Sleep disorders are common in children with neurodevelopmental disorder and are a major source of stress for the whole family. In children with neurodevelopmental disabilities the prevalence may be as high as 80%.¹ The current literature is suggestive of circadian rhythm dysfunction, social difficulties, and abnormal melatonin levels in children with autism.²

Hypnotics and sedatives can produce side effects and tolerance,³ so is melatonin the answer in children with sleep problems associated with severe developmental difficulties of social and communicating nature, which have not responded to behavioural and social measure? Previous studies and case reports have suggested that melatonin could be effective.

We retrospectively reviewed cases of nine autistic children with chronic sleep disorder, who were attending the Child Developmental Centre at Windmill Lodge. The age range of these children was 2–11 years. No additional non-pharmacological sleep intervention was instituted. They were started on 2.5–5 mg melatonin 45 minutes before their sleeping time. In four of these patients sleep latency was reduced. Our own experience of reduction in sleep latency is in accordance with literature.⁴ Five parents reported improvement in total duration of sleep. In three patients medication was stopped within a week because of no response. Four patients are still on melatonin for over a year without any side effects. We could not find the cause in non-responders.

To find out the real benefit of melatonin, the dose, short and long term side effects, and group of patients who will respond to melatonin, several authors have already identified the need for a double blind crossover study.⁴ Previous studies have reported response rates of up to 80%,^5,6 but it is seems likely that studies which group together children with “neurodevelopmental disorders” in a generic manner will not furnish the answer as to the true place of melatonin in the management of disturbed sleep patterns.