Sleeplessness in children with neurodevelopmental disorders - Epidemiologyand management

Sleeplessness, excessive waking and other disruptions of sleep are frequent ly evident in children with neurodevelopment disorders such as attention de ficit hyperactivity disorder, specific genetic syndromes associated with me ntal retardation, autistic disorders and Tourette syndrome. The severity of sleep disruption may or may not parallel the severity of associated illnes s. Sleeplessness in this population is often additionally affected by concu rrent medication use (such as central stimulants) and significant behaviour al and environmental influences. When attempting to treat sleeplessness in children with neurodevelopmental disorders, the first step is to obtain an accurate sleep history documentin g the child's typical sleep schedule. The child should be screened for the presence of other extrinsic causes of sleep problems such as obstructive sl eep apnoea and periodic limb movement, and use of medications known to disr upt sleep. These issues should be addressed if present. Nonpharmacological approaches to treatment include implementation of good sleep hygiene and th e use of behavioural programmes. Pharmacotherapy has not been extensively s tudied in children with neurodevelopmental disorders, although limited data suggest that melatonin, clonidine, guanfacine and hypnosedatives can be mo derately effective.