Managing insomnia in children with autism spectrum disorder

INTRODUCTION Autism Spectrum Disorder (ASD) is a neurodevelopmental disorder that often presents before the child enters the educational system and is characterized by developmental deficits with impairments in three main areas [1] personal, [2] social, and [3] academic or occupational functioning. The neurodevelopmental disorders represent a group of conditions with an onset early in the developmental period. Sleep disorders are commonly reported by parents of children with an ASD diagnosis with between 50% to 80% of parents reporting sleep problems with their children. Problems can be categorized into dyssomnias (problems falling and/or remaining asleep) and parasomnias (abnormal and/or unnatural movements, behaviors, emotions, perceptions, and dreams).

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). 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. 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. 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.

Advances in clinical and molecular understanding of the FMR1 premutation and fragile X-associated tremor/ataxia syndrome

In utero beta 2 adrenergic agonist exposure and adverse neurophysiologic and behavioral outcomes

Inherited and De Novo Genetic Risk for Autism Impacts Shared Networks.

Over a half of all proteins are glycosylated, and their proper glycosylation is essential for normal function. Unfortunately, because of structural complexity of nonlinear branched glycans and the absence of genetic template for their synthesis, the knowledge about glycans is lagging significantly behind the knowledge about proteins or DNA. Using a recently developed quantitative high throughput glycan analysis method we quantified components of the plasma N-glycome in 99 children with attention-deficit hyperactivity disorder (ADHD), 81 child and 5 adults with autism spectrum disorder, and a total of 340 matching healthy controls. No changes in plasma glycome were found to associate with autism spectrum disorder, but several highly significant associations were observed with ADHD. Further structural analysis of plasma glycans revealed that ADHD is associated with increased antennary fucosylation of biantennary glycans and decreased levels of some complex glycans with three or four antennas. The design of this study prevented any functional conclusions about the observed associations, but specific differences in glycosylation appears to be strongly associated with ADHD and warrants further studies in this direction.

Practice Parameter for the Assessment and Treatment of Children and Adolescents With Autism Spectrum Disorder

Copy number variation is now recognized as an important class of risk factor for several child psychiatric disorders. In this article, we first explain what copy number variants (CNVs) are. We then consider key findings and what these have told us about the etiology of these conditions. Finally, we discuss whether these findings can yet translate into clinical practice.

To formulate a rational approach to the pharmacologic treatment of pediatric insomnia, and to develop clinical guidelines regarding indications, target populations, and parameters for the use of these medications, especially by community-based pediatricians. A multidisciplinary task force developed under the auspices of the American Academy of Sleep Medicine, which included experts in pediatric sleep medicine, psychiatry, pharmacology, neurology, and general pediatrics. Review of existing data regarding current use of over-the-counter and prescription medications for pediatric insomnia in the primary care practice setting, and of empirical data on the pharmacology, safety, efficacy, and tolerability of medications commonly used for the treatment of pediatric insomnia. Group consensus definition of pediatric insomnia and clinical guidelines; working group recommendations regarding special populations and future directions. Use of medications for pediatric insomnia should be diagnostically driven, and should be implemented in conjunction with empirically-based behavioral treatment strategies and adequate sleep hygiene. Specific target populations include children with neurodevelopmental disorders, pervasive developmental disorders, chronic medical conditions, and psychiatric disorders. Additional research, including clinical trials, is critically needed to provide an evidence-based approach to the use of these medications in clinical practice.

Feeding difficulties and their treatment strategies in children with autism spectrum disorder

Background: Autism Spectrum Disorder (ASD) includes neurodevelopmental problems throughout life that affect all areas of child development such as abnormal and impaired social interaction, problems in communication, restricted interest, repetitive and stereotypical behaviors. Sleep problems are most commonly complained by parents of children suffering from ASD. About 20-30% of children less than 5 years with normal development give complaints of sleep problems mainly of bedtime resistance, sleep onset delay and night awakening. Less commonly reported sleep disturbance by parents is nightmares or night terrors repetitive and stereotypical behavior. Less frequently reported complain is of breathing sleep disorder. It has already been proved by many studies that ASD children have more complaints about sleep problems than in normal children. But the data of children with ASD having sleep problems in the Indian population is less, so with our study we want to know the prevalence of ASD children with sleep problems in children of the hilly area of Uttarakhand. Objective: The study aims to know the different problems related to sleep faced by children suffering from ASD ( Age range from 4 to 10 years ) with autistic spectrum disorders using the Children’s Sleep Habit Questionnaire (Preschool and school-age, abbreviated version). Subjects and Method s: All patients of ASD presenting to the Psychiatry and Pediatric Outpatient department of Government Medical College and Susheela Tiwari trust Hospital, Haldwani, Uttarakhand from in February 2019 to January 2020. It’s a cross-sectional study of children with different problems related to sleep faced by children suffering from ASD ( Age range from 4 to 10 years ) with autistic spectrum disorders using the Children’s Sleep Habit Questionnaire (CSHQ) (Preschool and school-age, abbreviated version). Results: Demographic and clinical characteristics: The sample consisted of 30 children of ASD with sleep problems ( Mean Age 8.06 years, SD 3.25, Male 21 and Female 9 Children) age range from 4 Years to 10 Years and is compare from 30 normal children (mean age 9.06 Years, SD 3.15, Male 21 and Female 9) for the control group. Both groups were analysed using CSHQ tools. There were no statistically significant differences in age and gender (P value more than 0.05). About 60% (n=18) of the children suffering from ASD had an intellectual disability and 40% (n=12) children with ASD had normal Intellectual. Comparison of Total CSHQ score, bedtime resistance and sleep anxiety showed a statistically significant difference in children suffering from ASD with sleep disorder when compared from normal children. Using CSHQ tools sleep onset delay, night waking, day time sleepiness, parasomnias and sleep –disorder breathing does not show any statistical difference between children with ASD and normal children used as Control. Conclusion: This study compared sleep problems between children with ASD and typically developing children (4-10 Years of age) and examined associated factors of sleep problems in ASD from a different point of view.

Genome-wide Transcriptome Profiling Reveals the Functional Impact of Rare De Novo and Recurrent CNVs in Autism Spectrum Disorders

BackgroundSleep disturbances are highly prevalent across neurological and neurodevelopmental disorders (NDDs) and often exacerbate core symptoms, impair daytime functioning, and increase caregiver burden. Despite frequent clinical use of behavioral and educational strategies, the evidence base for non-pharmacological sleep interventions in this population remains scarce.Data sourceThis narrative review aimed to analyze behavioral interventions that can be used for sleep problems in children and adolescents with NDDs, and synthesizes data from recent studies that examined those non-pharmacological interventions in epilepsy, autism spectrum disorder (ASD), attention-deficit/hyperactivity disorder (ADHD), cerebral palsy (CP), and rare genetic neurodevelopmental conditions (RGNCs).ResultsAcross NDDs, insomnia symptoms are highly prevalent, with circadian disturbances and sleep-disordered breathing also common in some groups. Behavioral and parent-led interventions—including psychoeducation, sleep hygiene, structured routines, and extinction-based strategies—consistently improve parent-reported sleep and often enhance daytime behavior, though objective sleep gains are smaller. In epilepsy and ASD, tailored behavioral–educational programmes are both effective and acceptable. In ADHD, behavioral sleep interventions and melatonin improve sleep, with behavioral approaches also yielding modest reductions in ADHD symptoms. Evidence for CP and RGNCs is limited but supports individualized, multimodal management targeting both behavioral and physiological contributors, while syndrome-specific chronobiological treatments offer only partial benefit.ConclusionsBehavioral and educational sleep interventions are generally safe, acceptable, and clinically useful across NDDs, particularly when embedded in multidisciplinary, condition-informed care. However, their efficacy is constrained by small, heterogeneous trials and non-standardized outcome measures. Robust, syndrome-specific randomized studies with harmonized sleep and daytime outcomes are urgently needed to guide evidence-based practice.

Gluten-Free Diet: Imprudent Dietary Advice for the General Population?

Sleep problems are common in children with autism spectrum disorder (ASD). This meta-synthesis collated eight previously published systematic reviews examining the efficacy of sleep interventions in children with ASD in an attempt to present a clear analysis of trialed interventions. The collated reviews consider five major groups of sleep interventions for children with ASD: melatonin therapy, pharmacologic treatments other than melatonin, behavioral interventions, parent education/education programs, and alternative therapies (massage therapy, aromatherapy, and multivitamin and iron supplementation). These eight reviews were based on 38 original studies and address the efficacy of interventions across 17 sleep problem domains. The results of this meta-synthesis suggest that no single intervention is effective across all sleep problems in children with ASD. However, melatonin, behavioral interventions, and parent education/education program interventions appear the most effective at ameliorating multiple domains of sleep problems compared with other interventions. Due to the heterogeneous causative factors and presentations of disordered sleep, further research into the effectiveness of sleep interventions may target specific phenotypic subgroups rather than a broad analysis across the general ASD population. Similarly, future research needs to consider the efficacy of different polytherapeutic approaches in order to provide clinicians with evidence to inform best practice. In the meantime, this review supports clinicians' decision making for a majority of the identified sleep problems in the ASD population.