title: A practice pathway for the identification, evaluation, and management of insomnia in children and adolescents with autism spectrum disorders.
abstract: OBJECTIVE
  This report describes the development of a practice pathway for the identification, evaluation, and management of insomnia in children and adolescents who have autism spectrum disorders (ASDs).
  
  
  METHODS
  The Sleep Committee of the Autism Treatment Network (ATN) developed a practice pathway, based on expert consensus, to capture best practices for an overarching approach to insomnia by a general pediatrician, primary care provider, or autism medical specialist, including identification, evaluation, and management. A field test at 4 ATN sites was used to evaluate the pathway. In addition, a systematic literature review and grading of evidence provided data regarding treatments of insomnia in children who have neurodevelopmental disabilities.
  
  
  RESULTS
  The literature review revealed that current treatments for insomnia in children who have ASD show promise for behavioral/educational interventions and melatonin trials. However, there is a paucity of evidence, supporting the need for additional research. Consensus among the ATN sleep medicine committee experts included: (1) all children who have ASD should be screened for insomnia; (2) screening should be done for potential contributing factors, including other medical problems; (3) the need for therapeutic intervention should be determined; (4) therapeutic interventions should begin with parent education in the use of behavioral approaches as a first-line approach; (5) pharmacologic therapy may be indicated in certain situations; and (6) there should be follow-up after any intervention to evaluate effectiveness and tolerance of the therapy. Field testing of the practice pathway by autism medical specialists allowed for refinement of the practice pathway.
  
  
  CONCLUSIONS
  The insomnia practice pathway may help health care providers to identify and manage insomnia symptoms in children and adolescents who have ASD. It may also provide a framework to evaluate the impact of contributing factors on insomnia and to test the effectiveness of nonpharmacologic and pharmacologic treatment strategies for the nighttime symptoms and daytime functioning and quality of life in ASD.
authors.affiliation: Departments of Neurology, Vanderbilt University Medical Center, Nashville, Tennessee, USA. beth.malow@vanderbilt.edu
authors.forename: Beth A
authors.initials: BA
authors.lastname: Malow
authors.forename: Kelly
authors.initials: K
authors.lastname: Byars
authors.forename: Kyle
authors.initials: K
authors.lastname: Johnson
authors.forename: Shelly
authors.initials: S
authors.lastname: Weiss
authors.forename: Pilar
authors.initials: P
authors.lastname: Bernal
authors.forename: Suzanne E
authors.initials: SE
authors.lastname: Goldman
authors.forename: Rebecca
authors.initials: R
authors.lastname: Panzer
authors.forename: Daniel L
authors.initials: DL
authors.lastname: Coury
authors.forename: Dan G
authors.initials: DG
authors.lastname: Glaze
mesh_terms: D000293:Adolescent; D002648:Child; D002659:Child Development Disorders, Pervasive / Q000150:complications*; D019091:Critical Pathways; D003663:Decision Trees; D017408:Guidelines as Topic; D006801:Humans; D007319:Sleep Initiation and Maintenance Disorders / Q000175:diagnosis* / Q000209:etiology / Q000628:therapy*; D011795:Surveys and Questionnaires