A practice pathway for the identification, evaluation, and management of insomnia in children and adolescents with autism spectrum disorders

Beth A. Malow, Kelly Byars, Kyle Johnson, Shelly Weiss, Pilar Bernal, Suzanne E. Goldman, Rebecca Panzer, Daniel L. Coury, Dan G. Glaze

Research output: Contribution to journalArticle

102 Scopus citations

Abstract

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.

Original languageEnglish (US)
Pages (from-to)S106-S124
JournalPediatrics
Volume130
Issue numberSUPPL. 2
DOIs
StatePublished - Nov 2012

Keywords

  • Actigraphy
  • Education
  • Sleep
  • Sleep latency

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health

Fingerprint Dive into the research topics of 'A practice pathway for the identification, evaluation, and management of insomnia in children and adolescents with autism spectrum disorders'. Together they form a unique fingerprint.

  • Cite this

    Malow, B. A., Byars, K., Johnson, K., Weiss, S., Bernal, P., Goldman, S. E., Panzer, R., Coury, D. L., & Glaze, D. G. (2012). A practice pathway for the identification, evaluation, and management of insomnia in children and adolescents with autism spectrum disorders. Pediatrics, 130(SUPPL. 2), S106-S124. https://doi.org/10.1542/peds.2012-0900I