Effectiveness of Cognitive Behavioural Therapy for Insomnia (CBT-I) in Individuals With Neurodevelopmental Conditions: A Systematic Review.

Abstract

Cognitive Behavioural Therapy for insomnia (CBT-I) is the recommended first-line treatment for chronic insomnia disorder in diverse populations with co-occurring conditions. However, individuals with neurodevelopmental conditions are frequently excluded from CBT-I research, despite the high prevalence of sleep problems in this population. The present systematic review and narrative synthesis investigates the effectiveness of CBT-I in individuals with neurodevelopmental conditions. A literature search was completed in February 2024 across five databases. Of 1988 unique entries, 8 studies from 5 countries met all inclusion criteria, amounting to a combined sample size of 598 participants (male = 75.92%, age range = 4-68). Five interventions were delivered to children and adolescents (M = 8.7 years ±1.46), whilst 3 were delivered to adults (M = 35.78 years ±5.71). All interventions included at least 2 CBT-I components but were diverse in content and format. Two randomised controlled trials and six before-after studies suggested significant short-term effectiveness of CBT-I in individuals with Autism Spectrum Disorder (ASD) and/or Attention-Deficit/Hyperactivity Disorder (ADHD). Improvements in the severity of condition-specific characteristics were observed in some studies. Still, findings were inconsistent and mostly not maintained at follow-up. The quality of included articles was moderate due to small sample sizes, lack of blinding and deviations from the intended intervention. This variability may be explained by a lack of guidance on conducting CBT-I in this population. Hence, there is a need for further rigorous research and updated reviews to inform the implementation of CBT-I protocols for those with insomnia and neurodevelopmental conditions.