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Melatonin: An Option for Improving Sleep in Children with Autism Spectrum Disorder (ASD) Previous posts discussed sleep problems in children and strategies for improving their sleep. If the non-medication strategies in the previous post don't work, other options are available that are relatively risk free. Studies support the use of melatonin to reduce the time it takes for children with ASD to fall asleep (1, 2). Some studies suggest that melatonin increases total sleep time as well (2). Get more details about two scientific papers about melatonin use with children with autism below. Check with your child's doctor before starting melatonin to see if there are any reasons why you should avoid it. Conduct a Melatonin Study with Your Child Yourself We recommend that you follow steps similar to these studies when you give your child melatonin.

1. Parents were given a sleep diary to keep track of their children's sleep patterns. They started entering data before the melatonin was given. You can use SymTrendSleep for that purpose. Record the time your child went to bed and fell asleep. Record the number of times awakened during the night. Record the time your child got up in the morning and how sleepy he/she is. If you have time, also jot down what happened before bedtime that might have made falling asleep more difficult (such as activities or food). 2. The Vanderbilt senior researcher then trained parents to establish a regular bedtime and wake time. You should follow the recommendations in the previous post for doing that. 3. Start with a small dose of melatonin – 1 mg. A satisfactory response was defined in the research as falling asleep within 30 minutes in five or more nights/week for 3 weeks. If that response did not occur, the melatonin was increased to 3 mg for 3 weeks. 4. Jot down anything unusual that occurs after your child starts taking melatonin – possible side effects of the supplement. Most studies find melatonin is tolerated well. If you think something has changed for the worse, discontinue the melatonin and see if it changes back. Consult a professional.

Research on Melatonin Researchers at Vanderbilt University published a study in 2012 (1) in which 24 children with autism who had sleep problems were given melatonin. This study found that supplemental melatonin improved the time to get to sleep in most children at 1 or 3 mg dosages. "It was effective in week 1 of treatment, maintained effects over several months, was well tolerated and safe, and showed improvements in sleep, behavior, and parenting stress." On average it took 20 minutes less for the child to go to sleep. Total sleep time did not significantly improve and the number of times the child woke up did not change. Parents completed a side effect checklist for review each week (1, 3) that includes such items as dizziness, diarrhea, speech difficulties, headache, loss of appetite, decreased concentration, slowness, hyperactivity, and behavior disturbances. Only one of 24 children exhibited mild diarrhea; all others tolerated the melatonin without difficulty. Rossignol and Frye (2) reviewed well-controlled studies of melatonin use with children with autism. Their analysis of the literature showed significant improvements in sleep. Studies demonstrated the largest impact of melatonin on the time to get to sleep. They also found large differences in sleep duration. The time to fall asleep was 66 minutes shorter than baseline on average among those taking melatonin and 39 minutes shorter than those who took a placebo. Sleep duration was 73 minutes longer than baseline on average among those who took melatonin and 44 minutes longer than those who took a placebo. 1. Malow, B., Adkins, K.W., McGrew, S.G., Wang, L., Goldman, S.E., Fawkes, D. Burnette, C. Melatonin for Sleep in Children with Autism: A Controlled Trial Examining Dose, Tolerability, and Outcomes. J. Autism Developmental Disorders (2012) 42(8): 1729-37. 2. Rossignol, D.A. and Frye, R.E. Melatonin in Autism Spectrum Disorders: A Systematic Review and Meta-Analysis. Developmental Medicine and Child Neurology (2011) 53 (9), 783-792. 3. Carpay, J.A., Arts, W.F.M., Vermeulen, J., Stroink, H., Brouwer, O.F., Peters, A.C.B, vanDonselaar, C.A., Aldenkamp, A.P. Parent-completed Scales for Measuring Seizure Severity and Severity of Side-Effects of Antiepileptic Drugs in Childhood Epilepsy: Development and Psychometric Analysis. Epilepsy Research (1996) 24:173-181.

#Autism #e-diaries #SymtrendSleep #KidSleep

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Strategies to Improve Sleep in Children The Autism Speaks Autism Treatment Network and Autism Intervention Research Network on Physical Health published a free parent's guide to provide strategies to improve sleep. The guide is particularly aimed at children with autism spectrum disorders (ASD), but it is relevant for all children. Children with ASD frequently have difficulty with sleep. As discussed in the previous post, sleep problems may arise from health issues (digestion or bowel, breathing problems), from “body rhythm” problems (difficulties calming down at some times during the day), or from wanting to be part of the action or to be with the parents. Management of sleep involves: 1) providing a comfortable sleep setting, 2) establishing regular bedtime habits, 3) adjusting daytime eating and activities, and 4) teaching the child to sleep alone. Provide a Comfortable Sleep Setting: Take note of what works for your child. Make sure the room is the right temperature (not too hot and not too cold), has at least some light, and is quiet. If your child has irregular sleep patterns, write down what things were like in the room each night for a week or two to see what the room was like on the good nights. Consider changing curtains or shades or adding nightlights to get the lighting right. Avoid TV or radios just before sleep. Some children like constant low noise in the background (such as from a fan or air filter). If your child has sensory sensitivities or "body rhythm" problems, these sleep setting factors are particularly important to address. The fabric of the sheets and blankets and their weight on the child may make a difference as well. Establish Regular Bedtime Habits: The parent guide mentioned above gives several recommendations about setting up a routine. It also presents an example of a visual schedule to post in your child's room to review and follow each night (displayed above). They suggest starting the routine 15 to 30 minutes before the set bedtime. To reinforce the schedule, some favored activities (books, toys/stuffed animals) should be available just at that time. Adjust Daytime Eating and Activities: Avoid letting your child have caffeinated beverages or foods (e.g., chocolate, coffee, tea, colas) several hours before bedtime. Avoid large snacks and lots of liquids just before bed. Exercise during the day helps your child sleep better at night, but the exercise should not be too close to bedtime. Exercise and TV can make children more alert. Teach the Child to Sleep Alone: Teaching your child to got to sleep alone in the evening, or after awakening during the night, takes patience and should be done gradually and over a few weeks' time. You should wait increasingly long before going into your child’s room, spend increasingly less time in the room with your child, and pay less attention while in there. Similar techniques should be used at bedtime, during the night, and when the child awakes up too early. Importance of Data Collection: Trying to control all of these factors at once may overwhelm you. You don’t have to change everything at once. Keep track of what you've done so that you can be consistent. SymTrend Sleep and SymTrend ADL can help you keep track of these factors and will generate reports to show you how effective changes you are making have been.

#SymTrendSleep #SymTrendADL #e-diaries #KidSleep

Identification and Evaluation of Sleep Problems in Children and Adolescents Sleep problems during childhood are relatively common (20% to 30% in some reports about preschoolers and up to 40% in self-reports of adolescents). They are a significant source of stress for families. They also may underlie behavior issues and poor performance at school. It is important to define the problem before treatment starts. Several tools are available in sleep, nursing and pediatrics journals for professionals to use to screen for and diagnose sleep problems. Parental completion of a sleep diary simplifies the diagnosis. SymTrend Sleep and SymTrend ADL are apps designed to provide professionals with most of the information they need. Some sleep features were excluded to simplify and shorten data entry. Parents can bring the reports generated by the software to a visit. One screening tool is called the "BEARS" sleep screening tool (1). It is divided into five major sleep domains: Bedtime problems, Excessive daytime sleepiness, Awakenings during the night, Regularity and duration of sleep, and Snoring. The authors suggest asking questions about the five areas at each well child visit. The SymTrend diaries include questions in all of these domains except Snoring. Information collected in the products about daytime sleepiness/napping is limited. The Sleep Committee of the Autism Treatment Network (ATN) developed a "practice pathway" to guide professionals through the identification, evaluation, and management of insomnia in children and adolescents who have autism spectrum disorders (ASDs) (2). Their report lists seven available questionnaires, including the BEARS, for the identification step. The second step involves the evaluation of insomnia. Their report also includes a questionnaire to help identify medical conditions that can affect sleep. It includes questions about stomach and bowel issues, seizures, asthma and breathing, pain or skin problems, nutrition, and muscle tone. They also recommend looking for psychiatric conditions and medication side effects. The SymTrend ADL product includes general health questions. The next blog posting will discuss the third step, management of insomnia. Management need not await the completion of an evaluation. A frequently cited place to start is education about "sleep hygiene", or good sleep habits. Language and behavioral deficits of children with ASD may make it more difficult to establish good sleep habits.

1. Use of the 'BEARS' Sleep Screening Tool in a pediatric residents' continuity clinic: a pilot study. 2. Practice Pathway for Identification, Evaluation, and Management of Insomnia in Children and Adolescents With Autism Spectrum Disorders.

#Autism #SymTrendSleep #SymTrendADL #e-diaries #KidSleep