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For those of us with children on the spectrum, we have seen how they have had great difficulties with falling asleep and staying asleep throughout the night.
Their sleep troubles may have made their behavior worse, disrupted their learning at school, and overall reduced their quality of life.
Our heart breaks for them when we see them going through this and we could feel powerless to help them.
But if we told you that there are ways to improve their sleep duration and quality?
One of the best ways to do so is through melatonin supplements.
In this article, we’ll be discussing how melatonin supplements functions as a sleep aid for children with autism spectrum disorder.
But first, let’s take a look at:
What is Melatonin?
Melatonin is referred to as the “sleep hormone” and “darkness hormone.” It is a naturally occurring hormone that is made by the pineal gland, found just above the middle of the brain. For most people, the pineal gland remains inactive during the daytime. In the nighttime, while your body is in a dark environment, it actively begins to produce and release melatonin for sleep.
Melatonin is then steadily released into the bloodstream, which helps you fall asleep.
Numerous studies have shown that melatonin benefits sleep in many ways:
- Puts you into a state of drowsiness to get you ready for sleep
- Extends your total sleep duration
- Helps you fall asleep quicker
- Enriches your overall sleep quality
- Enhances your alertness in the morning
- Helps sleep problems caused by insomnia or jet lag
During a normal night of sleep, the levels of melatonin in the bloodstream will remain elevated between the hours of 9 PM – 9 AM for a period of 12 hours.
As the sun rises and daylight comes, the pineal gland will become inactive and stop making melatonin, decreasing the levels of melatonin in the bloodstream. During the daytime, those levels are almost not even detectable in testing. So, what determines how much melatonin is produced in your body?
The amount of melatonin that is made and released into the bloodstream during the night depends on many factors, including your age.
As you get older, less melatonin will be made and released. Children typically have higher blood levels of melatonin than adults do.
Researchers have connected this to the occasional sleep disturbances that older adults may experience. Lower blood levels of melatonin may make it more difficult to fall and stay asleep. As a result, that makes it less likely that you will have a restful and energizing sleep.
Next, let’s get into:
What is Autism Spectrum Disorder?
Autism spectrum disorder refers to a developmental disorder that starts early in a person’s childhood years, usually before the age of 3, and lasts throughout that person’s life. It negatively affects the ability to learn, communicate, and how a person acts and interacts with other people.
The Diagnostic and Statistical Manual of Mental Disorders (DSM-5), which is a guide published by the American Psychiatric Association as a guide for the diagnosis of mental disorders, provides standardized criteria to help diagnose autism spectrum disorder.
- Persistent deficits in social communication and interaction across multiple contexts
- Restricted and repetitive patterns of interests, behaviors, and/or activities
- Symptoms that cause clinically significant impairment in social, academic, occupational, or other important areas of functioning
The reason that autism is called a “spectrum” disorder is because there is a lot of variation in the types of symptoms, as well as the severity of those symptoms that people experience.
Autism spectrum disorder occurs in all racial, ethnic, and economic groups of people.
However, the disorder is approximately 4 times more common among boys than girls. Additionally, it is more common in prematurely born children.
Now that we know what autism spectrum disorder is:
What Causes Autism Spectrum Disorder?
Researchers have yet to identify any one specific trigger for the development of autism.
Most researchers agree that it may be caused by abnormalities in the structure or function of the brain very early in development.
Imaging studies of people that have autism spectrum disorder showed that there were differences in how several regions of the brain developed compared to those of neurotypical children, or children who are not on the spectrum.
These differences could be due to genetic defects in those genes that regulate both brain development and intercellular communication in the brain.
Researchers are continuing to study how factors such as viral infections, chemical exposure, and metabolic imbalances may disrupt normal brain development, resulting in autism spectrum disorder.
It’s time that we connect melatonin to autism spectrum disorder.
Let’s get started with:
How is Sleep Affected in Children with Autism Spectrum Disorder?
It has been found that between 44%-86% of children with autism spectrum disorder have a sleep disorder.
Research has consistently found that sleep-onset insomnia and middle-of-the-night awakenings are the most frequently experienced sleep issues.
One study done at the Vanderbilt University School of Medicine was designed to define the sleep phenotype in children with autism spectrum disorder.
For reference:
Phenotype refers to the physical expression, or characteristics, of a trait.
Let’s dive into this study.
Fifty-eight children between the ages of 4-10 years who had received a clinical diagnosis of autism spectrum disorder participated in this study.
None of the 58 children in this study had a medical history of epilepsy or intellectual disability, and they were not on psychotropic medications at the time of the study.
The parents of the children were given a series of questionnaires to complete with their demographic information, as well as:
- Children’s Sleep Habits Questionnaire, or the CSHQ = recorded the children’s sleep habits
- Parental Concerns Questionnaire, or PCQ = recorded the parents’ concerns about their children’s behaviors
- Child Behavior Checklist, or CBCL = recorded the daytime behaviors that the children exhibited
- Repetitive Behavior Scale-Revised, or RBS-R = recorded the spectrum of their children’s repetitive behaviors
So what was found in these checklists?
Forty-two of the 58 children had autism spectrum disorder, while the other 16 were age-comparable typically developing children.
Of these 42 children on the spectrum, 15 of them were described by their parents as being good sleepers, whereas the other 27 were described as being poor sleepers.
All 16 of the typically developing children were described as being good sleepers on the PCQ.
All 27 of the children who were described as being poor sleepers reported moderate to severe sleep problems.
The parents of 19 out of the 27 children expressed their primary concern that their children had sleep-onset insomnia, or difficulty falling asleep.
These children were described as needing a long time to “wind down” and frequently vocalizing.
The parents of 14 out of the 27 children expressed a concern that their children would wake up in the middle of the night.
However, only 4 of these parents considered these middle-of-the-night awakenings as their primary concern.
These children were described as wandering outside of their bedrooms and being found asleep there.
Other concerns that parents had about their children was that the children either did not get enough sleep, or their sleep was restless.
Out of the 15 children who were described as being good sleepers, 9 parents described their children as having no sleep issues, and 6 parents reported that their children had mild sleep issues.
These issues include mild bedtime resistance, mild sleep onset delay, needing a parent to be present in order to fall asleep, occasional middle-of-the-night awakenings with a quick return to sleep, or getting too little sleep.
Several of the good sleeper children requested that they go to sleep at a scheduled time each night.
We should take a closer look at what each of these questionnaires measured and what they mean.
Let’s start with:
The Childhood Sleep Habits Questionnaire
The CSHQ features parameters such as:
- Sleep onset delay
- Sleep duration
- Sleep anxiety
- Middle-of-the-night awakenings
- Parasomnias
- Sleep disordered breathing
- Daytime sleepiness
- Total Score
For reference:
Parasomnias are sleep disorders that involve unwanted experiences that happen while you are falling asleep, sleeping, or are waking up, such as sleep terrors or sleep paralysis.
Higher total scores on this questionnaire indicate more severe sleep disturbances.
The results?
There were significant differences found among good sleepers, poor sleepers, and typically developing children.
The poor sleeper children had higher scores than good sleeper children on the parameters of sleep onset delay, sleep duration, middle-of-the-night awakenings, and total score.
The poor sleeper children had higher scores than typically developing children in all parameters except for sleep disordered breathing.
There were no significant differences between good sleeper children and typically developing children.
All 58 children were also measured on objective parameters of sleep, including:
- Sleep latency = the amount of time it takes to fall asleep after the lights have been turned off
- Sleep efficiency = the percentage of time spent asleep while in bed
- It is calculated by dividing the amount of time spent asleep, in minutes, by the total amount of time in bed, in minutes.
- Normal sleep efficiency measures at 85% and higher.
- Waking after sleep onset = the sum of all the time spent awake after waking up from sleeping
- Total Sleep Time
- Movement & fragmentation index = reflects all movement while asleep, regardless of the intensity
- Arousal index = a measurement of the total number and frequency of sleep disruptions
The children were measured on these parameters using two different methods: actigraphy and polysomnography.
Actigraphy is a non-invasive method of measuring sleep and wake patterns based on limb movement. Polysomnography requires wearing wires and electrodes, and is a more invasive and costly method of measuring sleep and diagnosing sleep disorders.
The children underwent two consecutive nights of simultaneous polysomnography and actigraphy monitoring. While the actigraph watch was maintained, as tolerated by the children, they were only connected to the polysomnography equipment during the nighttime.
The researchers of this study wanted to do both tests simultaneously because they wanted to identify the advantages of using actigraphy to measure sleep compared to polysomnography, and outside the limitations of the home setting.
So what were the results of these two tests?
All three groups of children showed differences on these objective parameters of sleep.
In the actigraphy test, all three groups had significant differences on the parameters of sleep latency, sleep efficiency, wake after sleep onset, and the movement and fragmentation index.
The poor sleeper children took longer to fall asleep, had worse sleep efficiency, had more wake after sleep onset, and a higher movement and fragmentation index than the good sleeper children. The good sleeper children had less wake after sleep onset and a lower movement and fragmentation index than the typically developing children. In the polysomnography test, all three groups of children showed significant differences on the parameter of sleep latency.
The poor sleeper children took much longer to fall asleep than the children in the other two groups. Compared to the results of the actigraphy test, there were no differences between the other sleep parameters among the three groups of children.
Next comes:
The Parental Concerns Questionnaire
In the PCQ, in which parents described their children as good or poor sleepers, the parents reported the extent to which each of 13 behaviors have been a problem for the past month. These 13 behaviors are:
- Language use and understanding
- Compulsive behavior
- Anxiety
- Sensory issues
- Sleep disturbance
- Aggression
- Hyperactivity
- Attention span
- Mood swings
- Eating habits
- Social interactions
- Self-stimulatory and repetitive behaviors
- Self-injurious behaviors
The results of this checklist?
There were differences found among all three groups of children on these behaviors. The poor sleeper children showed less attention and more hyperactivity than the good sleepers.
In the groups of children with autism spectrum disorder, the wake after sleep onset, measured by the actigraphy test, correlated positively with the hyperactivity scale on the PCQ.
The typically developing children showed lower scores on all behaviors than the poor sleepers and good sleepers, except for sleep disturbances. Both the good sleeper children and typically developing children scored similarly on the behavior of sleep disturbances.
Third is:
The Repetitive Behavior Scale-Revised
The RBS-R measures the parameters of:
- Stereotyped behaviors
- Self-injurious behaviors
- Compulsive behaviors
- Ritualistic behaviors
- Restricted behaviors
- A need for sameness
So, what were the results of this checklist?
All three groups showed differences in these parameters.
The poor sleeper children showed higher scores on compulsive and ritualistic behaviors than the good sleeper children. The typically developing children showed lower scales on all parameters than the children in both other groups.
In the groups of children with autism spectrum disorder, there was a significant positive correlation between middle-of-the-night awakenings, and ritualistic behaviors, compulsive behaviors, restricted behaviors, a need for sameness, and the total score.
Finally, we come to:
The Child Behavioral Checklist
The CBCL measures the parameters of:
- Somatic complaints = involves a significant focus on physical symptoms that result in major distress and/or problems functioning
- Internalizing = behaviors resulting from negativity that is focused inward because of difficulties coping with negative emotions or stressful situations
- Externalizing = behaviors resulting from negativity that is focused on the external environment because of difficulties coping with negative emotions or stressful situations
- Oppositional defiant problems = uncooperative, defiant, and hostile toward peers, parents, teachers, and other authority figures
- Anxious/depressed behaviors
- Attention problems
- Aggressive behavior
- Affective problems
- Anxiety problems
- ADD problems
There were no differences found on these parameters between the poor sleeper children and good sleeper children. There were significant differences on all of these parameters among all three groups. The typically developing children scored lower on all of these parameters than the children in the other two groups.
Overall, the study determined that, compared to the good sleeper children, the poor sleeper children showed a longer sleep latency in both the actigraphy and polysomnography tests and more sleep fragmentation and wake after sleep onset in the actigraphy test. The good sleeper children showed comparable, if not better sleep than the typically developing children on both subjective and objective sleep parameters.
The researchers were also able to show a positive correlation between hyperactivity, compulsive and ritualistic behaviors, and poor sleep in children with autism spectrum disorder.
The objective actigraph measurements also showed a positive correlation between hyperactivity and wake after sleep onset, and middle-of-the-night awakenings and restricted/repetitive behaviors.
The Connection Between Melatonin Benefits and Autism Spectrum Disorder
Researchers suggest that there is a connection between the circadian rhythms of melatonin and the sleep issues that children with autism spectrum disorder experience.
They believe that the sleep issues may be due to changes in the synchronization of circadian rhythms of melatonin. It has been well established that the neurotransmitters of serotonin, melatonin, and GABA are needed to set up a regular wake-sleep cycle. If the production of any of these neurotransmitters is impaired, then sleep will be disrupted.
It is believed that the regulation of melatonin may be abnormal in children with autism spectrum disorder. These children have shown decreased activity in the N-acetylserotonin O-methyltransferase gene, which catalyzes the final chemical reaction in the conversion of serotonin to melatonin. This implies that children on the spectrum have lower levels of melatonin. The preoptic area in the hypothalamus is the major area in the brain that promotes sleep, and uses GABA as a neurotransmitter.
GABA significantly increases calming alpha waves, and decreases beta waves, which are associated with busy or anxious thinking.
It also suppresses nerve cell activity and acts as a natural means of sleep induction.
How are GABA levels affected in children on the spectrum?
The migration and maturation of GABAergic interneurons may be affected in children with autism spectrum disorder.
This disrupts the circadian rhythms related to sleep and may contribute to the major problem of sleep onset insomnia.
The Developmental Medicine and Child Neurology journal published a 2011 scientific review of 35 studies that concentrated on melatonin benefits in children with autism spectrum disorders, including autistic disorder, Asperger’s Syndrome, Rett Syndrome, and other pervasive developmental disorders.
Nine of these 35 studies measured melatonin and its metabolites in children on the spectrum.
All of these studies reported at least one abnormality:
- Four of the nine studies reported that children on the spectrum showed an abnormal melatonin circadian rhythm.
- Seven of the nine studies reported that children with autism spectrum disorder showed below-average physiological levels of melatonin and/or its derivatives.
- Four of the nine studies reported a positive correlation between below-average physiological melatonin levels and autistic behaviors.
There were five studies that reported gene abnormalities that could lead to reduced melatonin production or adversely affect melatonin receptor function in a small percentage of children on the spectrum. So, what do these studies have to say about how melatonin benefits children with autism spectrum disorder?
Six studies reported that melatonin supplements improved daytime behavior in children on the spectrum. These improvements included:
- Less behavioral rigidity
- Ease of management by parents and teachers,
- Fewer temper tantrums
- Less irritability
- Better social interaction
- More playfulness
- Increased alertness
- Better academic performance
Eighteen studies on melatonin supplements as a treatment method for children on the spectrum reported that these children showed improvements in sleep latency, sleep duration, and middle-of-the-night awakenings.
Five of the 18 studies were randomized double-blind, placebo-controlled crossover studies, with two of the studies containing blended samples of children on the spectrum and children with other developmental disorders.
It should be noted that only the data pertaining to autism spectrum disorder was used in the meta-analysis.
The meta-analysis of these five studies showed significant improvements with large effect sizes on the parameters of sleep latency and sleep duration, but not in middle-of-the-night awakenings.
The researchers who conducted this review interpreted the results of the studies as evidence that melatonin supplements in children with autism spectrum disorder correlated positively with better sleep, improved behavior during the daytime, and having minimal side effects.
Additionally, melatonin supplements are relatively inexpensive and safe, even after multiple years of use.
Liposomal Melatonin Supplement Technology
If you are looking for ways to increase your levels of melatonin for improved sleep, then you should consider a melatonin supplement.
More specifically, you may want to do some research on Liposomal Melatonin Technology. Liposomal Melatonin Technology uses micro sized fluid filled liposomes to protect and deliver nutrients directly into the cells and tissues of the body.
These liposomes are very similar to human cells, which makes it easier for them to be transported within the body. As a result, nutrient absorption is greatly increased, and there is less intestinal discomfort than with using standard oral supplements.
Liposomal Technology provides several different advantages, including:
- Micro-sized encapsulation that protects against the harsh acidity of the gastrointestinal tract
- Increased delivery to cells, tissues, and organs
- Higher absorption rates and bioavailability than other standard oral supplements
- Noninvasive compared to intravenous supplementation
- Lower doses provide the same effects as high-dose standard oral supplements
- Helps put nutrients to use by the body faster
- Prevents gastrointestinal distress usually experienced with standard oral supplements
Clearly, Liposomal Melatonin Supplements deserve serious consideration for its potential sleep aid properties.
Why You Should Consider a Melatonin Supplement for Your Child on the Spectrum?
Many children with autism spectrum disorder may experience chronic sleeping issues that may make their daytime behaviors even worse. That results in much greater difficulty in getting them to go to sleep, and stay asleep. It almost becomes a negative cycle that keeps on repeating.
If your child on the spectrum is struggling with going to sleep at night, and/or wakes up repeatedly during the middle of the night, then you may want to strongly consider melatonin supplements.
It will improve your child’s ability to fall asleep and stay asleep throughout the night, and may help with many of their more problematic daytime behaviors. That will also help them go to sleep easier and faster and will help feed into a cycle of continuously improving sleep and daytime behavior.