Chapter 5: Psychiatric Disorders and Medications Affecting Sleep

Children with autism spectrum disorder (ASD) often present with comorbid psychiatric symptoms. In fact, upwards of 60–80% of children with ASD have at least one comorbid disorder and approximately 40–50% have two or more comorbid conditions (de Bruin, Ferdinand, Meester, de Nijs, & Verheij, 2007; Simonoff et al., 2008; van Steensel, Bogels, & de Bruin, 2013). The rates of comorbidity are even higher in children with ASD referred to a psychiatry clinic (Joshi et al., 2010). In these studies, the most common comorbid conditions are social anxiety disorder, attention-deficit/hyperactivity disorder (ADHD), and oppositional defiant disorder (ODD).

Children and adolescents with psychiatric disorders often experience sleep disturbances most notably insomnia. In fact, the association is common enough to warrant insomnia being a core symptom for many psychiatric conditions experienced by youth including major depressive disorder, posttraumatic stress disorder, generalized anxiety disorder and separation anxiety disorder. Further, when a child with ASD, already at risk for suffering insomnia, develops a comorbid psychiatric disorder, the risk for a clinically significant sleep disturbance may increase substantially. In addition, pharmacological agents used to treat comorbid psychiatric disorders in children and adolescents with ASD may impact sleep either positively or negatively. This chapter provides an overview of sleep disorders associated with various psychiatric conditions frequently comorbid in children and adolescents with ASD and the impact of psychotropic medications on sleep.