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Melatonin for insomnia in autism.

RANCHO MIRAGE, CALIF. -- Melatonin is the first-choice pharmacotherapy for insomnia in children with autism spectrum disorders, although behavioral interventions are the preferred initial treatment, Dr. Kyle P. Johnson said at a conference on sleep disorders in infancy and childhood sponsored by the Annenberg Center for Health Sciences.

Between 44% and 83% of children who have autism spectrum disorders also have sleep problems, with insomnia a particular issue in this population, said Dr. Johnson of Oregon Health and Science University, Portland.

Several studies--one of them a randomized controlled trial--support the use of melatonin in children with autism or Asperger's syndrome.

For example, in one open-label 24-month trial, 3-6 mg of melatonin nightly resulted in some improvement in all 20 children enrolled, with no adverse side effects. When melatonin was discontinued, 16 of the 20 relapsed (J. Autism Dev. Disord. 2006;36:741-52).

An unpublished, placebo-controlled, double-blind crossover trial of 5 mg of melatonin on 16 children with autism or Asperger's syndrome found increases in total sleep time, shorter sleep latencies, and significant improvements in child functioning. (The study was presented at the 2005 meeting of the American Academy of Child and Adolescent Psychiatry by Dr. J.E. Jan of the Children and Women's Health Centre of British Columbia, Vancouver.)

Dr. Johnson recommended starting patients at very low doses of melatonin--one-half of the standard 3-mg pill at bedtime. Many children do well at 1.5 mg or 3 mg, but a member of the audience related an anecdote about one child who slept for 48 hours after taking a single 1.5-mg dose of melatonin.

Still, many children with autism will require much higher doses. Dr. Johnson said that he's willing to go up to 9 mg, and others are willing to go up to 12 mg or even 15 mg before concluding that melatonin is ineffective in a certain child.

In response to a question from the audience, he said chloral hydrate is a poor choice for treating insomnia in children with autism spectrum disorders because it can cause paradoxical excitation, and it quickly causes tolerance.

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Title Annotation:Clinical Rounds
Publication:Pediatric News
Date:Apr 1, 2007
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