# Sleep disorders in children/adolescents with neurodevelopmental and neurological disorders: what evidences do we have with the use of non-pharmacological interventions?

## TL;DR

This review examines non-drug sleep interventions for children with neurological and developmental disorders, finding they can help but need better research.

## Contribution

The paper synthesizes recent evidence on non-pharmacological sleep interventions for various neurodevelopmental disorders, highlighting gaps in research and clinical practice.

## Key findings

- Behavioral interventions improve parent-reported sleep outcomes in children with NDDs.
- Tailored programs are effective in epilepsy and autism, while evidence for ADHD and cerebral palsy is more limited.
- Objective sleep improvements are modest, and research is hindered by small, inconsistent studies.

## Abstract

Sleep disturbances are highly prevalent across neurological and neurodevelopmental disorders (NDDs) and often exacerbate core symptoms, impair daytime functioning, and increase caregiver burden. Despite frequent clinical use of behavioral and educational strategies, the evidence base for non-pharmacological sleep interventions in this population remains scarce.

This narrative review aimed to analyze behavioral interventions that can be used for sleep problems in children and adolescents with NDDs, and synthesizes data from recent studies that examined those non-pharmacological interventions in epilepsy, autism spectrum disorder (ASD), attention-deficit/hyperactivity disorder (ADHD), cerebral palsy (CP), and rare genetic neurodevelopmental conditions (RGNCs).

Across NDDs, insomnia symptoms are highly prevalent, with circadian disturbances and sleep-disordered breathing also common in some groups. Behavioral and parent-led interventions—including psychoeducation, sleep hygiene, structured routines, and extinction-based strategies—consistently improve parent-reported sleep and often enhance daytime behavior, though objective sleep gains are smaller. In epilepsy and ASD, tailored behavioral–educational programmes are both effective and acceptable. In ADHD, behavioral sleep interventions and melatonin improve sleep, with behavioral approaches also yielding modest reductions in ADHD symptoms. Evidence for CP and RGNCs is limited but supports individualized, multimodal management targeting both behavioral and physiological contributors, while syndrome-specific chronobiological treatments offer only partial benefit.

Behavioral and educational sleep interventions are generally safe, acceptable, and clinically useful across NDDs, particularly when embedded in multidisciplinary, condition-informed care. However, their efficacy is constrained by small, heterogeneous trials and non-standardized outcome measures. Robust, syndrome-specific randomized studies with harmonized sleep and daytime outcomes are urgently needed to guide evidence-based practice.