Chapter 10: Pharmacological Strategies to Promote Sleep in Children with ASD

Sleep disturbance is common in individuals who have autism spectrum disorders (ASD), with pharmacological therapy often a consideration, especially when behavioral measures are not successful. The cornerstone of treatment is to establish the cause of the sleep concern, which is often multifactorial, and to target therapies toward the underlying cause and any related co-occurring conditions. A suggested approach to using pharmacological therapy in ASD, along with a review of the available options, is presented in this chapter. A case-based approach is used to make clinically applicable points.

The recommendations in this chapter have been adapted and modified with reference to the available literature on consensus guidelines for insomnia in children (Mindell et al., 2006; Owens et al., 2005) and a review on the subject (Owens & Moturi, 2009). These guidelines were not specific to ASD but provided a general framework for approaching insomnia in children. In addition, a practice pathway for children with ASD (Malow et al., 2012), a review of medication use in ASD within a large patient registry (Malow et al., 2016), and two reviews of medications for children with neurodevelopmental disorders Blackmer & Feinstein, 2016; Bruni et al., 2018) have been published. It should be noted that children with ASD, as well as those with ADHD, were emphasized as a high priority population in the Mindell consensus article (Mindell et al., 2006). Although there are few controlled studies on pharmacologic treatment of sleep disruption in children with ASD, the relevant research studies supporting the guidelines are presented.