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

Abstract

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