Pharmacological or non-pharmacological therapies? The impact of different therapies on sleep in children with autism spectrum disorder: A systematic review and network meta-analysis.

This study compared different treatments for sleep problems in children with autism. Researchers looked at 35 studies with over 2,700 children. Exercise programs like swimming or martial arts worked best for improving sleep. Melatonin also helped but can cause morning drowsiness. Structured bedtime routines had moderate benefits. The study suggests starting with regular exercise and parent coaching before trying medications.

This network meta-analysis of 35 randomized controlled trials evaluated therapies for sleep disturbances in children with autism spectrum disorder. Physical activity emerged as the most effective intervention (effect size = 1.13), followed by melatonin (effect size = 0.57) and behavioral interventions (effect size = 0.49). Parent education and adjunctive therapies showed limited efficacy. The study recommends a stepped-care approach: first-line treatment with daytime physical activity (30-45 minutes, 3-5 sessions weekly) combined with telehealth parent education, followed by prolonged-release melatonin and therapist-supported cognitive behavioral therapy for non-responders.

Moderate heterogeneity was addressed through sensitivity analyses.

Supports stepped-care model prioritizing physical activity (30-45 minutes, 3-5 sessions weekly) with parent education as first-line treatment. Prolonged-release melatonin and therapist-supported CBT recommended for non-responders. This evidence-based hierarchy can guide clinical decision-making and reduce trial-and-error approaches.

Moderate heterogeneity (I² = 67%) suggests variation between studies. The abstract doesn't specify age ranges, autism severity levels, or long-term follow-up data. Sample sizes for individual studies and specific outcome measures aren't detailed.

This systematic review and network meta-analysis evaluated the efficacy of various therapies on sleep disturbances in children with autism spectrum disorder. We analyzed 35 randomized controlled trials comparing five interventions: melatonin, parent-mediated sleep education, behavioral interventions, physical activity, and adjunctive therapies. Standardized mean differences and surface under the cumulative ranking curve values were calculated to rank efficacy. Physical activity demonstrated the largest effect size (standardized mean difference = 1.13, surface under the cumulative ranking curve = 98.1%), followed by melatonin (standardized mean difference = 0.57, surface under the cumulative ranking curve = 62.8%) and behavioral interventions (standardized mean difference = 0.49, surface under the cumulative ranking curve = 51.6%).

Parent education and adjunctive therapies showed limited efficacy. Heterogeneity (² = 67%) was addressed via sensitivity analyses. A stepped-care model is recommended, prioritizing daytime physical activity (30-45 min, 3-5 sessions/week) combined with telehealth parent education as first-line treatment, followed by prolonged-release melatonin and therapist-supported cognitive behavioral therapy for non-responders.Lay abstractMany children with autism spectrum disorder struggle with sleep problems like trouble falling asleep, waking up at night, or not sleeping enough. This study looked at different treatments to improve sleep in these children, including melatonin supplements, parent-led bedtime routines, exercise programs, and other therapies.

The researchers reviewed 35 studies involving over 2700 children with autism spectrum disorder. They compared how well each treatment worked using a method called network meta-analysis, which ranks treatments based on their effectiveness. Exercise programs, such as swimming or martial arts, were the most effective at improving sleep. These activities helped children fall asleep faster and stay asleep longer.

Melatonin supplements also worked well but had side effects like morning drowsiness. Behavioral strategies, like structured bedtime routines, showed moderate benefits, while therapies like weighted blankets or iron supplements had little impact. This study helps families and doctors choose the best treatments for sleep problems in children with autism spectrum disorder. Exercise is a safe, low-cost option that not only improves sleep but also enhances daytime behavior.

The findings support starting with physical activity and parent coaching before trying medications like melatonin. Recognizing effective treatments can reduce stress for caregivers and improve quality of life for children with autism spectrum disorder.