Melatonin Treatment for Insomnia in Pediatric Patients with Attention-Deficit/Hyperactivity Disorder
Abstract
OBJECTIVE: To evaluate the efficacy and safety of melatonin for the treatment of insomnia in pediatric patients with attention-deficit/hyperactivity disorder (ADHD). DATA SOURCES: Literature was accessed through MEDLINE (1948-August 2009), EMBASE (1950-August 2009), and Scopus (1960-August 2009) using the terms melatonin, attention-deficit/hyperactivity disorder (ADHD), pediatric, insomnia, sleep disorder, and sleep. In addition, reference citations from publications identified were reviewed for relevant information. STUDY SELECTION AND DATA EXTRACTION: All English-language articles and human studies were identified and evaluated. Results from all identified randomized trials (n = 5), safety studies (n = 1), long-term follow-up studies (n = 1), post hoc retrospective analyses (n = 1), meta-analyses (n = 2), review articles (n = 9), and letters (n = 1) were summarized. DATA SYNTHESIS: Pediatric insomnia is prevalent in children with ADHD and impacts academic performance, social functioning, overall health, and family life. First-line therapy includes ruling out differential diagnoses, optimizing ADHD stimulant treatment, and initiating good sleep hygiene and behavioral therapy. Adjuvant pharmacotherapy is then an option and melatonin is often prescribed. Melatonin regulates circadian rhythm sleep disorders such as sleep-onset insomnia (SOI) in children with ADHD. Four studies in children with ADHD and insomnia showed improvement in sleep onset and sleep latency. Studies included children 6–14 years old and melatonin doses ranged from 3 to 6 mg administered within a few hours of a scheduled bedtime. In all studies, adverse events were transient and mild. The available melatonin studies are limited by small size and short duration; variable SOI criteria, ADHD criteria, and treatment assessments; and lack of generalizability. CONCLUSIONS: Available data suggest that melatonin is a well-tolerated and efficacious treatment option for pediatric patients with chronic SOI and ADHD. Regulated melatonin products and larger, well-designed trials to establish optimal dosing regimens and long-term safety are needed.
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Recent research has shown that melatonin is effective in reducing sleep-onset problems in ADHD children.
“Recent research has also shown that melatonin is effective in reducing sleep-onset problems in ADHD children and could be considered a reasonable therapeutic approach [17].”
From European guidelines on managing adverse effects of medication for ADHD (2011) · cites this paper as [17]
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Checa-Ros, A., Muñoz‐Hoyos, A., Molina‐Carballo, A., Viejo-Boyano, I., Chacín, M., Bermúdez, V., & D’Marco, L. (2023) · Children · doi:10.3390/children10071121 · Cited by 7 · see citing works
“They may affect up to 70% of patients with ADHD [18], undermining their cognitive, behavioral, and physical states [19], as well as increasing parental stress levels [20].”
BackgroundMelatonin for sleep problems in children with neurodevelopmental disorders
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Stability of an extemporaneous alcohol-free melatonin suspension
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“2011; 68:420-3 Melatonin, or 5-methoxy-Nacetyltryptamine, was discovered in 1958 and is produced endogenously by the pineal gland.(1) It is often prescribed for children with insomnia-related attention-deficit/ hyperactivity disorder or other neurodevelopmental or sleep disturbances.”
BackgroundQuality of melatonin use in children and adolescents: findings from a UK clinical audit
Paton, C., Gringras, P., Ruan, A., Liew, A., Rendora, O., Bove, G., & Barnes, T. R. E. (2024) · BMJ Mental Health · doi:10.1136/bmjment-2023-300894 · Cited by 6 · see citing works
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“Monitoring should include improvement in sleep and changes in cognition, behavior, academic performance, quality of life, and adverse events.(19)”
BackgroundLi, X., Shea, K. S. C., Chiu, W. V., Lau, F. L. F., Wong, C. K. D., Yu, W. M. M., Li, A. M., Wing, Y. K., Lai, Y. C. K., & Li, S. X. (2022) · Journal of Clinical Sleep Medicine · doi:10.5664/jcsm.10060 · Cited by 6 · see citing works
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“…of ADHD or ASD, improving these could also improve sleep disorder; in this case, an increase in the dosage of drugs used may be justified [34,104] ● If ADHD symptoms (hyperactivity/impulsivity) are very unmanaged in the evening, addressing those (e.g. adjusting ADHD medication timing/dose)…”
Malkani, M. K., Sheridan, A. M. C., Crichton, A. J., Bucks, R., & Pestell, C. (2023) · BMC Pediatrics · doi:10.1186/s12887-023-04329-y · Cited by 5 · see citing works
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“Melatonin, in dosages of 3 to 6 mg, has been shown to be an effective treatment of insomnia in 6- to 14-year-old children with ADHD.(120) Studies suggest, however, that the decreased sleep latency did not affect the ADHD symptoms.”
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“…sleep/wake cycle and sleep-promoting activity have led to the widespread use of exogenous melatonin as a medication for the treatment of insomnia (Bendz & Scates 2010), jet-lag (Srinivasan et al. 2008) and other chronobiological disorders (Rosenthal et al. 1986; Cavallo et al. 2005; Skene &…”
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“MT treatment is recommended for children with hyper-activity, attention deficit, and insomnia (Bendz and Scates 2010).”
Sleep and Attention-Deficit/Hyperactivity Disorder
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A nurse-led sleep service for children and young people with disability
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“…with general sleep problems and complex disorders suggest the use of medications of which the long term effects are not well researched and are most effectively used in combination with non-pharmacological sleep hygiene interventions (Bruni & Novelli, 2010; NICE & SCIE, 2013; Bendz & Scates, 2009).”
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“In addition to the beneficial effects of MT, research has also shown risk factors that may occur with old age (Ball and Patel 2012; Bendz and Scates 2010; Hardeland 2013; Molaakbari, Mostafavi, and Beitollahi 2015).”
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- Authors
- Bendz, L. M., & Scates, A. C.
- Affiliations
- GlaxoSmithKline (United States) (US)
- Duke University Hospital (US)
- Corresponding author
- Bendz, Lisa M
- Venue
- Annals of Pharmacotherapy
- Publisher
- SAGE Publications
- Published
- 2010-01
- Volume
- 44
- Issue
- 1
- Pages
- 185-191
- ISSN
- 0012-6578 (ISSN-L)
- 1060-0280
- 1542-6270
- OpenAlex
- W2157115236
- Cited by
- 114
- References
- 21
- Citations by year
- 2026: 1 · 2025: 4 · 2024: 7 · 2023: 4 · 2022: 5 · 2021: 3 · 2020: 7 · 2019: 6 · 2018: 5 · 2017: 6 · 2016: 7 · 2015: 3 · 2014: 14 · 2013: 7 · 2012: 13
- FWCI
- 14.36
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Annals of Pharmacotherapy (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Sleep and related disorders
- Life Sciences › Neuroscience › Endocrine and Autonomic Systems › Circadian rhythm and melatonin
- Health Sciences › Medicine › Psychiatry and Mental health › Attention Deficit Hyperactivity Disorder
- Keywords
- melatonin, attention deficit hyperactivity disorder, pediatric insomnia, sleep onset insomnia, circadian rhythm sleep disorders, sleep latency, sleep hygiene, children
- MeSH terms
- Attention Deficit Disorder with Hyperactivity, Child, Humans, Sleep Initiation and Maintenance Disorders, Melatonin
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