Sleeplessness in children with neurodevelopmental disorders - Epidemiology and management

Sleeplessness, excessive waking and other disruptions of sleep are frequently evident in children with neurodevelopment disorders such as attention deficit hyperactivity disorder, specific genetic syndromes associated with mental retardation, autistic disorders and Tourette syndrome. The severity of sleep disruption may or may not parallel the severity of associated illness. Sleeplessness in this population is often additionally affected by concurrent medication use (such as central stimulants) and significant behavioural and environmental influences. When attempting to treat sleeplessness in children with neurodevelopmental disorders, the first step is to obtain an accurate sleep history documenting the child's typical sleep schedule. The child should be screened for the presence of other extrinsic causes of sleep problems such as obstructive sleep apnoea and periodic limb movement, and use of medications known to disrupt sleep. These issues should be addressed if present. Nonpharmacological approaches to treatment include implementation of good sleep hygiene and the use of behavioural programmes. Pharmacotherapy has not been extensively studied in children with neurodevelopmental disorders, although limited data suggest that melatonin, clonidine, guanfacine and hypnosedatives can be moderately effective.