Skip to main content

Sleep Disorders in Children and Adolescents with Autism Spectrum Disorder: Diagnosis, Epidemiology, and Management


Sleep problems are a common complaint in children/adolescents with autism spectrum disorder (ASD). Correctly diagnosing and treating sleep problems in individuals with ASD is key, as they can add to the psychosocial burden of the disorder and exacerbate associated symptoms, such as inattention or irritability. Here, we provide an overview of the epidemiology, diagnosis, and management of sleep problems/disorders in children and adolescents with ASD. This narrative review is mainly informed by a systematic search in PubMed and PsycInfo (last search: 10 October 2019) of available pertinent meta-analyses. We also searched for randomized controlled trials (RCTs) published after the search date of available meta-analyses. As for the epidemiology of sleep disorders in ASD, recent meta-analytic evidence shows a pooled prevalence of 13% (95% confidence interval [CI] 9–17) in the ASD population, compared with 3.7% in the general population. In terms of diagnosis of sleep disorders, it should be based on standardized criteria [e.g., the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) or third edition of the International Classification of Sleep Disorders (ICSD)]; clinicians should bear in mind that the communication difficulties presented by individuals with ASD may make the diagnostic process more challenging. Regarding the treatment, a meta-analysis of behavioral interventions, including only three RCTs, found significant effects in terms of increase in total sleep time (24.41 min, 95% CI 5.71–43.11, P = 0.01), decrease in sleep-onset latency (− 18.31 min, 95% CI − 30.84 to − 5.77, P = 0.004), and a significant effect on sleep efficiency (5.59, 95% CI 0.87–10.31, P = 0.02), albeit the risk of bias of the included studies was rated “high” in relation to issues with the blinding. The bulk of the evidence for the pharmacological treatment is for melatonin, with a meta-analysis of five double-blind RCTs showing a large effect size, favoring melatonin, in sleep duration (44 min compared with placebo, Hedge’s g 1.07 [95% CI 0.49–1.65]) and sleep-onset latency (39 min compared with placebo, Hedge’s g − 2.46 [95% CI − 1.96 to − 2.98]). We conclude that additional RCTs are desperately needed to support the management of sleep disorders in ASD with an evidence-based, precision medicine approach.

This is a preview of subscription content, access via your institution.


  1. Association AP. Diagnostic and statistical manual of mental disorders (5th ed.); 2013.

  2. (WHO) WHO. Autism spectrum disorders Fact Sheet. Updated 2017. Accessed 8 Feb 2020.

  3. Lord C, Elsabbagh M, Baird G, Veenstra-Vanderweele J. Autism spectrum disorder. Lancet. 2018;392(10146):508–20.

    Article  Google Scholar 

  4. Xue M, Brimacombe M, Chaaban J, Zimmerman-Bier B, Wagner GC. Autism spectrum disorders: concurrent clinical disorders. J Child Neurol. 2008;23(1):6–13.

    Article  Google Scholar 

  5. Medicine AAoS. International classification of sleep disorders; 2014.

  6. Lai M-C, Kassee C, Besney R, Bonato S, Hull L, Mandy W, et al. Prevalence of co-occurring mental health diagnoses in the autism population: a systematic review and meta-analysis. Lancet Psychiatry; 2019.

  7. Souders MC, Zavodny S, Eriksen W, Sinko R, Connell J, Kerns C, et al. Sleep in children with autism spectrum disorder. Curr Psychiatry Rep. 2017;19(6):34.

    Article  Google Scholar 

  8. Cummings JR, Lynch FL, Rust KC, Coleman KJ, Madden JM, Owen-Smith AA, et al. Health services utilization among children with and without autism spectrum disorders. J Autism Dev Disord. 2016;46(3):910–20.

    Article  Google Scholar 

  9. Elrod MG, Nylund CM, Susi AL, Gorman GH, Hisle-Gorman E, Rogers DJ, et al. Prevalence of diagnosed sleep disorders and related diagnostic and surgical procedures in children with autism spectrum disorders. J Dev Behav Pediatr. 2016;37(5):377–84.

    Article  Google Scholar 

  10. Hansen RL, Blum NJ, Gaham A, Shults J. Diagnosis of autism spectrum disorder by developmental-behavioral pediatricians in academic centers: a DBPNet study. Pediatrics. 2016;137(Suppl 2):S79–89.

    Article  Google Scholar 

  11. Houghton R, Liu C, Bolognani F. Psychiatric comorbidities and psychotropic medication use in autism: a matched cohort study with ADHD and general population comparator groups in the United Kingdom. Autism Res. 2018;11(12):1690–700.

    Article  Google Scholar 

  12. Houghton R, Ong RC, Bolognani F. Psychiatric comorbidities and use of psychotropic medications in people with autism spectrum disorder in the United States. Autism Res. 2017;10(12):2037–47.

    Article  Google Scholar 

  13. Logan SL, Carpenter L, Leslie RS, Hunt KS, Garrett-Mayer E, Charles J, et al. Rates and predictors of adherence to psychotropic medications in children with autism spectrum disorders. J Autism Dev Disord. 2014;44(11):2931–48.

    Article  Google Scholar 

  14. Meguid NA, Nashaat NH, Hashem HS, Khalil MM. Frequency of risk factors and coexisting abnormalities in a population of Egyptian children with autism spectrum disorder. Asian J Psychiatry. 2018;32:54–8.

    Article  Google Scholar 

  15. Neumeyer AM, Anixt J, Chan J, Perrin JM, Murray D, Coury DL, et al. Identifying associations among co-occurring medical conditions in children with autism spectrum disorders. Acad Pediatr. 2019;19(3):300–6.

    Article  Google Scholar 

  16. Díaz-Román A, Zhang J, Delorme R, Beggiato A, Cortese S. Sleep in youth with autism spectrum disorders: systematic review and meta-analysis of subjective and objective studies. Evid Based Ment Health. 2018;21(4):146–54.

    Article  Google Scholar 

  17. Keogh S, Bridle C, Siriwardena NA, Nadkarni A, Laparidou D, Durrant SJ, et al. Effectiveness of non-pharmacological interventions for insomnia in children with autism spectrum disorder: a systematic review and meta-analysis. PLoS One. 2019;14(8):e0221428.

    CAS  Article  Google Scholar 

  18. Adkins KW, Molloy C, Weiss SK, Reynolds A, Goldman SE, Burnette C, et al. Effects of a standardized pamphlet on insomnia in children with autism spectrum disorders. Pediatrics. 2012;130(Suppl 2):S139–44.

    Article  Google Scholar 

  19. Cortesi F, Giannotti F, Sebastiani T, Panunzi S, Valente D. Controlled-release melatonin, singly and combined with cognitive behavioural therapy, for persistent insomnia in children with autism spectrum disorders: a randomized placebo-controlled trial. J Sleep Res. 2012;21(6):700–9.

    Article  Google Scholar 

  20. Papadopoulos N, Sciberras E, Hiscock H, Mulraney M, McGillivray J, Rinehart N. The efficacy of a brief behavioral sleep intervention in school-aged children with ADHD and comorbid autism spectrum disorder. J Atten Disord. 2019;23(4):341–50.

    Article  Google Scholar 

  21. Meltzer LJ, Mindell JA. Systematic review and meta-analysis of behavioral interventions for pediatric insomnia. J Pediatr Psychol. 2014;39(8):932–48.

    Article  Google Scholar 

  22. Wachob D, Lorenzi DG. Brief Report: influence of physical activity on sleep quality in children with autism. J Autism Dev Disord. 2015;45(8):2641–6.

    Article  Google Scholar 

  23. Brand S, Jossen S, Holsboer-Trachsler E, Puhse U, Gerber M. Impact of aerobic exercise on sleep and motor skills in children with autism spectrum disorders—a pilot study. Neuropsychiatr Dis Treat. 2015;11:1911–20.

    Article  Google Scholar 

  24. Comments on: Behavioral teratogenic effect of methylmercury and d-amphetamine: meta-analysis and power analysis of data from the Collaborative Behavioral Teratology Study of National Center for Toxicological Research. Teratology. 1990;41(6):743–55.

  25. Ayyash HF, Preece P, Morton R, Cortese S. Melatonin for sleep disturbance in children with neurodevelopmental disorders: prospective observational naturalistic study. Expert Rev Neurother. 2015;15(6):711–7.

    CAS  Article  Google Scholar 

  26. Malow BA, Findling RL, Schroder CM, Maras A, Breddy J, Nir T, et al. Sleep, growth, and puberty after two years of prolonged-release melatonin in children with autism spectrum disorder. J Am Acad Child Adolesc Psychiatry. 2020.

  27. Rossignol DA, Frye RE. Melatonin in autism spectrum disorders: a systematic review and meta-analysis. Dev Med Child Neurol. 2011;53(9):783–92.

    Article  Google Scholar 

  28. Cuomo BM, Vaz S, Lee EAL, Thompson C, Rogerson JM, Falkmer T. Effectiveness of sleep-based interventions for children with autism spectrum disorder: a meta-synthesis. Pharmacotherapy. 2017;37(5):555–78.

    Article  Google Scholar 

  29. Gringras P, Nir T, Breddy J, Frydman-Marom A, Findling RL. Efficacy and safety of pediatric prolonged-release melatonin for insomnia in children with autism spectrum disorder. J Am Acad Child Adolesc Psychiatry. 2017;56(11):948–57.e4.

    Article  Google Scholar 

  30. Mehrazad-Saber Z, Kheirouri S, Noorazar SG. Effects of l-carnosine supplementation on sleep disorders and disease severity in autistic children: a randomized, controlled clinical trial. Basic Clin Pharmacol Toxicol. 2018;123(1):72–7.

    CAS  Article  Google Scholar 

  31. Maras A, Schroder CM, Malow BA, Findling RL, Breddy J, Nir T, et al. Long-term efficacy and safety of pediatric prolonged-release melatonin for insomnia in children with autism spectrum disorder. J Child Adolesc Psychopharmacol. 2018.

  32. Excellence NIfHaC. Autism spectrum disorder in under 19s: support and management, Clinical guideline [CG170]. Accessed 8 Feb 2020.

  33. Malow BA, Byars K, Johnson K, Weiss S, Bernal P, Goldman SE, et al. A practice pathway for the identification, evaluation, and management of insomnia in children and adolescents with autism spectrum disorders. Pediatrics. 2012;130(Suppl 2):S106–24.

    Article  Google Scholar 

  34. Bruni O, Angriman M, Calisti F, Comandini A, Esposito G, Cortese S, et al. Practitioner review: Treatment of chronic insomnia in children and adolescents with neurodevelopmental disabilities. J Child Psychol Psychiatry. 2018;59(5):489–508.

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations


Corresponding author

Correspondence to Samuele Cortese.

Ethics declarations


No funding was provided for this article.

Conflict of interest

Samuele Cortese declares reimbursement for travel and accommodation expenses from the Association for Child and Adolescent Central Health (ACAMH) in relation to lectures delivered for ACAMH, Canadian AADHD Alliance Resource (CADDRA), British Association of Psychopharmacology (BAP), and from Healthcare Convention for educational activity on ADHD. Fang Wang has nothing to disclose. Marco Angriman has nothing to disclose. Gabriele Masi has served on the advisory boards of Eli Lilly and Company, Shire, and Angelini. He has furthermore received research grants from Eli Lilly, Shire, and Lundbeck, and has been a speaker for Eli Lilly, Shire, Lundbeck, FB Health, and Otsuka. Oliviero Bruni has served as a consultant and provided expert testimony for both Angelini and Farmaceutici S.p.A.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Cortese, S., Wang, F., Angriman, M. et al. Sleep Disorders in Children and Adolescents with Autism Spectrum Disorder: Diagnosis, Epidemiology, and Management. CNS Drugs 34, 415–423 (2020).

Download citation

  • Published:

  • Issue Date:

  • DOI: