The following practice guidelines were published by the American Academy of Neurology [18].
Recommendations on Addressing Co-Existing Medical Conditions and Concomitant Medications
Clinicians seeking to improve sleep in children and adolescents on the autism spectrum should:
• Perform an assessment for co-occurring conditions that could contribute to sleep disturbance.
• Review concomitant medications that could contribute to sleep disturbance.
• Ensure patients on the spectrum receive appropriate treatment for their coexisting condition, if they have a coexisting condition that is contributing to their sleep disturbance.
• Counsel parents or guardians regarding strategies for improved sleep habits, with non-pharmacologic strategies as a first-line treatment approach either alone or in combination with pharmacologic or nutraceutical approaches, depending on individual circumstances.
• Clinicians seeking to improve sleep in children and adolescents on the autism spectrum who have medications that could be contributing to sleep disturbance should address whether the potentially contributing medications can be stopped or adjusted.
Recommendations on the Use of Melatonin
Physicians should offer melatonin to children and adolescents on the autism spectrum if non-pharmacologic strategies have not been helpful and contributing co-occurring conditions and the use of concomitant medications have been addressed.
Physicians offering melatonin for sleep disturbance in children and adolescents on the spectrum should write a prescription for melatonin or recommend using a high-purity pharmaceutical grade of melatonin when available.
Physicians offering melatonin for sleep dysregulation in children and adolescents on the spectrum should start by initiating a low dose (1–3 mg/d), 30–60 minutes before bedtime and titrate to effect, not exceeding 10 mg/d.
Physicians offering melatonin for sleep disturbance in children and adolescents on the spectrum should counsel children and adolescents on the spectrum and their parents regarding potential adverse events of the use of melatonin and the lack of long-term safety data.
Recommendations on the Use of Complementary Alternative Medicine
Clinicians should counsel children and adolescents on the autism spectrum and their parents that there is currently no evidence to support the routine use of weighted blankets or specialized mattress technology for improving disrupted sleep.
Although evidence of efficacy is lacking, clinicians should counsel children and adolescents on the spectrum and their parents asking about weighted blankets, that the reviewed trial reported no serious adverse events with blanket use and that blankets could be a reasonable nonpharmacologic approach to try for some individuals.