Behavioral interventions for sleep problems in autistic children: A systematic review

Autistic children are at high risk for sleep problems, which have significant detrimental effects on overall functioning. Behavioral treatment is effective for pediatric insomnia in the general population; however, current evidence on behavioral sleep interventions for autistic children has not been synthesized. This study addressed this gap by systematically reviewing available evidence on the effects of behavioral sleep interventions on sleep and daytime functioning in autistic children.

A systematic search of five databases (PubMed, PsycInfo, Web of Science, Embase, CINAHL) was conducted in accordance with PRISMA guidelines. Studies were eligible if they were published in English in a peer-reviewed journal, included autistic children under 18 years of age, evaluated a behavioral sleep intervention, measured sleep outcomes, and used a quantitative study design. Thirty-nine studies were included, published between 2002 and 2025. Most studies (92%) included multi-component behavioral interventions, and studies tested a range of treatment delivery modalities (in-person, virtual, online, and hybrid). Most studies (95%) found that behavioral interventions were effective for at least some sleep outcomes. Most studies (51%) were rated as "weak" quality overall, with 26% rated as "moderate," and only 23% rated as "strong" in overall quality.

Existing quantitative research provides consistent evidence supporting the overall effectiveness of behavioral sleep interventions for autistic children. However, the evidence base remains limited, as most studies employ research designs with notable methodological weaknesses. Future research is needed with larger, more representative samples, and with more rigorous study designs.