism Clinic at Children's Mercy Kansas City