Using pharmacotherapy to address sleep disturbances in autism spectrum disorders

ABSTRACT

Introduction

Sleep disorders are the second most common medical comorbidity in autism spectrum disorder (ASD), with effects on daytime behavior and functioning, mood and anxiety, and autism core features. In children with ASD, insomnia also has a negative impact on the whole family's quality of life. Therefore, treatment of sleep disturbances should be considered as a primary goal in the management of ASD patients, and it is important to clarify the scientific evidence to inappropriate treatments.

Areas covered

The authors review the current literature concerning the pharmacological treatment options for the management of sleep-related disorders in patients with ASD (aged 0–18 years) using the PubMed and Cochrane Library databases with the search terms: autism, autistic, autism spectrum disorder, ASD, drug, drug therapy, drug intervention, drug treatment, pharmacotherapy, pharmacological treatment, pharmacological therapy, pharmacological intervention, sleep, sleep disturbance, and sleep disorder.

Expert opinion

Currently, clinicians tend to select medications for the treatment of sleep disorders in ASD based on the first-hand experience of psychiatrists and pediatricians as well as expert opinion. Nevertheless, at the present time, the only compound for which there is sufficient evidence is melatonin, although antihistamines, trazodone, clonidine, ramelteon, gabapentin, or suvorexant can also be considered for selection.

KEYWORDS:

• Autism
• children
• drugs
• melatonin
• neurodevelopmental disorders
• sleep disorders

Article highlights

• Sleep disorders are the second most common medical comorbidity in autism spectrum disorder (ASD).

• Poor sleep quality in children with ASD is linked to increased aggressiveness, irritability, rule-breaking behaviors, mood swings, anxiety, and attention problems. Insomnia also adversely affects the overall health and well-being of the entire family.

• To date, no consensus guidelines have been released regarding the pharmacological treatment of insomnia in children diagnosed with ASD.

• Treatment should always begin with the introduction of sleep hygiene rules, behavioral interventions, and cognitive-behavioral therapy (CBT) as the first-line treatment; subsequently, pharmacological approaches could be introduced.

• The only compound with sufficient evidence for use in sleep disorders in ASD is melatonin, especially the controlled-release form, providing beneficial effects on daytime externalizing and internalizing symptoms. However, antihistamines, trazodone, clonidine, and ramelteon can also be considered as alternative treatment options.

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

One referee declares that they have worked on the development of melatonin-based formulations for insomnia in both the elderly and in children with autism. Peer reviewers on this manuscript have no other relevant financial relationships or otherwise to disclose.

Additional information

Funding

This manuscript has not been funded.