I have a 6-year-old daughter who has been diagnosed with ASD. I have received many recommendations from other parents regarding the use of melatonin to aid my daughter’s sleep. She is a typical ASD kid, who can be in bed by 8pm after the shower, reading, drink routine, but still active 3 hours later. Any advice you have would be appreciated. 

Associate Professor Amanda Richdale (PhD, MAPS), our Principal Research Fellow, has provided this answer.

Problems settling to sleep are very common in children with ASD. Each case is individual and needs individual assessment.  Some recent research suggests that trouble getting to sleep may be related to anxiety or that children may have trouble stopping thoughts racing round their minds.  That is, some children with ASD might be very anxious or simply highly aroused at bedtime.

First, it is important to look at your child’s bedtime routine, which you seem to have done. The bedtime routine should be calming and aimed at winding down. The bedroom environment is also important with regard to noise, temperature, light, comfort etc and there should be no TV, computers, iPads, phones or other electronic devices in the bedroom.  If these things have all been attended to then look at what might help your child relax. Teaching her to relax may be important.  You might find it useful to consult a psychologist regarding relaxation and to try and find out why your child spends such a long time awake.  If your child is anxious, treating the anxiety may resolve the sleeping issue.

It can help you, or any other professional you decide to consult, to work out why your daughter is having trouble getting to sleep by keeping a sleep diary for 2 weeks.  You should record when your child went to bed, what time the light was put out to settle her to sleep, what time she went to sleep, if and when she woke during the night, and when she woke (note if you woke her) in the morning.  Also note things that are different from usual on any days. For example, if she was sick that day, had a bad day at school, went somewhere after school or on the weekend etc.  It may be that on “bad school days” your child has more trouble getting to sleep for example.

Melatonin can be useful to help some children with ASD sleep, but it does not help all children.  Melatonin is a naturally occurring neurohormone that helps regulate our 24 hour (circadian) rhythms, such as the sleep-wake rhythm.  It is used to treat jet lag, as it can reset rhythms when we change time zones.  Melatonin also has a soporific effect (i.e., it generally makes people feel sleepy), if given prior to bedtime.  There have been a number of studies looking at the effect of melatonin on sleep in children with sleep problems, especially children with ASD.  The best evidence is that between 1 and 6 mg per night helps children with ASD fall asleep more quickly.  Children should only be given melatonin under the direction of a medical practitioner, and generally they would take the minimum dose required to help them fall asleep.

Thus the recommended approach for treating sleep problems in children is to attend to their bedtime routine and sleeping environment. If that is unsuccessful, get some information by keeping a sleep diary, and consult a psychologist who can determine if there is a psychological or behavioural reason for the sleep issue and can then treat that (e.g., relaxation, use behavioural intervention as appropriate for the individual child). If you and/or the psychologist suspect a possible medical issue, consult a medical practitioner who can determine if there is an underlying sleep issue or another issue that may require treatment, and who can decide if a medication like melatonin is appropriate.

For More Information:

Read more about the use and effects of melatonin for children with autism on The Raising Children’s Network website.