Digital and telehealth behavioral sleep interventions for improving sleep outcomes in children and adolescents with autism spectrum disorder: a systematic review and meta-analysis

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Sleep problems are highly prevalent in children with Autism Spectrum Disorder (ASD), negatively impacting core symptoms, daytime functioning, and family well-being. While behavioral interventions are the first-line treatment, access is often limited. Digital and telehealth delivery models offer a promising approach to increase accessibility. This review systematically evaluates the effectiveness of these technology-based behavioral sleep interventions for youth with ASD. Following PRISMA guidelines, we systematically searched five databases for randomized controlled trials (RCTs) and non-randomized studies (NRCTs) of digital or telehealth behavioral sleep interventions for youth (2-18 years) with ASD. The primary outcome was child sleep. Two reviewers independently screened studies, extracted data, and assessed the risk of bias. We conducted random-effects meta-analyses and sensitivity analyses. 12 studies met inclusion criteria: 6 RCTs (N = 349) and 6 NRCTs (N = 57). Across RCTs, digital and telehealth interventions significantly improved parent-reported sleep problems compared with controls (pooled SMD = –0.57, 95% CI –1.10 to –0.03; I 2 = 62%), reflecting a small-to-moderate benefit. Improvements were most evident for sleep initiation outcomes such as sleep-onset delay. In contrast, pooled NRCT results indicated large apparent gains (SMC = –1.03) but with wide confidence intervals and substantial heterogeneity, limiting interpretability. Evidence from randomized trials supports that digital and telehealth-delivered behavioral sleep interventions can yield small-to-moderate improvements in caregiver-reported sleep outcomes among autistic youth—particularly in reducing time to sleep onset. Non-randomized findings are encouraging but methodologically uncertain. Future research should prioritize adequately powered RCTs using objective sleep measures, standardized intervention frameworks, and longer follow-up to strengthen causal inference and inform scalable best-practice models. • Systematic review and meta-analysis of digital/telehealth sleep interventions in ASD. • Six RCTs (N=349) show small–moderate improvements in parent-reported sleep. • Objective outcomes suggest improved sleep efficiency and shorter sleep onset latency. • NRCTs show larger apparent effects but imprecision and high heterogeneity.

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