We try to review a research article each week. Because we were both recently at the Autism Research Institute (ARI) conference, we picked a research article related to one of our presentations: sleep–or the lack thereof. We are not talking about OUR lack of sleep (there is not much sleeping going on out here), we are talking about sleep issues for children with autism.
Missy was lucky enough to present alongside Dr. Rosignol. He presented on the medical aspects of treating sleep and she presented on the behavioral aspects of sleep programs.
Thus, we are going to review his recent article on the use of melatonin to aid with sleep for children with autism. He co-authored the article with Dr. Richard Frye. The article was published in Developmental Medicine and Child Neurology in April, 2011. The authors set out to review the research on the use of melatonin for children with autism. The authors conducted a meta-analysis which is simply analyzing the results from a group of studies to determine if a consistent outcome was observed.
A total of 35 studies were included in the review. However, the meta-analysis (statistical analysis) was performed on five studies which were considered to be highly experimental. Specifically, the five studies included random assignment to treatment groups, the use of double-blind procedures (which means the researchers and the participants were blind to treatment groups), and treatment groups received treatment or a placebo.
The authors reported some very interesting results across the studies. First 9 studies individually reported that melatonin or its metabolites were abnormal for the children with autism in the studies. Seven additional studies reported that the melatonin (or its derivates) levels were below average for participants. Five studies reported gene abnomalities that could have contributed to the decreased melatonin production.
In terms of outcomes following melatonin supplement use, the authors reported that six studies indicated improved daytime behavior following melatonin use. Eighteen studies reported improvements in “sleep duration, sleep onset latency, and night-time awakenings.The authors went on to report large effect sizes (which means that the studies consistently showed positive outcomes) for increases in sleep duration. However, there were no significant findings related to nighttime awakenings. Additionally, side effects were reportedly minimal to none.
In summary, many children with autism present with sleep difficulties including later onset, shorter duration of sleep, and frequent night awakenings. This meta-analysis showed that children with autism may have a lower level of melatonin or they may have an underlying condition that affects melatonin production. However, the use of melatonin as a supplement improved the overall duration of sleep for children. Additional studies are needed to determine how to address frequent awakenings during the night.
We want to know, does your child have sleep issues? What are they? Have you tried melatonin? Was it effective?
If you have a research topic that you would like for us to review, please let us know.
Happy sleeping!
Applied Behavioral Strategies 
We use melatonin every night and we love it! Kids go to sleep much quicker and seem more rested in the morning. Glad to see the research behind this!
Thanks Ann! I knew there were a few studies on melatonin but I was surprised to see so many. I am glad to see the research behind it too. I learned a lot from Dr. Rosignol’s talk.
hey, great blog! love it 🙂
Thanks! We appreciate the feedback!
[…] Research Review: Melatonin and Sleep (appliedbehavioralstrategies.wordpress.com) […]
[…] Research Review: Melatonin and Sleep (appliedbehavioralstrategies.wordpress.com) […]
[…] we know that some nutritional supplements can actually improve behavior. For example, the research on melatonin has been shown to improve the sleep of individuals with autism. Zinc supplementation can also […]
Even by autism’s standards, my son’s sleep problems aren’t normal. He can fall asleep on his own and sleep through the night (10-12 hours, he’s been doing it since before he turned 1). His problem is that his sleep/wake cycles somehow got so screwed up that he doesn’t get ANY REM sleep on his own. He would wake up exhausted, then be overtired and fight nap time, then would fight until he just passed out in the evening. It was a vicious cycle that we went through for a year and a half. The first morning after we started using it, my son woke up happy and well rested.
I am a strong advocate of melatonin usage as an alternative to over-the-counter and prescription sleep medications. With that said, do your research. There are many brands, some better than others. There’s also regular otc melatonin, which is only intended to work for approximately 4 hours and then there’s time released. Time released takes a little bit longer to kick in, but lasts for about 8 hours.
The average adult produces approximately 0.5-1mg of melatonin per night, and that’s enough for them to sleep. Even with possible gene abnormalities interfering with melatonin, common sense would tell you that giving a 4 year old 9mg every night is not wise. Too much melatonin can actually cause more problems than not using it at all. Most of the supposed reported side effects have come from people who essentially caused an overdose. If your child does not respond well to a low dosage (say between 1-5mg per night, depending on age and weight), then other factors need to be looked at before increasing the dosage. Are there underlying medical problems, such as digestion issues, food allergies/sensitivities, sleep apnea, etc that might be affecting their sleep? Are there environmental factors (such as too much/not enough light, noise, etc) contributing to the lack of sleep?
In addition to that, there are things that you can do to help boost the effectiveness of melatonin. First, timing is crucial. You have to figure out the child’s circadian rhythm and give the melatonin at a time when their body is naturally starting to wind down. Yes, I understand that this can be difficult to figure out with an autistic child (my son is autistic), but it’s doable if you take the time to look for the cues that they inevitably give. Second, if you give your child other nutritional supplements (specifically: calcium, vitamin d, magnesium and zinc), you can give these supplements in the evening as well. These supplements, when combined, have a synergistic effect that calms the body and boosts the melatonin. Third, when you do give the melatonin, turn down the lights and noise, to help wind down and stimulate the body’s natural melatonin production.
Thanks Raven! Sorry that you are having such sleep difficulties with your child but glad (and not surprised) to see that melatonin is helping. Your tips about timing and winding down are great! Thanks for stopping by and for taking the time to comment.
[…] Research Review: Melatonin and Sleep (appliedbehavioralstrategies.wordpress.com) […]