Ask any parent of a child with autism how their child sleeps, and chances are they've struggled. And it's no wonder: 44 to 83% of children with autism have suffered from sleep problems, which include difficulty falling asleep, staying asleep, or early morning awakenings. A new study published in the Journal of Child Neurology has found that melatonin supplements are well-tolerated in children with autism, and show promise for improving their sleep.
Melatonin is a naturally occurring hormone that regulates sleep-wake cycles. Available as a dietary supplement, it is frequently taken to relieve insomnia. Melatonin levels are low in children with autism, which suggested that taking a melatonin supplement could help them with sleep. "Rather than treating them with some other drug that would promote sleep, [we could] give them what they're missing," said Beth Malow, M.D., M.S., senior author of the study and a neurologist specializing in sleep at Vanderbilt University. As the mother of two children with autism, Dr. Malow has first-hand experience of sleep difficulties in autism. She noted that melatonin has a lot of appeal for parents because "it's something natural that's already in your child's body."
The study is the largest of its kind, looking at the medical records of 107 children with autism who had tried varying dosages of melatonin for insomnia. The children were seen in a clinic designed to address medical problems associated with autism by a single pediatrician, Susan McGrew, M.D. Together with Ivy Andersen, M.D., and Joanna Kaczmarska, M.D., Drs. McGrew and Malow studied this large sample consisting of a cross section of children with autism. The mostly male (80%) group included children 2-18 years old with a mix of ASD diagnosis subtypes, children with seizures (20%), children with coexisting psychiatric diagnoses such as depression or obsessive-compulsive disorder (29%), and children taking some kind of psychotropic medicine (90%). Parents were instructed on melatonin dosage and counseled on good sleep habits, including regular bedtimes and wake times, and a bedtime routine that avoided stimulating activities.
During melatonin treatment, a majority of parents reported improved sleep, some as early as the first follow up visit, two to six months later. Of these, 25% reported that sleep was no longer a concern, and 60% reported that sleep had improved, although there remained some sleep issues. For many children, these improvements were observed while taking low doses of melatonin (3 mg or less). The remaining 15% reported that sleep remained a concern despite melatonin treatment, and only one child had a report of worsened sleep.
Just as important was what the study didn't find: major side-effects. Seizure incidence was not increased, and only three children had mild adverse effects, such as morning sleepiness and increased bedwetting. Overall, melatonin was well-tolerated, even when taken in combination with other psychotropic medications.
Because of the "retrospective" design of the study--analyzing medical records after the fact--the reported sleep improvements cannot be definitely linked to melatonin. But the study does establish melatonin treatment as safe and tolerable for a wide range of children with autism, and indicates that a carefully controlled investigation into the efficacy of melatonin is worthwhile.
Such a "prospective" study is now underway, said Dr. Malow. "We are funded by Autism Speaks to look at 20 children with autism spectrum disorders who do not sleep well." This study will follow how sleep patterns change with the introduction of melatonin, as measured by parent reports and a method called actigraphy, which monitors sleep by tracking movements at night via a wristwatch-like device. Although preliminary, so far all children completing the trial have had improved sleep, improved daytime behavior, and parents report that they are coping better with their child's autism. "This has been a big impact on the family," said Dr. Malow, who also cautioned that melatonin should be administered under the care of a physician and combined with behavioral therapies for sleep.
Because of the potential to immediately benefit the lives of people affected by autism, several other groups are also studying uses for melatonin in autism. Dan Glaze, M.D., at Baylor University is conducting another Autism Speaks-sponsored melatonin trial. Both Dr. Glaze and Dr. Malow, and their respective institutions, belong to the Autism Treatment Network, an Autism Speaks' initiative that is committed to researching and addressing the medical issues that accompany autism.
–Michele Solis, Ph.D.
For further information on the Autism Treatment Network, click here.
For further information on Dr. Malow's recent and ongoing studies, click here.