Sleep in Children with Neurodevelopmental Disorders: From Diagnostic Labels to Phenotype-directed Care

Sleep disorders are highly prevalent in children with neurodevelopmental disorders (NDDs), but diagnostic labels alone provide limited guidance for assessment or treatment. This review summarizes recent advances and proposes a diagnosis-informed, phenotype-directed clinical framework.

Recent studies reinforce the heterogeneity of sleep disturbance within and across autism, attention-deficit/hyperactivity disorder, intellectual disability, and genetic syndromes. Clinically relevant phenotypes include insomnia and circadian dysregulation, sleep-disordered breathing, sleep-related movement disorders, hypersomnolence, and parasomnias. Emerging research points to convergence among circadian, arousal, synaptic, sensory, and dopamine-iron pathways. Evidence for adapted behavioral interventions is growing. Melatonin has the strongest pharmacological evidence, particularly for insomnia in ASD and selected neurogenetic conditions, whereas evidence for other sedating agents and for many other NDD populations remains limited. Management should integrate diagnosis-informed risk recognition with phenotype-directed assessment. The neurodevelopmental diagnosis can identify syndrome-specific risks and surveillance needs, whereas the dominant sleep phenotype, contributing medical and environmental factors, and functional consequences should guide investigation and treatment. Better trials must include children with severe disability and rare NDDs and use developmentally appropriate, objective, and family-centered outcomes.