Adherence to treatment and parents' perspective about effectiveness of melatonin in children with autism spectrum disorder and sleep disturbances.
Real-world parent data show melatonin remains safe and effective for months, helping autistic kids fall asleep faster and wake up less while giving one-third a daytime boost.
01Research in Context
What this study did
Sadeh et al. (2023) sent a short survey to parents of autistic children who take melatonin for sleep. Parents answered questions about dose, how long their child had used it, and any changes in sleep or daytime behavior.
The team wanted real-world data, not lab results. They asked if families stick with melatonin and what parents actually notice at home.
What they found
Most parents kept using melatonin for months or years. They said sleep started faster, lasted longer, and night wakings dropped. About one in three also saw small but clear daytime gains like calmer moods or better focus.
No serious side effects were reported. Parents called the benefits "clinically meaningful," meaning the change was big enough to matter in daily life.
How this fits with other research
The picture lines up with Lee et al. (2022). Their meta-analysis of 49 studies showed poor sleep drags down daytime functioning in autistic kids. Fixing sleep, as Sadeh now shows, should lift those same daytime skills.
Tse et al. (2022) took a different road: morning jogging instead of pills. Exercise raised the children’s own melatonin levels and also improved sleep. Both studies point to melatonin—inside or outside the body—as a key lever.
Fox et al. (2001) once called melatonin evidence "mixed." The new survey updates that view. Earlier work pooled many disabilities and short trials; Sadeh zooms in on autistic children in long, real use, showing parents stay loyal because they see steady benefit.
Why it matters
You now have parent-powered proof that melatonin keeps working month after month. Use this when families worry about "forever drugs." Share that most kids stay on the same low dose, sleep improves, and daytime life can get a little easier too. Pair the pill with simple sleep habits and track both night and day gains—you may see the wider payoff Lee et al. (2022) predict.
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02At a glance
03Original abstract
Melatonin is considered an effective pharmacological treatment for the sleep disturbances that are reported in > 50% of children with autism spectrum disorder (ASD). However, real-life data about the long-term course and effectiveness of melatonin treatment in children with ASD is lacking. In this retrospective cohort study, we assessed the adherence to melatonin treatment and parents’ perspective of its effect on sleep quality and daytime behavior in children with ASD via a parental phone survey of children in the Azrieli National Center for Autism and Neurodevelopment Research (ANCAN) database. Cox regression analysis was used to assess the effect of key demographic and clinical characteristics on treatment adherence. Melatonin was recommended for ~ 8% of children in the ANCAN database. These children were characterized by more severe symptoms of autism. The median adherence time for melatonin treatment exceeded 88 months, with the most common reason for discontinuation being a lack of effectiveness (14%). Mild side-effects were reported in 14% of children, and 86%, 54%, and 45% experienced improvements in sleep onset, sleep duration and night awakenings, respectively. Notably, melatonin also improved the daytime behaviors of > 28% of the children. Adherence to treatment was independently associated with improvements in night awakenings and educational functioning (aHR = 0.142, 95%CI = 0.036–0.565; and aHR = 0.195, 95%CI = 0.047–0.806, respectively). Based on parents’ report, melatonin is a safe and effective treatment that improves both sleep difficulties and daily behavior of children with ASD. The online version contains supplementary material available at 10.1186/s13034-023-00669-w.
Child and Adolescent Psychiatry and Mental Health, 2023 · doi:10.1186/s13034-023-00669-w