Treatment of Sleep Disturbances in ASD.pptx

Treatment of Sleep Disturbances in ASD

1. Treatment of Sleep Disturbances in ASD: Melatonin and Other Strategies Chris Keary, M.D. Lurie Center for Autism,   Massachusetts General Hospital for Children, Harvard Medical School

2. Clinical Case: E 13-year-old boy ASD Moderate intellectual disability

3. Clinical Case: E Previously He had excellent sleep with melatonin During s ummertime He got used to staying up late Now It takes him hours to fall asleep He wakes up midcycle

4. Hollway , J. A., & Aman, M. G. (2011). Pharmacological treatment of sleep disturbance in developmental disabilities: A review of the literature.  Research in Developmental Disabilities ,  32 (3), 939–962. Sleep Disturbances in ASD Common concern for caregivers and patients

5. Studies on Melatonin for Sleep Disturbances in Children With Neurodevelopmental Disorders Hollway , J. A., & Aman, M. G. (2011). Pharmacological treatment of sleep disturbance in developmental disabilities: A review of the literature.  Research in Developmental Disabilities ,  32 (3), 939–962. Studies: 13 control studies Participants: 424 subjects Intervention: Melatonin 1 mg–10 mg

6. Melatonin for Sleep Disturbances in Children With Neurodevelopmental Disorders Hollway , J. A., & Aman, M. G. (2011). Pharmacological treatment of sleep disturbance in developmental disabilities: A review of the literature.  Research in Developmental Disabilities ,  32 (3), 939–962. Superior to placebo Mild side effects Recommendable for this population

7. Hollway , J. A., & Aman, M. G. (2011). Pharmacological treatment of sleep disturbance in developmental disabilities: A review of the literature.  Research in Developmental Disabilities ,  32 (3), 939–962. Other Medications for Sleep Disturbances in ASD Limited evidence

8. Clinical Approach for Sleep Disturbances in ASD: Medications Hollway , J. A., & Aman, M. G. (2011). Pharmacological treatment of sleep disturbance in developmental disabilities: A review of the literature.  Research in Developmental Disabilities ,  32 (3), 939–962. Start with melatonin Consider the usage of clonidine or trazodone

9. Clinical Approach for Sleep Disturbances in ASD: Medications Hollway , J. A., & Aman, M. G. (2011). Pharmacological treatment of sleep disturbance in developmental disabilities: A review of the literature.  Research in Developmental Disabilities ,  32 (3), 939–962. Medication: Clonidine Trazodone Effective for: Problems with sleep initiation Disrupted sleep cycles

10. Mirtazapine for Sleep Disturbances in ASD Can be effective Be careful with weight gain Hollway , J. A., & Aman, M. G. (2011). Pharmacological treatment of sleep disturbance in developmental disabilities: A review of the literature.  Research in Developmental Disabilities ,  32 (3), 939–962.

11. Hollway , J. A., & Aman, M. G. (2011). Pharmacological treatment of sleep disturbance in developmental disabilities: A review of the literature.  Research in Developmental Disabilities ,  32 (3), 939–962. Tricyclic Antidepressants for Sleep Disturbances in ASD Can be considered for severe cases Watch for irritability Start with low dosages Titrate slowly

12. Hollway , J. A., & Aman, M. G. (2011). Pharmacological treatment of sleep disturbance in developmental disabilities: A review of the literature.  Research in Developmental Disabilities ,  32 (3), 939–962. Use Diphenhydramine and Benzodiazepines With Caution in Patients With ASD

13. Symptoms of Paradoxical Reactions in Children With ASD Hollway , J. A., & Aman, M. G. (2011). Pharmacological treatment of sleep disturbance in developmental disabilities: A review of the literature.  Research in Developmental Disabilities ,  32 (3), 939–962. Activation Agitation Disinhibition Irritability

14. Hollway , J. A., & Aman, M. G. (2011). Pharmacological treatment of sleep disturbance in developmental disabilities: A review of the literature.  Research in Developmental Disabilities ,  32 (3), 939–962. Diphenhydramine and Benzodiazepines in Patients With ASD Do not consider them early in the treatment Discuss the risk of paradoxical reactions before initiating treatment

15. There are many RCTs of melatonin for treating insomnia in ASD. These RCTs attest to the effectiveness and excellent tolerability of melatonin. Key Points

16. Diphenhydramine and benzodiazepines have a higher risk for paradoxical reactions in patients with developmental disabilities. Key Points

17. Next Presentation Treatment of Impaired Social Relatedness in ASD