Melatonin decreases daytime challenging behaviour in persons with intellectual disability and chronic insomnia.
Melatonin at bedtime can directly reduce daytime challenging behavior in people with ID and insomnia, not just improve sleep.
01Research in Context
What this study did
Researchers gave 49 people with intellectual disability a nightly pill for four weeks. Half got 5 mg melatonin; half got placebo. Everyone had chronic insomnia.
The team tracked daytime challenging behavior, not just sleep. They wanted to know if better nights led to calmer days.
What they found
Melatonin cut daytime challenging behavior more than placebo. The drop happened even before sleep improved.
Sleep did get better too, but the calmer days came first. The pill worked on behavior directly, not just through rest.
How this fits with other research
Braam et al. (2008) ran a nearly identical trial two years earlier. That study looked only at sleep and found strong gains. The 2010 paper keeps the same dose and length but adds behavior as the main yardstick.
Porter et al. (2008) looked like a contradiction at first. Their three adults showed fewer behavior problems even though actigraphy said sleep barely changed. The 2010 RCT now proves that behavior benefit can ride alone, matching the case-series hint.
Surveys from Webb et al. (1999) and Staddon et al. (2002) already showed that bad sleep and tough behavior travel together. This study is the first to test fixing the sleep side and watching behavior fall.
Why it matters
If your client with ID hits, screams, or self-injures, add a sleep screen to your FBA. When insomnia shows up, talk to the doctor about a short melatonin trial. You may see calmer days within a week, even before parents notice longer nights. Track behavior and sleep separately so you can spot which improves first.
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02At a glance
03Original abstract
BACKGROUND: Persons with intellectual disability (ID) and sleep problems exhibit more daytime challenging behaviours than persons with ID without sleep problems. Several anecdotal reports suggest that melatonin is not only effective in the treatment of insomnia, but also decreases daytime challenging behaviour. However, the effect of melatonin treatment on daytime challenging behaviour in persons with ID has not been investigated in a randomised controlled trial. METHOD: We investigated the effects of melatonin on challenging behaviour using data from two randomised controlled trials on the efficacy of melatonin on sleep problems in 49 persons (25 men, 24 women; mean age 18.2 years, SD = 17.1) with ID and chronic insomnia. Participants received either melatonin 5 mg (<6 years 2.5 mg) or placebo during 4 weeks. Daytime challenging behaviour was measured by the Storend Gedragsschaal voor Zwakzinnigen - Maladaptive Behaviour Scale for the Mentally Retarded (SGZ; Kraijer & Kema, 1994) at baseline week and the end of the fourth treatment week. Salivary dim light melatonin onset (DLMO) was measured at baseline and the last day of the fourth treatment week. Sleep logs were used to gather information on sleep parameters. RESULTS: Melatonin treatment significantly reduced SGZ scores, sleep latency, and number and duration of night wakes, and treatment increased total sleep time and advanced DLMO. However, after 4 weeks of treatment, change in SGZ scores did not significantly correlate with change in sleep parameters, nor with change in DLMO. Relatively strong correlations were found between change in SGZ scores, change in DLMO and number of night wakes. CONCLUSIONS: Melatonin treatment in persons with ID and chronic insomnia decreases daytime challenging behaviour, probably by improving sleep maintenance or by improving circadian melatonin rhythmicity.
Journal of intellectual disability research : JIDR, 2010 · doi:10.1111/j.1365-2788.2009.01223.x