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Melatonin Intervention in Autism

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Autism spectrum disorder, or ASD, encompasses a variety of conditions and affects a diverse population. One common issue plaguing many people with ASD is insomnia. Adults with ASD, as well as 40% to 80% of children with ASD, experience sleep disturbances including prolonged time to fall asleep, reduced sleep efficiency, shorter sleep time and continuity, and nighttime awakenings. [3, 11]

Unconventional and complementary treatments are commonly used for sleep issues and other concerns, with 74% of children using off-label or alternative therapies. Although common, healthcare practitioners are often unaware of their patients’ adjunctive treatments. [8] When considering implementing an alternative or complementary treatment for ASD or another condition, it is essential that the healthcare practitioner is informed, so that they can offer guidance and ensure that the treatment may be safe and effective for the individual. One therapy for insomnia growing in popularity is melatonin supplementation. New research supports this intervention for treating sleep disorders for people with ASD.

Abnormal Melatonin

Melatonin is a hormone produced by the pineal gland, a small endocrine gland in the brain, and is the final product of the serotonin pathway. Colloquially known as “the sleep hormone,” melatonin is released in cycles, and plays an important role in circadian rhythms, affecting cognition and behavior along with sleep. [7, 10] Research has found that melatonin and/or melatonin metabolite levels are lower in people with ASD. [4, 7, 10]

While the exact mechanisms behind this abnormality remain unknown, recent research indicated that low melatonin may be due to low activity of acetylserotonin O-methyltransferase (ASMT). ASMT is an enzyme in the serotonin synthesis pathway[RR1]  that catalyzes the last reaction to create melatonin. Irregular activity of this enzyme may be due to a genetic variation. [4, 7, 9, 10] Furthermore, there may be a positive correlation between abnormal circadian rhythm and below-average melatonin levels, and the presence of autistic behaviors. [9]

Effective, Sustainable, Safe

Supplementation with melatonin has been shown to be safe and effective for people with ASD. Research has demonstrated improvements in sleep onset latency (how long it takes to get to sleep), longer sleep duration, and number of nighttime awakenings. [2, 6, 8, 10, 12] Melatonin supplementation may also improve daytime behavior and help lessen parenting stress associated with parents of children with ASD. [6, 9]

These positive effects have been shown to be sustainable, maintained for several months during supplementation in research trials. [2, 6] Supplemental melatonin is well-tolerated and safe for adults and children, with research reporting minimal to no side effects. [1, 2, 6, 9, 10]

People with ASD should be screened for insomnia, as well as for potential contributing factors to their concerns, including other medical problems. Although melatonin is safe, well-tolerated, and effective, people with ASD/guardians of children with ASD should always consult with their primary healthcare practitioner to ensure a comprehensive and well-informed approach. The protocol should be tailored to the individual, complete with a follow-up after any intervention to evaluate effectiveness and tolerance of the therapy, as people may respond differently. [2, 5, 8]

To summarize, many people with ASD struggle with insomnia and sleep issues that affect daytime functioning and behavior, and are associated with the dysregulated melatonin levels and serotonin pathway found in ASD. Out of a sea of complementary treatments for ASD issues, melatonin supplementation is rising as an effective, evidence-based approach. Current research supports the efficiency and safety of supplemental melatonin in regulating circadian rhythms and improving sleep issues, providing a potentially life-changing intervention for people with ASD.

References

1. Andersen IM, Kaczmarska J, McGrew SG, & Malow BA. (2008). Melatonin for insomnia in children with autism spectrum disorders. Journal of child neurology.

2. Galli-Carminati GM, Deriaz N, & Bertschy G. (2009). Melatonin in treatment of chronic sleep disorders in adults with autism: a retrospective study. Swiss medical weekly, 139(19-20), 293-296.

3. Goldman SE, Richdale AL, Clemons T, & Malow BA. (2012). Parental sleep concerns in autism spectrum disorders: variations from childhood to adolescence. Journal of autism and developmental disorders,42(4), 531-538.

4. Jonsson L, Ljunggren E, Bremer A, et al. (2010). Mutation screening of melatonin-related genes in patients with autism spectrum disorders. BMC medical genomics, 3(1), 10.

5. Malow BA, Byars K, Johnson K, et al. (2012). A practice pathway for the identification, evaluation, and management of insomnia in children and adolescents with autism spectrum disorders. Pediatrics, 130(Supplement 2), S106-S124.

6. Malow B, Adkins KW, McGrew SG, et al. (2012). Melatonin for sleep in children with autism: a controlled trial examining dose, tolerability, and outcomes. Journal of autism and developmental disorders, 42(8), 1729-1737.

7. Melke J, Botros HG, Chaste P, et al. (2008). Abnormal melatonin synthesis in autism spectrum disorders. Molecular psychiatry, 13(1), 90-98.

8. Rossignol DA. (2009). Novel and emerging treatments for autism spectrum disorders: a systematic review. Ann Clin Psychiatry, 21(4), 213-36.

9. Rossignol DA, & Frye RE. (2014). Melatonin in autism spectrum disorders. Current clinical pharmacology, 9(4), 326-334.

10. Rossignol DA, & Frye RE. (2011). Melatonin in autism spectrum disorders: a systematic review and meta‐analysis. Developmental Medicine & Child Neurology, 53(9), 783-792.

11. Souders MC, Mason TB, Valladares O, et al. (2009). Sleep behaviors and sleep quality in children with autism spectrum disorders. Sleep, 32(12), 1566-1578.

12. Wirojanan J, Jacquemont S, Diaz R, et al. (2009). The Efficacy of Melatonin for Sleep Problems in Children with Autism, Fragile X Syndrome, or Autism and Fragile X Syndrome. J Clin Sleep Med, 5(2), 145-150.

 

Clinical Contributor

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Connie Shoemaker, ND

Connie Shoemaker, ND

“Educating Sanesco’s clients is the culmination of a life’s work.” Beginning when she left the hospital environment to manage a functional laboratory, Genova Diagnostics (formerly Great Smokies Laboratories) in 1987, Dr. Connie Shoemaker has continued to increase her knowledge of herbs and biochemistry as a journey of love. With her bachelor’s in science from Western Carolina University, she had worked in hospital laboratories for the first twelve years of her career. Then, personal health challenges led her to discover a new approach to her health and a determination to share it with others. In 1991, she began teaching and educating innovative practitioners in the U.S. and internationally as a manager of marketing, sales, and customer service.

The addition of her Doctor of Naturopathy degree to her existing knowledge base expanded her knowledge and her respect for a more natural approach to healing through balance. At Sanesco, she initially served to oversee technical development of products and services.

Now, she educates Sanesco’s clients on application of the CSM™ model for their specific patients and how to integrate the CSM™ model with other modalities they offer in their practice. In her personal life, Connie educates private clients on various health topics.

Disclaimer: The information provided is only intended to be general educational information to the public. It does not constitute medical advice. If you have specific questions about any medical matter or if you are suffering from any medical condition, you should consult your doctor or other professional healthcare provider.

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