I recently ran across this fantastic article in Psychology Today about nature versus nurture in child rearing. Robert Plomin Ph.D., dives into the research he presents in his book, Blueprint: How DNA Makes Us Who We Are.
What he has found is that our DNA is the driving force behind our psychology from personality to behavior. Your wonderfully sassy kid is probably genetically designed to be sassy. So strap in and hold on for this ride, because that kid isn’t going to change. (Keep that in mind when you’re feeling some type of way about your child’s “attitude.”)
He notes, for instance, that parents who read a lot to their children likely have children who enjoy being read to at a basic psychological level. So, when your mom friend starts bragging about reading 400 books to her daughter over the summer and asking you how many books you read to yours, don’t feel bad that your own daughter was too busy drawing to be bothered to sit for many stories. Your child’s personality is going to be very close to what it already was at conception, save for a major brain event.
On one hand, it’s freeing to know that all the experiences children encounter and process through the lens of their DNA help form their understanding of how the world works. Experiences are important and the field of epigenetics is informing us more every day about just how important they are. What we know for certain is that it’s crucial to develop a relationship with your child to find out their strengths and aptitudes and build on those. That sassy child I mentioned likely has heaps of natural confidence. Consider all the wonderful things they’ll be able to do, perhaps, in the public sphere. They may become an influencer or a politician. When you take note and support their interests, so many wonderful things will happen.
My son, for instance, is pretty chill at the most basic level. He mostly works with Peaceful Dad and me and follows directions well, but he needs our patience because he works in his own time. My daughter, on the other hand, is a spitfire. She’s demand avoidant to an extent and will fall to the floor in a heap at the slightest resistance on my part. Respecting my children means I plan in lots of thinking time for my son and I try not to rush him. And, for my daughter, I stay in her space without judgment as she frets. Then, when she’s ready to do something else, we work together.
Peaceful Parenting offers the ideal framework and guidance to work with children’s different personalities and needs. It respects the essence of the child and is flexible enough to move with a child’s genetic tendencies without any of the rigidity that can stifle a child’s inborn potentiality.
ABA is an extremely sensitive topic. You may experience intense emotions as you read this piece. I ask that you read through the post in its entirety before you make a final decision on what your perspective will be. If you need clarification, please ask. If you disagree, I’d appreciate your feedback.
It has taken me months to prepare this post for so many reasons, not the least of which is that I’ve been coming to terms with my own very late autism diagnosis. I’m one of the fortunate people who wasn’t subjected to Applied Behavior Analysis (ABA) therapy, but so many autistic people are not so lucky. I write this post for them and for all the children now and in the future who will undergo this very painful experience.
At the start, I have to make clear that I am not a professional. I’m an autistic mom of an autistic child, and I have been in the position of deciding whether or not to put my child into ABA therapy.
I also need my fellow parents to know that I am not condemning you if you’ve chosen ABA therapy. It is the gold standard “treatment” for Autism Spectrum Disorder (ASD), it’s covered by insurance, and it certainly seems to work. Unless you’ve been exposed to autistic adults and our position on ABA, there’s little reason for you to be concerned. I hope you will hear what we have to say and consider whether you want to continue down this path.
Autism Isn’t a Behavior Disorder
So, why treat it with compliance-based training? Autism is a completely natural, neurological variant. It is only disabling in cultures where autistic people are not included and embraced.
Autistic brains perceive and process the world differently from allistic brains. But, we are fundamentally human beings, like everyone else, with the same emotions and responses to stimuli. If you hear a loud noise, do you not cover your ears? That’s not considered odd at all, right? So, why would it be odd for an autistic person to do the same? Sure, it might be accompanied by humming and rocking, because stimming is so comforting to us, but we’re doing the same thing you do to reduce the strain of overstimulation. When allistic children relieve intense stress by cutting, we don’t send them to compliance-based training to try and coerce them to stop. We get them into helpful therapies to give them back control and provide relief that doesn’t harm, thereby addressing the problem rather than the behavior. And, that’s what autistic kids need: acknowledgement that behavior is communication and relief from the underlying problem.
A History of ABA Therapy
Back in the 1970s, UCLA psychologist, Ole Ivar Lovaas, participated in the development of a therapy that promised to alter “deviant” behavior. His involvement in the Feminine Boy Project offered him an opportunity to engage in a form of behaviorism soon-to-be-called conversion therapy wherein gay men would theoretically be converted to heterosexuality. He also used this new therapy in his work with autistic children.
Conversion therapy for homosexual people has since fallen out of favor, for obvious and good reason. However, autistic children are still subjected to the same behaviorism that we’ve deemed unacceptable for use on other human beings. The reason? It was the same back then as it is now. In the words of Lovaas himself, ABA therapy can make autistic kids “indistinguishable from their normal friends.” Unfortunately, that so-called progress comes at the price of an uptick in PTSD and suicide among autistic people. I’m sure you can understand how devastating it is to go through life feeling that the person you genuinely are simply isn’t enough for the people who say they love you. Now, before you decide that my criticism is unfounded, let me make it abundantly clear that Lovaas was a pretty despicablefellow:
Modern ABA might look gentler on the surface; however, at its core, it starts with the assumption that autistic people are broken and wrong, and it seeks to make our behavior more comfortable for allistic people.
Autistic Perspectives on ABA
Amythest Schaber is an autistic artist, writer, public speaker, and advocate. Her series, Ask an Autistic, tackles a great many topics that have proved helpful to her many allistic followers. In this episode, she explains what ABA is from her perspective.
The following list includes links to other autistic writers and advocates, as well as allies, who explain why ABA should be avoided:
Finally, this post from the Non-Binary Intersectionalist (and I must give tremendous credit to this page for the wealth of resources I’ve been able to provide in this post!) describes a recent interaction with a young child in ABA therapy:
If you’re interested in reading some personal accounts of ABA therapy, I encourage you to check out this post on Stop ABA, Support Autistics. If you still aren’t convinced that ABA therapy is harmful, read this post.
What’s the Alternative to ABA Therapy?
To answer this question, we have to consider what well-meaning parents intend to happen when they put their children into ABA therapy. Some of the most common reasons I’ve seen are 1) to help the child be more independent, 2) to help the child navigate society more easily, and 3) to protect the child from danger. There are many, many more reasons of course! These are simply the top three as I’ve understood them.
I imagine you won’t be very surprised to learn that the best alternative to ABA therapy, in my experience and in accordance with my values, is Peaceful Parenting.
Peaceful Parenting achieves each of the three aims I mentioned by instilling self-sufficiency, self-assurance, and boundary recognition in children, as well as improving emotional development and self-regulation, one interaction at a time. Peaceful Parenting does not require thousands upon thousands of dollars or 40+ hours a week of therapy. For symptomatic concerns, there are other wonderful therapies like speech therapy, occupational therapy, and physical therapy. These therapies can help discover and meet needs that parents may not fully understand. And, much like taking an ESL class, they help autistic kids learn a different culture without coercion.
Autistic kids deserve the same gentle treatment as any other child. If you wouldn’t put your neurotypical child into ABA therapy, there’s no need to put your autistic child into ABA therapy. If you’d consider Cognitive Behavioral Therapy (sidenote: CBT and ABA are not the same) to help your neurotypical child handle the stresses of life, offer the same to your autistic child. Figuring out how best to support a child – any child – can be complicated. But treating our children with the same responsive gentleness, regardless of neurology, need not be the least bit complicated.
In this TED Talk, Dr. Amy Laurent explains why autistic people need support in developing emotional skills, not behavior management:
ABA therapy is simply incompatible with Peaceful Parenting. The entire concept hinges on the adult therapist’s ability to coerce a child into compliance by withholding beloved objects and activities until the child “earns” them by obeying the therapist. ABA therapy discourages children from saying “no.” It does nothing to meet underlying, unmet needs and, instead, attempts to force children to ignore those needs while behaving as though the needs do not exist.
If you are a Peaceful Parent who is alarmed by what you’ve read, please know you and your child are enough just as you are. Your connection with your child is the key to comfort and growth. All children want to be heard and understood. Your job, then, is to learn how your child communicates and become conversant in their preferred language. Trust yourself. Trust your child. And, when you need help, find people who are willing to do the hard work of figuring out why your child is suffering and then find ways to relieve that suffering by way of accommodations and modifications. For instance, if your child hits himself in the head in the presence of very bright lights, the remedy is simple. Turn the lights down or off. When you start to see remedies everywhere, the rest falls right into place.
My son was diagnosed with ASD, Level 2 (since autism is diagnosed by how burdensome we are to allistic people, which is unfortunate) which means the expectation is that he will have far more additional needs as he grows up than an allistic child might. Considering the dire prognoses presented in medical literature, one might expect my son to barely function in the broader culture. In fact, many people do. But, let me tell you a story.
Recently, I took both of my kids to the gym for the first time ever. My gym has free childcare which makes my life so much simpler. So, here you have a young, autistic boy who has never set foot in this new place and finds himself face to face with brand new sounds and smells that he’s never experienced. He’s led into a small room with an abundance of toys, all bright and mishmashed, and he sees two complete strangers sitting there smiling at him. What does the boy do?
Well, he finds a stand-up racing track and begins racing little cars. He listens attentively to the caregivers, and he has a relaxed smile on his face when it’s time to go home. No meltdowns. No shutdowns. No stimming. No fear. And, the reason? He’s been the recipient of Peaceful Parenting from the day he was born. Peaceful Dad and I are firmly connected with him, so he feels safe. We do not punish or reward him, so he doesn’t feel coerced. We are honest with him and prepare him for new experiences, so he doesn’t feel blindsided. We treat him like any other deeply loved person and include him in all our activities, so he has plenty of other experiences to draw from when encountering something new. And he knows that, if it’s ever too much for him, we will respect his needs and find the exit as quickly as we can.
On the way to the gym, I explained in great detail what he could expect. His communication is primarily gestural and minimally verbal, so it’s not as though he could tell me in words that he understood. However, his reaction to the new experience said it all.
No autistic child is the same and your child may not be able to handle a new experience at a gym like what I’ve described. That’s totally normal and ok. There are going to be things your child can do that mine can’t. Again, all autistic people are different from one another. The key is learning what exactly that means for your child and filling in every single crevice in your child’s heart that is aching for your love and attention.
That includes autistic children who exhibit self-destructive and violent behavior. Remember, all behavior is communication. If a child, any child, is lashing out, something is wrong that the child can’t overcome. Our goal as parents has to be to investigate the underlying cause of our children’s challenging behavior and help to relieve any stressors we discover.
You Want Action Steps? We’ve Got Actions Steps.
You’ll find this to be a very short section, because I’m directing you to the single most helpful post I’ve ever read on helping autistic kids as a parent. For concrete, comprehensive details on what you can do for your autistic child without the use of any ABA whatsoever, please read If Not ABA, Then What at The Thinking Person’s Guide to Autism. The recommendations there will support what you are already doing as a Peaceful Parent.
Careful! ABA Ideology Can Wriggle Into Other Therapies
If you’ve gotten this far, I want to make sure you know that ABA ideology has infiltrated all aspects of the way professionals care for autistic people. Plus, because ABA is so profitable, some professionals use ABA codes to bill insurance even while they claim they aren’t practicing “traditional” ABA. However, don’t be fooled! If it’s called ABA, it is ABA. And, even if it’s not called ABA, the professional could be using ABA tactics to pressure your child into making advances. It can all be very confusing. An excellent post by Autistic Mama describes the red flags that should send you running for the door if you see them in any therapy your child undergoes. Please visit her post directly for a full explanation of each red flag.
Observation is Not Allowed
No Stimming Allowed
Requires Eye Contact
Excessive Reliance on Token Systems and Edibles
Rigid Approach or Refusing to Make Basic Accommodations
Focus on Outward Behaviors, Rather than Functional Skills
Expecting Kids to Perform on Command, Regardless of How Difficult Something is or Where the Child is at Emotionally
Moving too Fast or Not Breaking Down Tasks into Manageable Pieces
Learned Skills Don’t Transfer
Focus on Compliance
Focus on Verbal Communication
Punishment of Any Kind
You Are a Good Parent
Any parent who would go to the ends of the Earth, at any expense, for their child has earned that title. Please know my intention is not to attack you, though I understand why such an impact could result. You may be thinking that your child’s ABA looks nothing like what I’ve described or that your child loves their ABA therapist. I’m not here to argue or to condemn you. I ask only that you carefully consider the history of ABA, its inherent weaknesses, and the voices of autistic adults urging caution.
A Thank You to All My Fellow Autistic Adults
This post wouldn’t have been possible without the labor of my fellow autistics. You are so incredibly valuable and I appreciate you more than I can express. I have learned from you and I’ve been able to offer my son a better life because of you. Thank you!
Disclaimer: Nothing stated in this post should be construed as an alternative to diagnosis and treatment by a medical professional. I am not qualified to provide medical advice.
If you’re anything like me, you’ve heard of the near miraculous wonders of melatonin supplementation. You may have also heard some of the not so great effects. So, let’s get down to the truth with our dear friend, science.
Use the Navigation links below to jump to sections of interest or read through for all the knowledge.
Melatonin (5-methoxy-N-acetyltryptamine) is a fat-soluble hormone that confers widespread health benefits and is produced in the pineal gland of the brain as well as by the retina of the eye and by the gastrointestinal tract. Production of endogenous (meaning made by the body) melatonin is triggered by darkness, and it typically peaks between 11 PM and 3 AM. Our bodies’ ability to produce melatonin decreases with age.
Melatonin “plays the role of a universal endogenous synchronizer” which, in addition to helping to maintain the wake-sleep cycle, also influences hemostasis, glucose homeostasis, phosphocalcic metabolism, blood pressure, and antioxidant defenses. In other words, melatonin stabilizes the circadian rhythms in the body, thereby impacting the body’s ability to coagulate blood, maintain normal blood glucose levels and blood pressure, metabolize phosphate and calcium for functions such as bone mineralization, and defend against the damage caused by free radicals.
Exogenous (meaning man-made) melatonin supplements can be made one of two ways. Either from the pineal glands of animals, which can be dangerous due to the potential for viral contamination, or as a synthetic product that is manufactured in a lab. Most commercial supplements are synthetic. Plant-based supplements are in the pipeline and melatonin naturally exists in the foods we eat as forms of it are produced by living organisms from animals to bacteria to algae to plants and beyond.
Back in 1994, Dr. Richard Wurtman, professor of neuroscience at MIT, led a team that confirmed where melatonin was produced in the body and how it functioned. His team discovered that a dose of 0.3 milligrams of melatonin helped older adults fall asleep faster and get back to sleep if they woke up in the night. However, researchers also discovered that commercial melatonin contained 10 times the effective dose, which, when taken regularly, ultimately overwhelms melatonin receptors in the brain, causing them to become unresponsive. At the time, he warned that “People should not self-medicate with melatonin.”
Studies to date have utilized pharmaceutical grade melatonin that is strictly regulated and certified to contain the ingredients in the appropriate proportions as labeled. Under these controlled conditions, substantive support exists for the presence of a plateau effect in adults with doses higher than 0.3 milligrams; the maximum effect being achieved at low doses with decreasing effectiveness in doses exceeding 1 milligram. In addition, there is some evidence that exogenous melatonin requires dosage over the course of a few days to achieve detectible effectiveness, and that it may increase in effectiveness over the course of time until the benefits plateau. The half-life of melatonin is less than one hour, which means that its usefulness from a given dose is short-lived. Some pharmaceutical grade melatonin medications have extended-release formulations to help improve the usefulness of the drug. It is unclear whether or not single doses of melatonin are effective.
High doses of exogenous melatonin have been demonstrated to desensitize receptors in the brain, thereby eventually making supplementation ineffective. However, without clear guidelines on appropriate dosing, the level at which overdose occurs remains unknown. Unfortunately, a 2017 analysis out of Canada found egregious mislabeling of melatonin supplements with counts varying from −83% to +478% of labeled melatonin. Chewable tablets suffered from the highest variability with one tablet containing nearly 9 milligrams of melatonin when it was labeled as 1.5 milligrams. Capsules suffered the greatest variability among lots. And, liquids had the greatest levels of stability, though they too were highly inconsistent. Oral and sublingual tablets with few ingredients proved the least variable of all the options. However, many of the supplements also contained impurities, including serotonin which has known effects and should not be taken by accident.
There is no known safe dose or dosing frequency for children.
In 2017, a task force from the American Academy of Sleep Medicine conducted a systematic review of the available literature to identify randomized controlled trials. Based on the evidence, this task force established recommendations for use by medical professionals. The task force listed 14 types of sleep aids and noted whether they were recommended for use or not. They advised clinicians not to use melatonin as a treatment for sleep onset and sleep maintenance insomnia.
Also, it is unknown whether melatonin supplements are safe during pregnancy or breastfeeding. High doses of melatonin may present fertility problems by affecting ovulation.
Possible Safety Issues
In 2015, Dr. David Kennaway conducted a review of the evidence for melatonin use in children, which was published in the Australian Journal of Paediatrics and Child Health. He determined that melatonin can produce “small advances in the timing of sleep onset” in both adults and children, but that there have “no appropriate studies to show that melatonin is safe in the long term for children or adults.” Use in children is always an off-label application of this hormone. He noted that, as a hormone, melatonin directly impacts the endocrine system and that long-term use may result in future “endocrine or other abnormalities.” He recommended that melatonin be prescribed only following a “biochemical diagnosis of an underlying sleep timing abnormality and after full disclosure to the carers of information about the known actions of melatonin on reproductive and other systems.”
In the United Stated, melatonin is considered a supplement. Therefore, it is generally unregulated by the Food and Drug Administration (FDA) and consumers have no guarantees regarding the safety of the commercial melatonin they purchase.
When I began to seek out studies, I discovered thousands of papers that mentioned the term “melatonin.” In order to refine the list, I began by excluding studies published before 2009 and including only studies conducted on humans and written in/translated into English. From this list, I sorted by relevance and chose 175 to skim for abstracts. Then, I selected 80 to read in full, which resulted in a final resource list of 23 papers having targeted relevance. These studies involve research in countries around the world. I have grouped them by year for ease in assessing the progression of the research and recommendations.
OBJECTIVE: To investigate the effects of prolonged-release melatonin 2 mg (PRM) on sleep and subsequent daytime psychomotor performance in patients aged 55 years and older with primary insomnia.
FINDINGS: By the end of the double-blind treatment, the PRM group had significantly shorter sleep onset latency and scored significantly better on a psychomotor performance test than the placebo group.
OBJECTIVE: To provide a systematic review of efficacy and safety of exogenous melatonin for treating disordered sleep in individuals with ASD.
FINDINGS: The literature supports the existence of a beneficial effect of melatonin on sleep in individuals with ASD, with only few and minor side effects. However, these conclusions cannot yet be regarded as evidence-based. Randomized controlled trials and long-term follow-up data are still lacking.
OBJECTIVE: To evaluate the age cut-off from a previous study for response to PRM and the long-term maintenance of efficacy and safety by looking at the total cohort (age 18-80).
FINDINGS: At 3 weeks, significant differences in favor of PRM vs placebo were found for the 55-80 year population but not the 18-80 year cut-off which included younger patients. Other variables improved significantly with PRM in the 18-80 year population more so than in the 55-80 year age group. No withdrawal symptoms or rebound insomnia were detected.
OBJECTIVE: To assess dose-response, tolerability, safety, feasibility of collecting actigraphy data, and ability of outcome measures to detect change during 14-week intervention on children aged 3-10 years with a clinical diagnosis of an autism spectrum disorder who were free of psychotropic medications and whose parents reported sleep onset delay of 30 minutes or longer on three or more nights per week.
FINDINGS: Researchers documented an improvement in sleep latency with melatonin treatment. Because the study criteria were designed to enroll children with sleep-onset delay, they could not definitively comment on the effects of melatonin on sleep duration or night wakings.
OBJECTIVE: To define the optimal dosage of exogenous melatonin administration in disorders related to altered melatonin levels in older adults aged 55 years and above by determining the dose-response effect of exogenous administered melatonin on endogenous levels.
FINDINGS: Based on a systematic review of 16 articles from 1980 to 2013, nine of which were randomized controlled trials, the best applicable dosage for melatonin for older adults still cannot be adequately determined, as endogenous melatonin levels are subject to altered pharmacokinetics and -dynamics. This causes the risk of prolonged and elevated endogenous melatonin levels after exogenous melatonin administration in older adults. The researchers advise the use of the lowest possible oral dose of immediate-release formulation melatonin to best mimic the normal physiological circadian rhythm of melatonin and to avoid prolonged, supra-physiological blood levels.
OBJECTIVE: To critically assess the available peer-reviewed literature on the use of melatonin in military service members and in healthy subjects to determine whether melatonin might be useful in military populations.
FINDINGS: The use of melatonin by healthy adults shows promise to prevent phase shifts from jet lag and improvements in insomnia, but to a limited extent. For the initiation of sleep and sleep efficacy, the data cannot yet confirm a positive benefit.
OBJECTIVE: To describe overnight endogenous and PK melatonin profiles in children aged 3-8 years with ASD participating in open-label trial of melatonin for sleep onset insomnia.
FINDINGS: In children with ASD and insomnia responsive to treatment with supplemental melatonin, evidence exists for normal endogenous melatonin profiles. Furthermore, despite a relatively short duration of action of supplemental melatonin, night wakings improved in most children with treatment. This raises the possibility that supplemental melatonin may be influencing sleep onset delay and night wakings by mechnanisms other than simply replacing melatonin.
The effect of melatonin treatment on postural stability, muscle strength, and quality of life and sleep in postmenopausal women: a randomized controlled trial https://www.ncbi.nlm.nih.gov/pubmed/26424587 doi: 10.1186/s12937-015-0093-1
OBJECTIVE: To document the safety of melatonin in postmenopausal women given evidence from previous studies that suggests a protective role of melatonin against osteoporosis through an increase of bone mineral density.
FINDINGS: Melatonin in a daily dose of 1 or 3 mg is safe to use in postmenopausal women with osteopenia. There is no long term hangover effect causing a reduction in balance- and muscle function or quality of life. In women with poor quality of sleep, small doses of melatonin trended towards improving quality of sleep.
OBJECTIVE: To establish a consensus on the roles of melatonin in children and on treatment guidelines at a conference in Rome in 2014.
FINDINGS: So far, the best evidence for the indication of melatonin treatment in children is for insomnia caused by circadian rhythm sleep disorders. Because insomnia due to other situations and disorders, including bad sleep hygeine, ADHD/ADD, personality disorders and depression, can mimic insomnia caused by circadian rhythm sleep disorders, the diagnosis should only be made after careful clinical assessment and possibly measuring dim light melatonin onset (DLMO). Melatonin can be effective not only for primary sleep disorders but also for sleep disorders associated with several neurological conditions. Controlled studies on melatonin for sleep disturbance in children are needed since melatonin is very commonly prescribed in infants, children and adolescents, and there is a lack of certainty about dosing regimens. The dose of melatonin should be individualized according to multiple factors, including not only the severity and type of sleep problem, but also the associated neurological pathology.
OBJECTIVE: To provide a succinct summary to help inform clinical and research practices for children with developmental disabilities (i.e. children with unspecified developmental delays or cognitive impairments and specific disorders/syndromes including ASD, Smith-Magenis syndrom, Angleman’s syndrom, fragile X syndrom, Down syndrom, and Rett syndrome).
FINDINGS: Following a review of a number of studies and a meta-analysis by Braam and associates, researchers determined that melatonin treatment yields beneficial effects with minimal side effects. However, melatonin is not approved by the US Food an Drug Administration and no drug is approved for use in pediatric insomnia (as of the time of this study).
OBJECTIVE: To provide information on the documented actions and properties of melatonin outside its ability to alter sleep timing that have been widely ignored but which raise questions about the safety of its use in infants and adolescents.
FINDINGS: Melatonin is increasingly being prescribed off lable for children and adolescents for difficulty in initiating and maintaining sleep. There is extensive evidence from animal and human studies that melatonin acts on multiple physiological systems, including the reproductive, cardiovascula, immune, and metabolic systems. Long-term safety studies on children and adults are lacking. Prescription of melatonin to any child whether severely physically or neurologically disabled or developing normally should be considered only after the biochemical diagnosis of an underlying sleep timing abnormality and after full disclosure to the carers of information about the known actions of melatonin on reproductive and other systems and the disclosure that there is a lack of appropriate studies conducted on children. Should endocrine or other abnormalities appear in the future in children previously treated with melatonin, it will not be tenable to argue that were were surprised.
OBJECTIVE: To present and evaluate the literature concerning the possible adverse effects and safety of exogenous melatonin in humans and provide recommendations concerning the possible risks of melatonin use in specific patient groups.
FINDINGS: A substantial number of both animal and human studies document that short-term use of melatonin is safe, even in extreme doses. No studies indicate that exogenous melatonin possesses any serious adverse effects. Also, randomized clinical studies indicate that long-term administration only induces mild adverse effects comparable to placebo treatment. Due to a lack of human studies, pregnant and breastfeeding women should not take exogenous melatonin. Also, long-term safety of melatonin in children and adolescents requires further investigation.
OBJECTIVE: To evaluate the effectiveness of melatonin supplementation for improving the sleep disturbance and severity of disease in children with AD.
FINDINGS: Sleep-onset latency shortened by 21.4 minutes after melatonin treatment compared with after placebo. Melatonin supplementation is a safe and effective way to improve the sleep-onset latency and disease severity in children with AD.
OBJECTIVE: To assess the evidence base for the therapeutic effects of exogenous melatonin in treating primary sleep disorders.
FINDINGS: Results from the metaanalysis shoed the most convincing evidence for exogenous melatonin use was in reducing sleep onset latency in primary insomnia, delayed sleep phase syndrome, and regulating the sleep-wake patters in blind patients compared with placebo.
OBJECTIVE: To quantify melatonin in 30 Canadian commercial supplements, comprising different brands and forms and screen supplements for the presence of serotonin.
FINDINGS: Melatonin content was found to range from -83% to +478% of the labeled content. Additionally, lot-to-lot variable within a particular product varied by as much as 465%. This variability did not appear to be correlated with manufacturer or product type. Furthermore, serotonin was identified in eight of the supplements at levels of 1 mg to 75 mg. Melatonin content did not meet label within a 10% margin of the label claim in more than 71% of supplements and an additional 26% were found to contain serotonin. It is important that clinicians and patients have confidence in the quality of supplements used in the treatment of sleep disorders. To address this, manufacturers require increased controls to ensure melatonin supplements meet both their label claim, and also are free from contaminants, such as serotonin.
OBJECTIVE: To explore the evidence for using exogenous melatonin in the treatment of sleep disorders, both primary and secondary, in children and adults.
FINDINGS: There is evidence for the efficacy of melatonin in the management of insomnia and some intrinsic disorders of circadian rhythm in adults and children as well as in reducing sleep onset latency in jet-lag and shift work disorder in adults. Melatonin is used routinely in the treatment of rapid-eye movement sleep-behaviour disorder despite limited trial evidence. Increasingly, dual melatonin receptor agonists are being trialed in a variety of sleep disorders. Long-term adverse effects are currently not fully identified.
OBJECTIVE: To discuss the normal sleep development and needs in children, and we will provide an overview of sleep disorders, based on the 3rd edition of the International Classification of Sleep Disorders [ICSD-3].
FINDINGS: Melatonin is an effective, safe, and well-tolerated agent, particularly in cases of sleep-initiation insomnia caused by circadian factors. Several placebo-controlled studies of melatonin in adults and children (in some studies, as young as 3 years of age) showed that melatonin administered at bedtime reduces sleep-onset latency time and increases total sleep time.
OBJECTIVE: To review pharmacological treatment options for children and adolescents with ASD, with emphasis on recently published studies since our previous published update. We focus on randomized double-blind placebo controlled (RDBPC) trials, with at least 10 subjects. We also discuss CAM treatment options used in children with ASD.
FINDINGS: In addition to its effect on sleep, a few RDBPC trials have shown that melatonin can improve communication, rigidity, and anxiety in children with ASD.
OBJECTIVE: To assess the clinical effectiveness and safety of NHS-relevant pharmacological and non-pharmacological interventions to manage sleep disturbance in children and young people with NDs, who have non-respiratory sleep disturbance.
FINDINGS: It was not possible to draw conclusions about the effectiveness of non-pharmacological interventions for managing sleep disturbance, and although there was some benefit with melatonin the degree of benefit is uncertain. There is some evidence of benefit for melatonin compared with placebo, but the degree of benefit is uncertain. There are various types of non-pharmacological interventions for managing sleep disturbance; however, clinical and methodological heterogeneity, few RCTs, a lack of standardised outcome measures and risk of bias means that it is not possible to draw conclusions with regard to their effectiveness. Future work should include the development of a core outcome, further evaluation of the clinical effectiveness and cost-effectiveness of pharmacological and non-pharmacological interventions and research exploring the prevention of, and methods for identifying, sleep disturbance. Research mapping current practices and exploring families’ understanding of sleep disturbance and their experiences of obtaining help may facilitate service provision development.
OBJECTIVE: To summarize some of the current knowledge about the potential effects of exogenous melatonin on puberty
FINDINGS: This review suggests that the role of melatonin in sexual maturation and the timing of puberty is understudied in humans. The three human studies that have examined the question have done so as an ancillary research question in small samples of children and youth, some of whom had neurodevelopmental disorders. This limits the generalizability to the general population and is insufficient evidence to draw conclusions for patients with mental health and neurological disorders. Further experimental studies on the impact of melatonin on puberty, notably in non-seasonal mammals, and advances in the research about the intermediary processes between melatonin and kisspeptin activation, could ultimately inform us about the potential influence of exogenous melatonin on puberty.
The effects of melatonin administration on disease severity and sleep quality in children with atopic dermatitis: A randomized, double-blinded, placebo-controlled trial https://www.ncbi.nlm.nih.gov/pubmed/30160043 doi: 10.1111/pai.12978
OBJECTIVE: To determine the effects of melatonin administration on disease severity and sleep quality in children diagnosed with atopic dermatitis (AD).
FINDINGS: Following 6 weeks of intervention, melatonin supplementation significantly improved SCORAD index, serum total IgE levels, and CSHQ scores. Though melatonin had no significant impact on pruritus scores, high sensitivity C-reactive protein, sleep-onset latency, total sleep time, weight and BMI compared with placebo. Overall, melatonin supplementation had beneficial effects on disease severity, serum total IgE levels and CSHQ among children diagnosed with AD.
OBJECTIVE: To determine the efficacy of exogenous melatonin versus placebo in managing secondary sleep disorders.
FINDINGS: Meta-analysis of the data from a series of studies with small sample size demonstrates that exogenous melatonin improves the sleep quality of secondary sleep disorders. Based on the current advantages of melatonin in the management of secondary sleep disorders, it is hoped that there will be a tremendous growth in the use of melatonin application worldwide. Besides, little evidence is available regarding the adverse effects of long-term use of melatonin. Clinicians should be alert to these shortcomings but also aware of the potential role of melatonin in clinical psychiatry and sleep medicine.
OBJECTIVE: To review the role of melatonin in the circadian regulation of sleep and mood and the phase-shifting and sleep-promoting properties of exogenous melatonin and melatonin agonists and outline how melatonin and melatonin agonists might be used for treatment of various sleep and mood disorders.
FINDINGS: The phase-shifting and sleep-promoting effects of melatonin plus additional effects of melatonin agonists on melatonin and serotonin receptors have shown promise for novel treatments for a variety of circadian, sleep and mood disorders. Importantly, the main advantage melatonin and its agonists offer over traditional sleep and depression treatments is that they assist to restore circadian function which is often misaligned in these disorders and which is increasingly thought to be a causal mechanism and part of the aetiology of sleep and mood disorders. Treatments that fail to address the misaligned circadian system present in sleep and mood disorders may not fully address the underlying causes, and for this reason, further investigation on the potential for melatonin-based treatments should be undertaken.
Assessment of the Evidence
Endogenous melatonin provides widespread health benefits for the human body across many functional systems. Exogenous melatonin is strongly evidenced as an effective sleep aid for sleep onset (meaning, falling asleep) and less strongly for night wakings and other other sleep-related applications in adults aged 55 and older.
However, the literature is glaringly lacking in randomized, controlled trials as well as research on younger adults, teenagers, adolescents, children, and infants. Existing studies utilize small subject pools and short- to medium-term time frames for research, most stopping short at 3 months and few-to-none lasting more than one year. There is no evidence yet that consistent long-term use is safe for any age group. Dosing remains a challenge and a standard dosing table does not yet exist, although it has been long established that overdoses cause receptors in the brain to become unresponsive and supplementation to be rendered useless. Given the lack of information about dosing, it is impossible to determine what amount constitutes an overdose without investigative blood work. Melatonin supplements are almost entirely unregulated in the United States, so high doses are regularly consumed. While high doses don’t appear to have extreme deleterious effects on humans, the fatal dose is yet unknown. Future studies are needed to ameliorate concerns about safety, dosage, and pediatric use.
Promoting Better Sleep
While I cannot make any formal recommendations to you about whether or not to give your child melatonin, I can suggest some solutions to help with sleep outside of melatonin supplements.
Eating lots of fresh fruits, vegetables, whole grains, and low fat protein sources provides plenty of tryptophan as well as group B vitamins, minerals, and unrefined carbohydrates, all of which supports healthy sleep. Reach for things like salmon, poultry, eggs, spinach, seeds, milk, soy products, and nuts to get a good dose of sleep-promoting nutrients. (Source and Source)
Tart Montmorency cherries contain high levels of phytochemicals including melatonin. Cherry juice is a natural source of plant-based exogenous melatonin and may help support good sleep. (Source)
Exercise in the mornings can improve the quality of nighttime sleep by “increasing parasympathetic nerve activity.” However, high-intensity exercise in the evening should be avoided. Getting your child out for some fresh air every morning may make your bedtime routine a breeze. (Source)
Help your child avoid blue light LED sources like smartphones, tablets, and TVs near bedtime as this type of light suppresses endogenous melatonin. (Source)
In one of the studies referenced in this Guide, a young girl did not respond to melatonin treatments but was later diagnosed with bipolar disorder, medicated with risperidone, and subsequently experienced improved sleep. If your child is really struggling, it may be worthwhile to seek out age-appropriate therapy to rule out other treatable sources of difficulty. (Source)
The Bottom Line
Do melatonin supplements help your child? Unless you’re using pharmaceutical grade supplements under the strict care of a physician, my best answer is maybe. But it’s hard to know what your child really needs in the way of a dose without extensive blood work . The placebo effect is also in play to an extent. If you and your child believe the supplement works, it’ll probably work even better than the actual physiological impact, if there is one to begin with.
Will melatonin supplements seriously harm your child? Probably not, but there’s no guarantee and there are other effective options that don’t involve using unregulated supplements with potentially harmful impurities.
If you discover any errors in my work, please contact me at peacefulmom(at)peaceigive.com.