Current practices recommend parent-directed behavioural sleep interventions as first-line management for paediatric insomnia in ASD/NGD (Neurogenetic Disorders), with reportedly a 25% response rate.
In a study of children who failed to improve on behavioural intervention alone, immediate release (IR) melatonin demonstrated beneficial effects on sleep latency (time to fall asleep) and, to a lesser extent, on total sleep time.
Licensed and unlicensed liquid formulations of melatonin are also available; however, these are all immediate release, typically contain additives and preservatives, and require a willing patient for their effective administration. Moreover, unregulated melatonin preparations, or food supplements, are used despite concerns over their provenance, quality, potential safety hazards and lack of evidence for long-term efficacy and safety. Other medications are used outside of licence including antihistamines, alpha-adrenergic agonists (clonidine), antidepressants, and antipsychotics, for their sedative side effects, but in absence of proven safety or efficacy.6
6. Maras, A. et al. Long-Term Efficacy and Safety of Pediatric Prolonged-Release Melatonin for Insomnia in Children with Autism Spectrum Disorder. Jnl Child and Adolesc Psychpharmacol. 2018; doi 10.1089:1-12
12. Chua, HM. et al. Dissolution of Intact, Divided and Crushed Circadin Tablets: Prolonged vs. Immediate Release of Melatonin. Jnl Pharmaceutics. 2016;8(2):1-11
16. Gringras P, et al. Melatonin for sleep problems in children with neurodevelopmental disorders: randomised double masked placebo-controlled trial. BMJ. 2012;345:e6664