NICE Clincal Guidance on Sleep in Children and Young People on the Autism Spectrum

The following is an extract from "Autism spectrum disorder in under 19s: support and management£. (2013). London: NICE.

Sleep in Children and Young People with Autism

If a child or young person with autism develops a sleep problem offer an assessment that identifies:

  • what the sleep problem is (for example, delay in falling asleep, frequent waking, unusual behaviours, breathing problems or sleepiness during the day)
  • day and night sleep patterns, and any change to those patterns
  • whether bedtime is regular
  • what the sleep environment is like, for example:
    • the level of background noise
    • use of a blackout blind
    • a television or computer in the bedroom
    • whether the child shares the room with someone
  • presence of comorbidities especially those that feature hyperactivity or other behavioural problems
  • levels of activity and exercise during the day
  • possible physical illness or discomfort (for example, reflux, ear or toothache, constipation or eczema)
  • effects of any medication
  • any other individual factors thought to enhance or disturb sleep, such as emotional relationships or problems at school
  • the impact of sleep and behavioural problems on parents or carers and other family members.

If the child or young person with autism snores loudly, chokes or appears to stop breathing while sleeping, refer to a specialist to check for obstructive sleep apnoea.

Develop a sleep plan (this will often be a specific sleep behavioural intervention) with the parents or carers to help address the identified sleep problems and to establish a regular night-time sleep pattern. Ask the parents or carers to record the child or young person's sleep and wakefulness throughout the day and night over a 2-week period. Use this information to modify the sleep plan if necessary and review the plan regularly until a regular sleep pattern is established.

Do not use a pharmacological intervention to aid sleep unless:

  • sleep problems persist despite following the sleep plan
  • sleep problems are having a negative impact on the child or young person and their family or carers.

If a pharmacological intervention is used to aid sleep it should:

  • only be used following consultation with a specialist paediatrician or psychiatrist with expertise in the management of autism or paediatric sleep medicine
  • be used in conjunction with non-pharmacological interventions
  • be regularly reviewed to evaluate the ongoing need for a pharmacological intervention and to ensure that the benefits continue to outweigh the side effects and risks.

If the sleep problems continue to impact on the child or young person or their parents or carers, consider:

  • referral to a paediatric sleep specialist, and
  • short breaks and other respite care for one night or more. Short breaks may need to be repeated regularly to ensure that parents or carers are adequately supported. Agree the frequency of breaks with them and record this in the care plan.

Do not use omega-3 fatty acids to manage sleep problems in children and young people with autism.

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23 Aug 2021