Diagnostic labels alone provide limited guidance for assessment or treatment of sleep disorders in children with neurodevelopmental disorders; a diagnosis-informed, phenotype-directed framework is proposed.
The paper reviews evidence that sleep disorders are highly prevalent in children with neurodevelopmental disorders (NDDs) and that diagnostic labels are insufficient for guiding care. It proposes a framework that integrates diagnosis-informed risk recognition with phenotype-directed assessment, focusing on sleep phenotypes such as insomnia, circadian dysregulation, sleep-disordered breathing, movement disorders, hypersomnolence, and parasomnias. Melatonin has the strongest pharmacological evidence, particularly for insomnia in ASD and selected neurogenetic conditions.
Evidence Score
Study Evidence
Study 1. Sleep in Children with Neurodevelopmental Disorders: From Diagnostic Labels to Phenotype-directed Care.
observationalBruni O, Breda M, Mammarella V, Polese D, Mogavero MP, Lanza G, Ferri R · Current neurology and neuroscience reports (2026)
Result:
Mechanism Graph
Limitations
- ⚠Review article, not a primary study; no quantitative effect sizes
- ⚠Evidence for many NDD populations and sedating agents remains limited
- ⚠Calls for better trials including children with severe disability and rare NDDs
Frequently Asked Questions
What is the main recommendation for managing sleep disorders in children with neurodevelopmental disorders?▼
The main recommendation is to use a diagnosis-informed, phenotype-directed framework, where the neurodevelopmental diagnosis identifies syndrome-specific risks and surveillance needs, while the dominant sleep phenotype and contributing factors guide investigation and treatment.
Which pharmacological treatment has the strongest evidence for sleep disorders in this population?▼
Melatonin has the strongest pharmacological evidence, particularly for insomnia in autism spectrum disorder (ASD) and selected neurogenetic conditions.
What are the clinically relevant sleep phenotypes mentioned in the paper?▼
The clinically relevant phenotypes include insomnia and circadian dysregulation, sleep-disordered breathing, sleep-related movement disorders, hypersomnolence, and parasomnias.
Why are diagnostic labels alone insufficient for managing sleep disorders in children with NDDs?▼
Diagnostic labels alone are insufficient because sleep disturbance is heterogeneous within and across different NDDs, and the same diagnosis can present with different sleep phenotypes, requiring individualized assessment and treatment.
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References
- 1.Bruni O, Breda M, Mammarella V, Polese D, Mogavero MP, Lanza G, Ferri R. "Sleep in Children with Neurodevelopmental Disorders: From Diagnostic Labels to Phenotype-directed Care.." Current neurology and neuroscience reports, 2026. PMID: 42635877 DOI: 10.1007/s11910-026-01513-2