Pediatric neurologist and sleep expert Dr. Amy Licis shares available methods to consider when treating a pediatric patient with sleep issues or sleep disorders accompanied by autism or ADHD.
In an interview with HCPLive, Amy Licis, MD, MSCI, Associate Professor, Pediatric Neurology and Sleep Medicine, Washington University Department of Neurology, spoke about the significance of addressing sleep dysfunction in children with autism or ADHD and the different treatment options available.
"Over time the sleep issues can improve so, I think seeking care is helpful," Licis said. "And I think our awareness should be raised that referring to a pediatric sleep specialist, or a pediatric psychologist, is indicated that it can absolutely help the children get better sleep with time."
Both pyschiatric disorders are increasing in prevalence and sleep issues are prominent among children with these diagnoses. So, treating children with autism or ADHD is something pediatric sleep specialists encounter often, according to Licis.
There are psychological programs and resources that are supported by data and can help children with autism or ADHD to not only improve their sleep hygiene but can also address other obstacles that come with the disorders.
"There's strong evidence for trials of cognitive behavioral therapy (CBT) for insomnia," Licis said. "So, if a child is able to see a pediatric sleep psychologist who's experienced in working with children with autism or ADHD, it's a very valuable resource."
A specialist in this field not only has a vast amount of experience with these patients but will also be familiar with the data. There's been significant progress made over the last few years of research, but Licis explained that some methods of treatment are backed by more data than others, and seeing a pediatric sleep psychologist is the most effective way to find a solution.
A specialist may not be accessible to everyone, Licis acknowledged, but even when a provider is able to educate parents, or share educational resources to parents, research has supported this as an effective method to improving a child's quality of sleep.
"Having parents undergo sleep education has been shown to be helpful," she explained. "So, just things like emphasizing a regular wakeup time, morning light exposure, good light and good activities during the day, regular bedtimes and wind down times. Then, ideally having electronic free time at least an hour before bedtime–all those processes can be helpful for better quality sleep and parent education has been shown to play a role."
There's some evidence that melatonin is helpful in these populations and can be obtained over the counter, making it a more accessible form of treatment. Although it's generally well-tolerated, melatonin can be associated with some side effects like sleepiness or headaches, and Licis cautioned that there can be inconsistencies in melatonin content across different brands.
"Parents can be advised to look for a pharmaceutical grade, or at least with the US Pharmacopoeia verified label," she said. "But think a family friendly way to at least have some degree of quality control is to refer them also to some testing websites."
There are some companies that undergo supplement testing, but their information isn't independently verified, according to Licis. Melatonin can also be prescribed to patients to ensure consistency and provide a specific regimen.
There's limited data regarding hypnotic usage for sleep in these pediatric populations, but Licis said there is some case level report data that support using hynotics like ramelteon, clonidine, gabapentin, doxepin, mirtazapine, or trazodone.
"We certainly could use more studies, we could use a registry of those hypnotic usages in children with autism or ADHD," she said.
In addition to registry studies and placebo controlled studies surrounding hypnotic treatments for childrenw with autism or ADHD, Licis believes there's more to be understood about the relationship between these disorders and sleep disorders.
"There's a complex, likely bi-directional, relationship that I think we should further explore for better understanding of the pathophysiology of sleep in kids with autism and ADHD. Especially, it does seem like there's some phenotypic variability that I think could better inform our treatments," she said.
It'd also be helpful to investigate the role of nutrient deficiencies in these children, like iron, which is thought to contribute to restless leg syndrome in these children in turn, exacerbate insomnia. According to Licis, there's evidence that these populations may have relative iron deficiencies which could indicate that they metabolize iron differently or could be that their food intake is more restricted.
"It's also important to just understand the role of treating other sleep disorders like obstructive sleep apnea," she added, "because obstructive sleep apnea seems to be relatively more common in children with autism or ADHD, and can be a component to their sleep problems as well."