Adherence to treatment and parents' perspective about effectiveness of melatonin in children with autism spectrum disorder and sleep disturbances.

Sadeh H, Meiri G, Zigdon D, et al. Adherence to treatment and parents' perspective about effectiveness of melatonin in children with autism spectrum disorder and sleep disturbances. Child Adolesc Psychiatry Ment Health. 2023;17(1):123. Published 2023 Oct 27. doi:10.1186/s13034-023-00669-w

Overview

 A retrospective cohort study explored adherence to melatonin treatment and the parents' perception of its effectiveness for autism spectrum disorder (ASD). Parents reported that melatonin was a safe and effective treatment for their children, with improved sleep and daily behavior.

SNHI Advisory Council’s comments/takeaway from the article

Autism spectrum disorder (ASD) is a clinical condition for which the safety and efficacy of using melatonin have been established in the literature. This study highlighted these same findings with improved sleep parameters. In addition, it revealed that adherence to its use is good, and safety remains intact, with a mean of 88 months of use, which is much higher than some current safety studies report. This information could provide additional insight into the long-term use of melatonin in the ASD population.

Of note, using melatonin within the pediatric population for general sleep concerns, while safe, is not the first line of action that is recommended. Rather, employing sleep hygiene and behavior practices should first be considered.

Article summary

 A retrospective cohort study explored adherence to melatonin treatment and the parents' perception of its effectiveness for autism spectrum disorder (ASD). A survey was conducted by phone to parents of children registered in the Azrieli National Center for Autism and Neurodevelopmental Research (ANCAN). Of the 1,355 children with autism registered in this database, 8% of them were recommended melatonin. It was noted that adherence to melatonin was associated with the severity of ASD symptoms. Parents adhered to providing a dose of up to 6 mg] before bedtime to their children.

Results:

Most parents reported adherence to melatonin for at least 1 week, though the median use time was 88 months. 

• Improvements in sleep onset (86%), sleep duration (53%) and night awakenings (45%) were reported.

• Better educational functioning, moods, communication, sensory regulation, and a reduction in tantrums were reported for 35% of the children.

• Of the 78 children included in this study, 26 discontinued the use of melatonin for various reasons, including lack or loss of effectiveness, improvements reached, side effects, starting other medications/doctors request to discontinue, child’s refusal to take it, cost, and starting behavioral sleep intervention.

Limitations Noted by Author(s)

• Large database/cohort of children, but a low number of them were using melatonin, resulting in a smaller sample size.

• Over-the-counter (OTC) melatonin was used, but specific formulations/brands were not known, which left the authors unable to explore the differences between specific types of OTC melatonin.

• Surveys are subject to recall and information bias.

• The socioeconomic status of parents was not accessible, which may impact melatonin use and parent’s perspective.

Other limitations noted in this review

• Lack of clarity on the dosing used. The mean dose was 3.9 mg +/- 2.7 mg.

• As discussed in the article, the severity of ASD symptoms, particularly circadian rhythm misalignment, can alter the clinical recommendations on the dose, timing, and overall duration of use to aid in restoring the circadian rhythm. Comparing severity and dosing would be desirable.

Article review completed by Kim Ross, DCN

Content reviewed by Deanna Minich, PhD

November 3, 2023