Children that are identified as being on the autism spectrum often present with sleep disturbances as well. The range of children on the spectrum that have sleep disorders in this study range anywhere from 44-83%. Where ever that true number may be, it demonstrates a high prevalence of children on the spectrum that demonstrate sleep issues.
The article selected by Anderson et al (2008), studied children on the autism spectrum who all used the same pediatrician. The range of sleep issues that were reported included having difficulty falling asleep, difficulty staying asleep, and waking too early in the morning. Melatonin was chosen as the implement to be introduced because it is a chemical that is naturally produced by the body. It is considered to be a hormone that is of the endogenous pineal variety that affects the suprachiasmatic nucleus part of the hypothalamus. As such, it helps in the regulation of the body’s awake-sleep cycle.
Dosing of melatonin is done on a trial and error basis, starting on a low end of .5mg and increasing of 10mg or higher. The particular pediatrician in this study did not advocate dosing above 6 mg in children. The predominate metabolite that is found in melatonin is sulphatoxymelatonin and it is reduced in children with autism, which is why supplementing melatonin in children with autism often helps to regulate their sleep cycle.
The method that was used in this study was initial approval through the Institutional Review Board at Vanderbilt University. The main feature to find the initial control group was to review the electronic medical records of one particular pediatrician. There were 180 children diagnosed with autism spectrum disorder in the practice. Of these 180 children, 107 were using melatonin to help control sleep issues. Follow-up visits confirmed that these children were still using the melatonin, as it is available over-the counter. Follow-up visits were used to also confirm the dosage that the child was receiving at that time. The dosage was administered 30-60 minutes before bedtime. Parents were given the instruction to increase the dose by 1mg every two weeks if there was no positive response at the lower dose. At any time, if daytime sleepiness was noted, parents were told to call the office to receive instructions to decrease the dose.
The majority of parents noted positive reports in their children’s sleep habits at the higher doses. About 25% of the parents were able to eventually report that they were no longer having any issues of sleep with their child. Another 60% of parents noted that there were significant improvements in their child’s sleep, but some issues still remained. Most parents reported positive results as soon as the first visit of the study. The parents of seven children reported that the melatonin helped for 3-12 months and then the positive results lessened. The last 14 children’s parents reported that sleep issues continued to be a major concern for their children. Only one child had negative effects after using melatonin and had worse sleep issues.
The discussion for the article noted that the melatonin was well-tolerated and deemed safe as a dietary supplement. It was beneficial to many of the participants in the study to assist with children with autism spectrum disorders who had either issues with sleep maintenance or difficulty falling asleep. There were very few negative reports during the course of the study and none were severe. Most children benefitted from doses of 3mg or less.
Anderson, I. M., Kaczmarska, J., McGrew, S. G., & Malow, B. A. (2008). Melatonin for insomnia in children with autism spectrum disorders. Journal of Child Neurology, 23 (5), 482-485.