Supplemental melatonin has shown promise in treating sleep onset insomnia in children with autism spectrum disorders (ASD). Twenty-four children, free of psychotropic medications, completed an open-label dose-escalation study to assess dose-response, tolerability, safety, feasibility of collecting actigraphy data, and ability of outcome measures to detect change during a 14-week intervention. Supplemental melatonin improved sleep latency, as measured by actigraphy, in most children at 1 or 3 mg dosages. It was effective in week 1 of treatment, maintained effects over several months, was well tolerated and safe, and showed improvement in sleep, behavior, and parenting stress. Our findings contribute to the growing literature on supplemental melatonin for insomnia in ASD and inform planning for a large randomized trial in this population.

Objectively measured poorer sleep was associated with worse physical function. Future research is needed to identify the underlying mechanisms for the association between poor sleep and functional decline.

This study provided sleep education to parents of children with autism spectrum disorder (ASD) to determine whether an individual or group format was more effective in improving sleep and aspects of daytime behavior and family functioning. Eighty children, ages 2-10 years, with ASD and sleep onset delay completed the study. Actigraphy and parent questionnaires were collected at baseline and one month after treatment. Mode of education did not affect outcomes. Sleep latency, insomnia subscales on the Children's Sleep Habits Questionnaire, and other outcomes related to child and family functioning improved with treatment. Parent-based sleep education, delivered in relatively few sessions, was associated with improved sleep onset delay in children with ASD. Group vs. individualized education did not affect outcome.

Sleep concerns are common in children with autism spectrum disorders (ASD). We identified objective sleep measures that differentiated ASD children with and without parental sleep concerns, and related parental concerns and objective measures to aspects of daytime behavior. ASD poor sleepers differed from ASD good sleepers on actigraphic (sleep latency, sleep efficiency, fragmentation) and polysomnographic (sleep latency) measures, and were reported to have more inattention, hyperactivity, and restricted/repetitive behaviors. Fragmentation was correlated with more restricted/repetitive behaviors. This work provides the foundation for focused studies of pathophysiology and targeted interventions to improve sleep in this population. KeywordsActigraphy; Polysomnography; Insomnia; Children's Sleep Habits Questionnaire; Child Behavior Checklist; Repetitive Behavior Scale Autism spectrum disorders (ASD) are disorders of neurodevelopment characterized by impaired social interaction and communication (American Psychiatric Association, 2000). The prevalence of these disorders is estimated at approximately 1 in 150 children (CDC, 2007). Sleep disorders are common associated conditions , with a prevalence estimated to range from 44-83% (Richdale, 1999;Couturier et al., 2005;Krakowiak et al., 2008). Sleep-onset insomnia and nocturnal awakenings are the most frequent and consistent findings (Richdale, 1999;Honomichl et al., 2002;Wiggs and Stores, 2004;Williams et al., 2004). A recent consensus statement identified the treatment of insomnia in ASD to be a high priority area (Mindell et al., 2006). Treating disordered sleep in ASD also represents a potential avenue to improve daytime behavior and family functioning in this population (Malow and McGrew, 2008).An essential component in planning interventional trials to improve sleep in children with ASD is to define objective measures of sleep that can be measured to document improvement with the intervention, and related to parent concerns. Objective measures used to define sleep concerns include polysomnography (PSG) and actigraphy. In our prior work, PSG differentiated children with ASD who had significant parental sleep concerns from those who did not (Malow et al., 2006). However, some children with ASD may not be able to tolerate Correspondence to: Suzanne E. Goldman, PhD. NIH Public Access Author ManuscriptDev Neuropsychol. Author manuscript; available in PMC 2010 September 27. NIH-PA Author ManuscriptNIH-PA Author Manuscript NIH-PA Author ManuscriptPSG, given the anxiety of "sleeping with wires" in a non-home environment, intolerance due to a given child's tactile sensitivities, or both. Furthermore, PSG is a costly methodology and the limited amount of information provided by a pediatric PSG study may not justify its large expense. Actigraphy, a modality that measures sleep and wake patterns based on limb movement, is less-intrusive and costly than PSG, and can be performed in a child's home setting. It is recognized as a useful adjunct in the evaluation of pat...

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Sleep problems of adolescents and older children with Autism Spectrum Disorder (ASD) were compared to toddlers and young children in 1,859 children. Sleep was measured with the Children's Sleep Habits Questionnaire. Total sleep problems were significant across all age groups, however the factors contributing to these problems differed. Adolescents and older children had more problems with delayed sleep onset, shorter sleep duration, and daytime sleepiness; while younger children had more bedtime resistance, sleep anxiety, parasomnias, and night wakings. The results suggest that sleep problems persist through adolescence in ASD with differences in types of problems experienced and emphasize the need for clinicians to address sleep behaviors not only in young children with ASD but throughout the age span.

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. Pediatrics 2012;130:S106-S124

Inflammatory markers, lifestyle, and health status explained mortality risk associated with short sleep, while the mortality risk associated with long sleep was explained predominantly by lifestyle and health status.