Sleep Disorders in Children with Autism

Sleep disorders are far more common in children with autism spectrum disorders (ASDs) than in typically developing children and may have a significant impact upon both child and family functioning. Children with ASDs who sleep well show fewer behavioral problems and better social interactions than those who are poor sleepers. In addition, sleep problems correlate with family stress and may affect daytime functioning. Sleep-related behavioral problems and poor sleep hygiene are responsible for the majority of sleep disorders in children on the autism spectrum. Potential medical causes of disordered sleep should be considered and treated appropriately. Medical problems that may contribute to sleep difficulties include but are not limited to sleep apnea, gastroesophageal reflux, abdominal pain related to constipation, asthma, and restless leg syndrome. [Johnson: 2008]
A detailed sleep history should be obtained, including bedtime routine, onset and duration of sleep, nighttime wakenings, snoring, restlessness, and sleep hygiene. [Jan: 2008]
An example screening checklist developed by the Autism Treatment Network for Medical Comorbidities Associated with Sleep Problems is available for review. [Reynolds: 2011]
Individuals on the autism spectrum have been shown to have abnormalities in the regulation of melatonin. The use of melatonin at bedtime has been shown to improve sleep latency, sleep duration, and subsequent improved daytime behaviors. [Rossignol: 2011] For children age 2-6 years, begin at 0.5-1 mg and adjust upward to 3 mg as needed. Children older than 6 years of age may respond to doses as low as 1 mg; adjust upward to 5 mg as needed. Melatonin, particularly at the higher end of the dosage range, has an immediate hypnotic effect allowing parents to gauge effectiveness after the first few doses. Adverse effects are rare and include vivid dreams and nightmares. Families should be informed that melatonin is considered a supplement and is therefore not regulated by the US Food and Drug Administration. [Andersen: 2008]
Low iron stores have been associated with periodic limb movement disorder/restless leg syndrome. In children with restless sleep, consider obtaining a CBC and serum ferritin. Supplementation with iron to replenish iron stores has had positive effect in individuals with restless sleep and low or low-normal serum ferritin levels. Supplementation with 1-3 mg/kg elemental iron per day in one to three divided doses is recommended; iron may be discontinued after 2-3 months if serum ferritin has normalized. [Dosman: 2007]
The alpha-2 agonist clonidine has shown effectiveness in improving sleep latency and nighttime wakenings. The half life of this medication is variable and it may cause daytime sedation and irritability. In addition, alpha-2 agonists may cause hypotension, bradycardia, and EKG changes. Obtaining an EKG should be considered if an alpha-2 agonist is to be added to a stimulant medication. For children ages 3-5, begin with a dose of .025-.05 mg (1/4 to 1/2 of a 0.1 mg tablet) 30-60 minutes before bedtime. The dose may be adjusted upward to a maximal dose of 0.2 mg. For children 6 years and older, begin with 0.1 mg and adjust upward to a maximal dose of 0.2 mg. When it is discontinued, this medication should be tapered over 1 week to avoid rebound hypertension. [Ming: 2008]
Consider referral to a pediatric sleep medicine specialist if questions remain regarding the nature of the sleep disorder. A sleep study may help identify disorders such as obstructive sleep apnea and periodic limb movement disorder.
Other classes of medications such as antidepressants, antipsychotics, and anticonvulsants have been used successfully in the management of sleep disorders. These medications have not, however, been well studied in the pediatric population and should be prescribed by or in consultation with a physician experienced in their use.


Information & Support

For Parents and Patients

Strategies to Improve Sleep in Children with Autism Spectrum Disorders (PDF Document 2.6 MB)
A free parents' guide of Strategies to Improve Sleep in Children with Autism Spectrum Disorders is available for download from the Autism Treatment Network.


Pediatric Sleep Medicine

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Sleep Studies/Polysomnography

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Authors: Tara Buck, MD - 8/2012
Catherine Jolma, MD - 8/2009
Content Last Updated: 8/2012

Page Bibliography

Andersen IM, Kaczmarska J, McGrew SG, Malow BA.
Melatonin for insomnia in children with autism spectrum disorders.
J Child Neurol. 2008;23(5):482-5. PubMed abstract

Dosman CF, Brian JA, Drmic IE, Senthilselvan A, Harford MM, Smith RW, Sharieff W, Zlotkin SH, Moldofsky H, Roberts SW.
Children with autism: effect of iron supplementation on sleep and ferritin.
Pediatr Neurol. 2007;36(3):152-8. PubMed abstract

Jan JE, Owens JA, Weiss MD, Johnson KP, Wasdell MB, Freeman RD, Ipsiroglu OS.
Sleep hygiene for children with neurodevelopmental disabilities.
Pediatrics. 2008;122(6):1343-50. PubMed abstract

Johnson KP, Malow BA.
Sleep in children with autism spectrum disorders.
Curr Treat Options Neurol. 2008;10(5):350-9. PubMed abstract

Ming X, Gordon E, Kang N, Wagner GC.
Use of clonidine in children with autism spectrum disorders.
Brain Dev. 2008;30(7):454-60. PubMed abstract

Reynolds AM, Malow BA.
Sleep and autism spectrum disorders.
Pediatr Clin North Am. 2011;58(3):685-98. PubMed abstract
Sleep disorders are common in children with autism spectrum disorders. Identifying and treating sleep disorders may result not only in more consolidated sleep, more rapid time to fall asleep, and avoidance of night waking but also favorably affect daytime behavior and parental stress.

Rossignol DA, Frye RE.
Melatonin in autism spectrum disorders: a systematic review and meta-analysis.
Dev Med Child Neurol. 2011;53(9):783-92. PubMed abstract / Full Text
Melatonin administration in ASD is associated with improved sleep parameters, better daytime behavior, and minimal side effects.