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ASD and Sleep — MRCPsych Paper B MCQ

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ModerateChild & Adolescent PsychiatryASD and SleepMRCPsych Paper B

A 12-year-old boy with autism has persistent sleep-onset insomnia, usually taking more than 2 hours to fall asleep. Assessment identifies no pain, medication effect, breathing disorder or other treatable cause. An individualised sleep plan has been followed and reviewed for 3 months without improvement. The resulting daytime tiredness is affecting his education and placing significant strain on his family. Following consultation with a psychiatrist experienced in autism, which pharmacological option should be considered alongside the sleep plan?

Educational content. Not a substitute for clinical judgement or local policy.

Reveal the answer and explanation

Correct answer: A — Melatonin

The correct answer is melatonin. NICE recommends considering melatonin when an autistic child or young person has sleep problems that persist despite an appropriately developed and reviewed sleep plan and that adversely affect the child or family. It should be initiated following consultation with a specialist paediatrician or psychiatrist experienced in autism or paediatric sleep medicine, used alongside non-pharmacological measures, and reviewed regularly. Prolonged-release melatonin has a UK marketing authorisation for insomnia in people aged 2–18 years with autism when sleep-hygiene measures are insufficient. Promethazine and hydroxyzine are sedating antihistamines but are not the NICE-recommended option for persistent autism-associated insomnia. Clonidine is sometimes used off-label in selected neurodevelopmental presentations but is not recommended here by NICE. Zopiclone is unsuitable as routine treatment for chronic insomnia in a child.

Reference: National Institute for Health and Care Excellence. Autism spectrum disorder in under 19s: support and management (CG170), recommendation 1.7.7, 2013, amended 2021. https://www.nice.org.uk/guidance/cg170/chapter/recommendations