Supplemental melatonin has shown promise in treating sleep onset insomnia in children with autism spectrum disorders (ASD). Twenty-four children, free of psychotropic medications, completed an open-label dose-escalation study to assess dose-response, tolerability, safety, feasibility of collecting actigraphy data, and ability of outcome measures to detect change during a 14-week intervention. Supplemental melatonin improved sleep latency, as measured by actigraphy, 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 improvement in sleep, behavior, and parenting stress. Our findings contribute to the growing literature on supplemental melatonin for insomnia in ASD and inform planning for a large randomized trial in this population.

This study provided sleep education to parents of children with autism spectrum disorder (ASD) to determine whether an individual or group format was more effective in improving sleep and aspects of daytime behavior and family functioning. Eighty children, ages 2-10 years, with ASD and sleep onset delay completed the study. Actigraphy and parent questionnaires were collected at baseline and one month after treatment. Mode of education did not affect outcomes. Sleep latency, insomnia subscales on the Children's Sleep Habits Questionnaire, and other outcomes related to child and family functioning improved with treatment. Parent-based sleep education, delivered in relatively few sessions, was associated with improved sleep onset delay in children with ASD. Group vs. individualized education did not affect outcome.

Sleep concerns are common in children with autism spectrum disorders (ASD). We identified objective sleep measures that differentiated ASD children with and without parental sleep concerns, and related parental concerns and objective measures to aspects of daytime behavior. ASD poor sleepers differed from ASD good sleepers on actigraphic (sleep latency, sleep efficiency, fragmentation) and polysomnographic (sleep latency) measures, and were reported to have more inattention, hyperactivity, and restricted/repetitive behaviors. Fragmentation was correlated with more restricted/repetitive behaviors. This work provides the foundation for focused studies of pathophysiology and targeted interventions to improve sleep in this population. KeywordsActigraphy; Polysomnography; Insomnia; Children's Sleep Habits Questionnaire; Child Behavior Checklist; Repetitive Behavior Scale Autism spectrum disorders (ASD) are disorders of neurodevelopment characterized by impaired social interaction and communication (American Psychiatric Association, 2000). The prevalence of these disorders is estimated at approximately 1 in 150 children (CDC, 2007). Sleep disorders are common associated conditions , with a prevalence estimated to range from 44-83% (Richdale, 1999;Couturier et al., 2005;Krakowiak et al., 2008). Sleep-onset insomnia and nocturnal awakenings are the most frequent and consistent findings (Richdale, 1999;Honomichl et al., 2002;Wiggs and Stores, 2004;Williams et al., 2004). A recent consensus statement identified the treatment of insomnia in ASD to be a high priority area (Mindell et al., 2006). Treating disordered sleep in ASD also represents a potential avenue to improve daytime behavior and family functioning in this population (Malow and McGrew, 2008).An essential component in planning interventional trials to improve sleep in children with ASD is to define objective measures of sleep that can be measured to document improvement with the intervention, and related to parent concerns. Objective measures used to define sleep concerns include polysomnography (PSG) and actigraphy. In our prior work, PSG differentiated children with ASD who had significant parental sleep concerns from those who did not (Malow et al., 2006). However, some children with ASD may not be able to tolerate Correspondence to: Suzanne E. Goldman, PhD. NIH Public Access Author ManuscriptDev Neuropsychol. Author manuscript; available in PMC 2010 September 27. NIH-PA Author ManuscriptNIH-PA Author Manuscript NIH-PA Author ManuscriptPSG, given the anxiety of "sleeping with wires" in a non-home environment, intolerance due to a given child's tactile sensitivities, or both. Furthermore, PSG is a costly methodology and the limited amount of information provided by a pediatric PSG study may not justify its large expense. Actigraphy, a modality that measures sleep and wake patterns based on limb movement, is less-intrusive and costly than PSG, and can be performed in a child's home setting. It is recognized as a useful adjunct in the evaluation of pat...

Supplemental melatonin has been used to treat sleep onset insomnia in children with autism spectrum disorders (ASD), although the mechanism of action is uncertain. We assessed endogenous and supplemental melatonin profiles in relation to sleep in nine children with ASD. In endogenous samples, maximal melatonin concentration (Cmax) and time to peak concentration (Tmax) were comparable to those previously published in the literature for typically developing children, and dim light melatonin onsets were captured in the majority of children. In treatment samples (supplemental melatonin), melatonin parameters were also comparable to those previously published for typically developing children. Our findings support that children with ASD and insomnia responsive to low dose melatonin treatment have relatively normal profiles of endogenous and supplemental melatonin.