Melatonin for sleep problems in children with neurodevelopmental disorders

Abstract

Children with neurodevelopmental disorders are at risk of sleep problems, typically difficulty getting to sleep, sleep/wake rhythm disturbances and reduced duration of sleep (insomnia). This may be associated with abnormally timed or inadequate secretion of melatonin, a naturally-occurring hormone involved in coordinating the body's sleep-wake cycle. Previously, we reviewed the use of a melatonin product licensed for primary insomnia in adults aged over 55 years. Here we review off-label and unlicensed use of melatonin in children with attention-deficit hyperactivity disorder (ADHD) or autism spectrum disorder or related neurodevelopmental disorders.

Quality of melatonin use in children and adolescents: findings from a UK clinical audit

“…There are a large number of non-pharmacological interventions aimed at improving various aspects of sleep disturbance in different clinical populations of children and adolescents. Clinical guidelines generally recommend that such interventions are tried before medication is prescribed 2 13 20 : in some cases, response to non-pharmacological interventions may be adequate, thus avoiding the need for melatonin. 21 In our subsample of patients treated with melatonin for less than 3 months, there was documented evidence in the clinical records to suggest that non-pharmacological interventions had been tried in just over two-thirds.…”

“…These standards were derived from good practice recommendations in a review of the use of melatonin for sleep problems in children with neurodevelopmental disorders that was published in the Drug and Therapeutics Bulletin. 2 …”

“…These standards were derived from good practice recommendations in a review of the use of melatonin for sleep problems in children with neurodevelopmental disorders that was published in the Drug and Therapeutics Bulletin. 2 Information related to performance against these practice standards was collected using a bespoke data collection tool. The data collected on each eligible patient included the following: age, sex, ethnicity, nature of clinical service providing care and clinical diagnoses.…”

“…It has a more extensive evidence base than any other drug used for paediatric sleep disorder. Although uncertainties about its optimal use remain, there is an emerging consensus that for children with circadian rhythm disorders, particularly delayed sleep phase syndrome, melatonin, with regular follow-up and assessment, can be a useful treatment, 2 9 10 particularly in those with neurodevelopmental disorders. 3 11 However, the benefits are generally modest.…”

“…Compared with their healthy peers, sleep disturbances are far more common in children with neurodevelopmental or psychiatric disorders, affecting 50-80%. [1][2][3][4] These disorders can adversely affect the daytime functioning of a child and impact on family life 5 prompting parents to seek medical help.…”