Consensus document on the treatment of insomnia in patients with autism spectrum disorder under 18 years of age.

Spanish pediatric and sleep experts created guidelines for treating sleep problems in autistic children under 18. They recommend starting with good sleep routines and behavioral strategies. If medication is needed, melatonin is the first choice, starting at 2mg daily and adjusting up to 10mg as needed. Other medications like alimemazine, risperidone, or clonidine may be added if sleep problems continue.

Parents should keep sleep diaries to track progress and work with doctors to adjust treatments regularly.

This Spanish consensus document provides evidence-based guidelines for treating insomnia in children and adolescents with autism spectrum disorder. Developed by the Spanish Association of Pediatrics and Spanish Sleep Society using a modified Delphi process, it addresses the high prevalence of sleep problems in this population. The document recommends a stepped approach beginning with sleep hygiene and cognitive-behavioral interventions. For maintenance insomnia, pediatric prolonged-release melatonin (2-10mg daily) is the first-line medication, with alimemazine, risperidone, or clonidine as sequential add-ons if needed.

For early insomnia, immediate-release melatonin (2-7mg daily) or pediatric prolonged-release melatonin are recommended. Regular monitoring with sleep diaries is emphasized for ongoing assessment and dosage adjustment.

Provides structured treatment guidelines for clinicians managing sleep problems in autistic children. Establishes clear medication hierarchy and dosing recommendations, emphasizing behavioral interventions first. Regular monitoring protocols support individualized treatment approaches and ongoing care optimization.

This is a consensus document rather than original research, so findings reflect expert opinion rather than new empirical evidence. The specific methodology of the Delphi process and level of expert agreement are not detailed in the abstract.

The prevalence of sleep problems in people with ASD is high, affecting their quality of life and social skills. To date, there is no guideline for the treatment of insomnia in people with ASD at the national level in Spain or the European level. With the aim to guide the comprehensive management of insomnia, this consensus document was created under the leadership of the Spanish Association of Pediatrics (AEP) and the Spanish Sleep Society (SES). Modified and adapted Delphi process.

The document describes diagnostic tools for use before treatment initiation and provides recommendations for comprehensive management. The treatment of insomnia begins with sleep hygiene measures and personalized cognitive-behavioral therapies. In maintenance insomnia, if these are not sufficient, pediatric prolonged-release melatonin (PedPRM) is recommended as the first-line drug, starting with a dose of 2mg/day and adjusting it to up to 10mg/day as needed. If the problems persist, alimemazine, risperidone or clonidine can be added, in that order, in a stepwise fashion.

For early insomnia, immediate-release melatonin (IRM) is recommended, starting with a dose of 5mg/day and reducing it to up to 2mg/day if it is effective or increasing it to up to 7mg/day otherwise, or else PedPRM. The dosage should be reevaluated periodically in regular follow-up visits using sleep diaries.