Sleep problems occur in 50-80% of children with autism spectrum disorder (ASD)1 and can exacerbate symptoms of autism present in social interactions, affective problems, repetitive behaviors, and inattention/ hyperactivity.2 Due to the high prevalence and impact sleep problems can have on children and their families researchers are attempting to find better interventions to address this condition.
The Journal of Autism and Developmental Disorders recently published a study concerning the benefits of melatonin in children with autism spectrum disorder (ASD) who have sleep-onset insomnia. Some of their aims were to determine effective doses, assess swiftness of sleep improvement, and determine the effectiveness of methods of data collection in this field.
The study recruited participants from subspecialty clinics and the community in general with flyers, letters, and emails to community members. Participants were children ages 3-10 with ASD (diagnosed by physicians) that were not currently using psychotropic medications.
Methods
Before administration of supplemental melatonin, there was a one-week baseline and two-week familiarization phase to monitor sleeping patterns. During the first phase, parents received one hour of structured sleep education and were taught to monitor actigraphy procedures. The children wore actigraphy watches to monitor how long it took them to fall asleep. During the second phase, parents gave their children liquid with the same flavor as the supplemental melatonin 30 minutes before bedtime to familiarize them with the process.
For the remaining 14 week period, the second phase liquid was then substituted for the liquid melatonin (Natrol®, Chatsworth CA). Parents were given the option to increase the dose protocol in three-week periods. This gradual increase was done to ensure determination of the lowest possible effective dose was possible. The starting dose was 1mg. If the child fell asleep within 30 minutes of bedtime for at least five nights in one week the melatonin was given until the end of the 14 week dosing period. If the child did meet this satisfactory response at that 1 mg dose during the first three-week period, the dose was increased to 3 mg. If the child did meet the satisfactory response at that 3 mg dose during the second three-week period, the dose was increased to 6 mg. If the child did meet the satisfactory response at that 6 mg dose during the third three-week period, the dose was increased to 9 mg. Doses were not changed during the last two weeks.
Results
The data of the 24 children who completed all study procedures demonstrated a significant decrease in the amount of time it took the children to fall asleep after bedtime (sleep latency). The decrease in sleep latency did not differ greatly between individuals on 1mg and 3 mg doses in comparison to individuals on 6mg and 9 mg doses. Sleep latency was often seen to be improved during the first week of treatment. In addition, there was no significant effect on sleep duration, wake time after sleep onset, or sleep efficiency after receiving the melatonin treatment. Furthermore, levels of parental stress were seen to decrease with treatment.
In sum, the study added new information on dosing, tolerance/safety, and outcome measures in the rapidly growing literature on the use of melatonin in children with ASD. This finding has implications for further research and potential use of melatonin as a treatment option for sleep-onset insomnia in individuals with ASD.
It important to note that though melatonin is considered safe the study emphasizes it should nevertheless be administered by a physician.
1Couturier et al 2005; Krakowiak et al 2008; Souders et al 2009; Goldman et al 2011b
2Schreck et al 2004; Gabriels et al 2005; Malow et al 2006; Goldman et al 2009; Goldman et al 2011a