Autism Spectrum Disorder

The aims of this chapter are to present the state of the science of sleep in children with autism spectrum disorder (ASD), hypotheses for the high prevalence of insomnia in children with ASD, and an ecological approach for promoting optimal sleep. An ecological approach includes environmental, sensory, culturally sensitive, and behavioral strategies. About two-thirds of children with ASD have chronic insomnia. The strongest evidence on promoting sleep in children with ASD is on sleep education, ecological changes, behavioral interventions, and exogenous melatonin. In 2012, the Sleep Committee of the Autism Treatment Network (ATN) developed a practice pathway, based on expert consensus, to capture best practices for screening, identification, and treatment for sleep problems in ASD. An exemplar case is presented to integrate key constructs of the practice pathway and address arousal dysregulation in a child with ASD and anxiety disorder. This chapter concludes with recommendations for dissemination of the practice pathway and future directions for research on insomnia in ASD.