Sleep disturbances in autistic children and adolescents: A systematic review and meta-analysis of randomized controlled trials

Sleep disturbances are one of the most common comorbidities in autistic children and adolescence. Considering the impact of sleep disorders on development and daily functioning, it is important to know which treatments are considered effective in literature. This systematic review and meta-analysis study specifically aimed to investigate the effectiveness of non-pharmacological interventions for the treatment of sleep disorders in autistic children and adolescents without intellectual disability. Search across PubMed, PsycINFO, Scopus, and Web of Science were identified 11 randomized controlled trial studies published between 2012 and 2024 that met the inclusion criteria. The results indicate that the interventions considered (Behavioral/psychological, Physical activity, and Somatosensory sleep interventions) significantly improve sleep parameters in this population (p < 0.05). Objective data from actigraphy show an increase in total sleep time and sleep efficiency and a reduction in sleep onset latency. The results also show an improvement in sleep quality assessed through the Children's Sleep Habits Questionnaire filled out by parents. This study is one of the first to examine through a meta-analysis the positive impact of non-pharmacological therapies in the treatment of sleep disorders in autistic children and adolescents without intellectual disability. Alternative treatments are essential, particularly for those who are intolerant to medication, as it allows clinicians to provide effective interventions tailored to this population. Lay Abstract Sleep disorders are common in people on the autistic spectrum and can affect their development, daily function, and overall well-being. This study examined the effectiveness of non-pharmacological intervention to improve sleep in autistic children and adolescents without intellectual disability. We considered 11 studies of non-pharmacological treatments for autistic children and adolescents. The results indicate that these interventions help to improve several sleep parameters, either by increasing, for example, the total time and quality of sleep, or by reducing the time needed for falling asleep. These approaches offer important treatment options especially for those cases where medication is not feasible, allowing physicians and specialists to propose more targeted and safer solutions for managing sleep difficulties in this population.