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Sleep Initiation and Maintenance Disorders: HELP
Articles by Beth A. Malow
Based on 18 articles published since 2010
(Why 18 articles?)
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Between 2010 and 2020, B. A. Malow wrote the following 18 articles about Sleep Initiation and Maintenance Disorders.
 
+ Citations + Abstracts
1 Guideline A practice pathway for the identification, evaluation, and management of insomnia in children and adolescents with autism spectrum disorders. 2012

Malow, Beth A / Byars, Kelly / Johnson, Kyle / Weiss, Shelly / Bernal, Pilar / Goldman, Suzanne E / Panzer, Rebecca / Coury, Daniel L / Glaze, Dan G / Anonymous1500741. ·Departments of Neurology, Vanderbilt University Medical Center, Nashville, Tennessee, USA. beth.malow@vanderbilt.edu ·Pediatrics · Pubmed #23118242.

ABSTRACT: OBJECTIVE: This report describes the development of a practice pathway for the identification, evaluation, and management of insomnia in children and adolescents who have autism spectrum disorders (ASDs). METHODS: The Sleep Committee of the Autism Treatment Network (ATN) developed a practice pathway, based on expert consensus, to capture best practices for an overarching approach to insomnia by a general pediatrician, primary care provider, or autism medical specialist, including identification, evaluation, and management. A field test at 4 ATN sites was used to evaluate the pathway. In addition, a systematic literature review and grading of evidence provided data regarding treatments of insomnia in children who have neurodevelopmental disabilities. RESULTS: The literature review revealed that current treatments for insomnia in children who have ASD show promise for behavioral/educational interventions and melatonin trials. However, there is a paucity of evidence, supporting the need for additional research. Consensus among the ATN sleep medicine committee experts included: (1) all children who have ASD should be screened for insomnia; (2) screening should be done for potential contributing factors, including other medical problems; (3) the need for therapeutic intervention should be determined; (4) therapeutic interventions should begin with parent education in the use of behavioral approaches as a first-line approach; (5) pharmacologic therapy may be indicated in certain situations; and (6) there should be follow-up after any intervention to evaluate effectiveness and tolerance of the therapy. Field testing of the practice pathway by autism medical specialists allowed for refinement of the practice pathway. CONCLUSIONS: The insomnia practice pathway may help health care providers to identify and manage insomnia symptoms in children and adolescents who have ASD. It may also provide a framework to evaluate the impact of contributing factors on insomnia and to test the effectiveness of nonpharmacologic and pharmacologic treatment strategies for the nighttime symptoms and daytime functioning and quality of life in ASD.

2 Review Pediatric Insomnia. 2016

Brown, Kelly M / Malow, Beth A. ·Sleep Disorders Division, Department of Neurology, Vanderbilt University School of Medicine, Nashville, TN. Electronic address: kelly.m.brown@vanderbilt.edu. · Sleep Disorders Division, Department of Neurology, Vanderbilt University School of Medicine, Nashville, TN. ·Chest · Pubmed #26378738.

ABSTRACT: Insomnia in children is complex and frequently multifactorial. This review discusses the major categories of insomnia as well as common causes. The consequences of insomnia, including issues with mood, behavior, and cognition, are discussed. Sleep disorders are much more prevalent in certain pediatric populations, such as children with autism spectrum disorders. The evaluation of insomnia in children includes a focused history and examination and occasionally actigraphy or polysomnography. Behavioral and pharmacological therapies are discussed, as are future directions for research and clinical practice.

3 Article Long-Term Efficacy and Safety of Pediatric Prolonged-Release Melatonin for Insomnia in Children with Autism Spectrum Disorder. 2018

Maras, Athanasios / Schroder, Carmen M / Malow, Beth A / Findling, Robert L / Breddy, John / Nir, Tali / Shahmoon, Shiri / Zisapel, Nava / Gringras, Paul. ·1 Yulius Academy, Yulius Mental Health Organization , Barendrecht, The Netherlands . · 2 Strasbourg University Hospital Department of Child and Adolescent Psychiatry , Strasbourg, France . · 3 CNRS UPR 3212, Department of Psychiatry and Mental Health, Institute of Cellular and Integrative Neurosciences , Strasbourg, France . · 4 Sleep Division, Department of Neurology, Vanderbilt University Medical Center , Nashville, Tennessee. · 5 Department of Psychiatry and Behavioral Sciences, Kennedy Krieger Institute/Johns Hopkins University , Baltimore, Maryland. · 6 Pharmastat Consulting Ltd. , Canterbury, United Kingdom . · 7 Neurim Pharmaceuticals Ltd. , Tel Aviv, Israel . · 8 Children's Sleep Medicine, Evelina London Children's Hospital , Guy's and St. Thomas', London, United Kingdom . ·J Child Adolesc Psychopharmacol · Pubmed #30132686.

ABSTRACT: OBJECTIVE: A recent double-blind randomized placebo-controlled study demonstrated 3-month efficacy and safety of a novel pediatric-appropriate prolonged-release melatonin (PedPRM) for insomnia in children and adolescents with autism spectrum disorder (ASD) and neurogenetic disorders (NGD) with/without attention-deficit/hyperactivity disorder comorbidity. Long-term efficacy and safety of PedPRM treatment was studied. METHODS: A prospective, open-label efficacy and safety follow-up of nightly 2, 5, or 10 mg PedPRM in subjects who completed the 13-week double-blind trial (51 PedPRM; 44 placebo). Measures included caregiver-reported Sleep and Nap Diary, Composite Sleep Disturbance Index (CSDI), caregiver's Pittsburgh Sleep Quality Index (PSQI), Epworth Sleepiness Scale, and quality of life (WHO-5 Well-Being Index). RESULTS: Ninety-five subjects (74.7% males; mean [standard deviation] age, 9 [4.24]; range, 2-17.5 years) received PedPRM (2/5 mg) according to the double-blind phase dose, for 39 weeks with optional dose adjustment (2, 5, or 10 mg/day) after the first 13 weeks. After 52 weeks of continuous treatment (PedPRM-randomized group) subjects slept (mean [SE]) 62.08 (21.5) minutes longer (p = 0.007); fell asleep 48.6 (10.2) minutes faster (p < 0.001); had 89.1 (25.5) minutes longer uninterrupted sleep episodes (p = 0.001); 0.41 (0.12) less nightly awakenings (>50% decrease; p = 0.001); and better sleep quality (p < 0.001) compared with baseline. The placebo-randomized group also improved with PedPRM. Altogether, by the end of 39-week follow-up, regardless of randomization assignment, 55/72 (76%) of completers achieved overall improvement of ≥1 hour in total sleep time (TST), sleep latency or both, over baseline, with no evidence of decreased efficacy. In parallel, CSDI child sleep disturbance and caregivers' satisfaction of their child's sleep patterns (p < 0.001 for both), PSQI global (p < 0.001), and WHO-5 (p = 0.001) improved in statistically significant and clinically relevant manner (n = 72) compared with baseline. PedPRM was generally safe; most frequent treatment-related adverse events were fatigue (5.3%) and mood swings (3.2% of patients). CONCLUSION: PedPRM, an easily swallowed formulation shown to be efficacious versus placebo, is an efficacious and safe option for long-term treatment (up to 52 weeks reported here) of children with ASD and NGD who suffer from insomnia and subsequently improves caregivers' quality of life.

4 Article Family-Driven Goals to Improve Care for Children With Autism Spectrum Disorder. 2018

Bellesheim, Katherine R / Cole, Lynn / Coury, Daniel L / Yin, Larry / Levy, Susan E / Guinnee, Meghan A / Klatka, Kirsten / Malow, Beth A / Katz, Terry / Taylor, Jane / Sohl, Kristin. ·Thompson Center for Autism and Neurodevelopmental Disorders, and. · Departments of Psychological Sciences and. · University of Rochester Medical Center, University of Rochester, Rochester, New York. · Department of Pediatrics, Nationwide Children's Hospital, Columbus, Ohio. · Children's Hospital Los Angeles, Los Angeles, California. · Children's Hospital of Philadelphia, Philadelphia, Pennsylvania. · Catalyst Research, Depew, New York. · National Institute for Children's Health Quality, Boston, Massachusetts. · Department of Neurology, School of Medicine, Vanderbilt University, Nashville, Tennessee; and. · Department of Pediatrics, School of Medicine, University of Colorado, Aurora, Colorado. · Thompson Center for Autism and Neurodevelopmental Disorders, and sohlk@health.missouri.edu. · Child Health, University of Missouri, Columbia, Missouri. ·Pediatrics · Pubmed #30108141.

ABSTRACT: OBJECTIVES: Constipation and insomnia are not consistently identified and treated in children with autism spectrum disorder (ASD) despite their high prevalence and deleterious impact in this population. To standardize care, a constipation practice pathway and an insomnia practice pathway were previously developed by Autism Treatment Network clinicians. Our objective was to implement and refine these practice pathways in clinical settings. METHODS: Eleven Autism Treatment Network sites participated in a Learning Collaborative (ie, multidisciplinary quality improvement team) and chose to implement either the constipation or insomnia practice pathway in the clinical setting. Families set intervention goals (eg, increase stool frequency, decrease nighttime awakenings) before treatment. Each site began implementation with 1 patient and then increased implementation by factors of 5. Before each increase, the Learning Collaborative evaluated progress and refined the practice pathways. Process improvement was measured primarily by duration until goal attainment and by percentage of families who meet their goals. RESULTS: Across sites, 82 children with ASD and constipation and 101 children with ASD and insomnia were managed. Difficulties with intervention adherence and communication between providers and families were reported and were subsequently improved with parallel refinements to both practice pathways. The most notable modification was incorporating a goal-setting session in which families generated their own intervention goals (ie, family-driven goals). In this quality improvement initiative, 75% of families met at least 1 constipation or insomnia goal, with the median time to improvement being 6 weeks. CONCLUSIONS: By integrating a family-centered approach into the standardization of care, constipation and insomnia practice pathways may improve engagement, adherence, and management of medical conditions in children with ASD.

5 Article Modification of the Children's Sleep Habits Questionnaire for Children with Autism Spectrum Disorder. 2018

Katz, Terry / Shui, Amy M / Johnson, Cynthia R / Richdale, Amanda L / Reynolds, Ann M / Scahill, Lawrence / Malow, Beth A. ·Department of Pediatrics, University of Colorado Denver School of Medicine, 13123 E. 16th Street, B-140, Aurora, CO, 80045, USA. terry.katz@ucdenver.edu. · Biostatistics Center, Massachusetts General Hospital, Boston, MA, USA. · STAR Center for ASD & NDDs, Department of Psychiatry, University of California, San Francisco, CA, USA. · Department of Clinical and Health Psychology, University of Florida, Gainesville, FL, USA. · Olga Tennison Autism Research Centre, School of Psychology and Public Health, La Trobe University, Melbourne, Australia. · Department of Pediatrics, University of Colorado Denver School of Medicine, 13123 E. 16th Street, B-140, Aurora, CO, 80045, USA. · Marcus Autism Center, Emory University School of Medicine, Atlanta, GA, USA. · Sleep Disorders Division, Department of Neurology, Vanderbilt University School of Medicine, Nashville, TN, USA. ·J Autism Dev Disord · Pubmed #29500758.

ABSTRACT: Sleep problems are common in children with autism spectrum disorder (ASD) and adversely impact daytime functioning. Although no questionnaires have been developed to assess sleep in children with ASD, the 33-item Children's Sleep Habits Questionnaire (CSHQ) is widely used in this population. We examined the factor structure of the CSHQ in 2872 children (age 4-10 years) enrolled in the Autism Treatment Network. A four-factor solution (Sleep Initiation and Duration, Sleep Anxiety/Co-Sleeping, Night Waking/Parasomnias, and Daytime Alertness) with 5-6 items per factor explained 75% of the total variation. Ten items failed to load on any factor. This abbreviated 23-item four-factor version of this measure may be useful when assessing sleep in children with ASD.

6 Article Characterizing Sleep in Adolescents and Adults with Autism Spectrum Disorders. 2017

Goldman, S E / Alder, M L / Burgess, H J / Corbett, B A / Hundley, R / Wofford, D / Fawkes, D B / Wang, L / Laudenslager, M L / Malow, B A. ·Sleep Disorders Division, Department of Neurology, Vanderbilt University School of Medicine, 1161 21st Avenue South, Room A-0116, Nashville, TN, 37232-2551, USA. · Departments of Behavioral Sciences & Internal Medicine, Rush University Medical Center, Chicago, USA. · Department of Psychiatry and Kennedy Center, Vanderbilt University School of Medicine, Nashville, USA. · Department of Pediatrics, Vanderbilt University School of Medicine, Nashville, USA. · Department of Biostatistics, Vanderbilt University School of Medicine, Nashville, USA. · Behavioral Immunology and Endocrinology Laboratory, Department of Psychiatry, University of Colorado Anschutz Medical Campus, Denver, CO, USA. · Sleep Disorders Division, Department of Neurology, Vanderbilt University School of Medicine, 1161 21st Avenue South, Room A-0116, Nashville, TN, 37232-2551, USA. beth.malow@vanderbilt.edu. ·J Autism Dev Disord · Pubmed #28286917.

ABSTRACT: We studied 28 adolescents/young adults with autism spectrum disorders (ASD) and 13 age/sex matched individuals of typical development (TD). Structured sleep histories, validated questionnaires, actigraphy (4 weeks), and salivary cortisol and melatonin (4 days each) were collected. Compared to those with TD, adolescents/young adults with ASD had longer sleep latencies and more difficulty going to bed and falling asleep. Morning cortisol, evening cortisol, and the morning-evening difference in cortisol did not differ by diagnosis (ASD vs. TD). Dim light melatonin onsets (DLMOs) averaged across participants were not different for the ASD and TD participants. Average participant scores indicated aspects of poor sleep hygiene in both groups. Insomnia in ASD is multifactorial and not solely related to physiological factors.

7 Article Relationship Between Subtypes of Restricted and Repetitive Behaviors and Sleep Disturbance in Autism Spectrum Disorder. 2016

Hundley, Rachel J / Shui, Amy / Malow, Beth A. ·Division of Developmental Medicine, Department of Pediatrics, Vanderbilt University School of Medicine, 11101 Doctors' Office Tower, Nashville, TN, 37232-9003, USA. Rachel.j.hundley@vanderbilt.edu. · Biostatistics Center, Massachusetts General Hospital, 50 Staniford St, Suite 560, Boston, MA, 02114-2540, USA. · Sleep Disorders Division, Department of Neurology, Vanderbilt University School of Medicine, A-0118 MCN, Vanderbilt University Medical Center, Nashville, TN, 37232, USA. ·J Autism Dev Disord · Pubmed #27511195.

ABSTRACT: We examined the association of two types of restricted and repetitive behaviors, repetitive sensory motor (RSM) and insistence on sameness (IS), with sleep problems in children with autism spectrum disorder (ASD). Participants included 532 children (aged 2-17) who participated in the Autism Speaks Autism Treatment Network research registry. Confirmatory factor analysis of the Autism Diagnostic Interview-Revised detected the presence of RSM and IS. RSM behaviors were positively associated with parent-reported sleep problems, and this relationship remained significant after controlling for anxiety symptoms. IS was not significantly associated with sleep problems. Better understanding of the relationship between specific types of repetitive behaviors and sleep problems may allow providers to tailor interventions to the individual presentations of their patients with ASD.

8 Article The Pediatric Sleep Clinical Global Impressions Scale-A New Tool to Measure Pediatric Insomnia in Autism Spectrum Disorders. 2016

Malow, Beth A / Connolly, Heidi V / Weiss, Shelly K / Halbower, Ann / Goldman, Suzanne / Hyman, Susan L / Katz, Terry / Madduri, Niru / Shui, Amy / Macklin, Eric / Reynolds, Ann M. ·*Sleep Disorders Division, Department of Neurology, Vanderbilt University Medical Center, Nashville, TN; †Department of Pediatrics, University of Rochester, Rochester, NY; ‡Department of Neurology, Hospital for Sick Children, University of Toronto, Toronto, ON; §Department of Pediatrics, University of Colorado Denver, Aurora, CO; ‖Biostatistics Center, Massachusetts General Hospital, Boston, MA. ·J Dev Behav Pediatr · Pubmed #27244298.

ABSTRACT: OBJECTIVE: To pilot a clinician-based outcome measure that provides complementary information to objective measures and parent-based questionnaires for insomnia in children with autism spectrum disorders (ASD). METHOD: The authors developed a Pediatric Sleep Clinical Global Impressions Scale (CGI). Questions included (1) the child's ability to fall asleep and remain sleeping independently (i.e., apart from parents); (2) bedtime resistance; (3) sleep onset delay; (4) night awakening; (5) parental satisfaction with their child's current sleep patterns; (6) family functioning as affected by their child's current sleep patterns; and (7) clinician's overall concern with the child's sleep. After refining the instrument through the evaluation of vignettes by ASD and sleep experts, the authors piloted the Pediatric Sleep CGI in a 12-week randomized trial of iron supplementation in children with ASD. Clinicians completed Pediatric Sleep CGIs and structured sleep histories, parents completed the Children's Sleep Habits Questionnaire (CSHQ), and children wore actigraphy watches. RESULTS: In repeated measures models, the Pediatric Sleep CGI and CSHQ were correlated for sleep onset delay (r = .66, p < .001), night wakings (r = .40, p < .001), and total score (r = .29, p < .001). The CGI-S sleep onset delay and actigraphy sleep onset delay scores (r = .75, p = .0095) were also correlated. The overall CGI-S showed improvement with therapy (p = .047). CONCLUSION: The Pediatric Sleep CGI shows promise in measuring clinician-rated outcomes in pediatric insomnia in children with ASD. Larger samples will be necessary to examine reliability, validity, and measure to change, as well as applicability to other populations with pediatric insomnia.

9 Article Objective Sleep Assessments in Patients with Postural Tachycardia Syndrome using Overnight Polysomnograms. 2016

Bagai, Kanika / Peltier, Amanda C / Malow, Beth A / Diedrich, André / Shibao, Cyndya A / Black, Bonnie K / Paranjape, Sachin Y / Orozco, Carlos / Biaggioni, Italo / Robertson, David / Raj, Satish R. ·Autonomic Dysfunction Center, Vanderbilt University School of Medicine, Nashville, TN. · Department of Neurology, Vanderbilt University School of Medicine, Nashville, TN. · Department of Medicine, Vanderbilt University School of Medicine, Nashville, TN. · Department of Clinical Pharmacology, Vanderbilt University School of Medicine, Nashville, TN. · Biomedical Engineering, Vanderbilt University School of Medicine, Nashville, TN. · Department of Pharmacology, Vanderbilt University School of Medicine, Nashville, TN. · Department of Cardiac Sciences, Libin Cardiovascular Institute of Alberta, University of Calgary, AB, Canada. ·J Clin Sleep Med · Pubmed #26951415.

ABSTRACT: STUDY OBJECTIVES: Patients with postural tachycardia syndrome (POTS) commonly complain of fatigue, unrefreshing sleep, daytime sleepiness, and diminished quality of life. The study objective was to assess objective sleep quality in POTS patients using overnight polysomnography. METHODS: We studied 16 patients with POTS and 15 healthy control subjects performing daytime autonomic functions tests and overnight polysomnography at the Vanderbilt Clinical Research Center. RESULTS: There were no significant differences in the objective sleep parameters including sleep efficiency, sleep onset latency, wake time after sleep onset, REM latency, percentage of time spent in N1, N2, N3, and REM sleep, arousal index, apnea-hypopnea index, or periodic leg movement index in POTS patients as compared with healthy control subjects. There were significant negative correlations between sleep efficiency and the change in HR from supine to stand (rs = -0.527; p = 0.036). CONCLUSIONS: POTS patients do not have significant differences in objective sleep parameters as compared to control subjects based on overnight polysomnograms. Activation of the sympathetic nervous system may contribute significantly to the hyper arousal state and worsening of subjective estimates of sleep quality as previously reported in POTS patients.

10 Article Sleep Difficulties and Medications in Children With Autism Spectrum Disorders: A Registry Study. 2016

Malow, Beth A / Katz, Terry / Reynolds, Ann M / Shui, Amy / Carno, Margaret / Connolly, Heidi V / Coury, Daniel / Bennett, Amanda E. ·Sleep Disorders Division, Department of Neurology, Vanderbilt University School of Medicine, Nashville, Tennessee; beth.malow@vanderbilt.edu. · Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colorado; · Biostatistics Center, Massachusetts General Hospital, Boston, Massachusetts; · Department of Pediatrics, University of Rochester, Rochester, New York; · Department of Pediatrics, Nationwide Children's Hospital, Columbus, Ohio; and. · Department of Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania. ·Pediatrics · Pubmed #26908483.

ABSTRACT: OBJECTIVES: Sleep difficulties are common in children with autism spectrum disorders, with wide-ranging effects on the child's daytime behavior. We reviewed data within our Autism Speaks Autism Treatment Network Registry to determine the prevalence of sleep difficulties and patterns of medication use. METHODS: Data from 1518 children ages 4 to 10 years were analyzed to determine the number of children documented to have sleep difficulties by parent-completed questionnaires and clinician-completed forms and how these findings related to the use of sleep medications. RESULTS: The Children's Sleep Habits Questionnaire total score was ≥41 (associated with clinically significant sleep problems in past research) in 71% of children. The prevalence of sleep diagnoses was less frequent (30% of children aged 4-10 years; P < .0001). Medications for sleep were prescribed in 46% of 4- to 10-year-olds given a sleep diagnosis. The most common medication used for sleep was melatonin followed by α-agonists, with a variety of other medications taken for sleep (anticonvulsants, antidepressants, atypical antipsychotics, and benzodiazepines). Children taking medications for sleep had worse daytime behavior and pediatric quality of life than children not taking sleep medications. CONCLUSIONS: Parent concerns about sleep may not be reflected in the information gathered during a clinic visit, supporting the need to develop screening practice pathways for sleep in autism spectrum disorders. Furthermore, many medications taken for sleep have adverse effects, supporting the need for evidence-based interventions in this population.

11 Article Sleep in Children With Autism Spectrum Disorders: How Are Measures of Parent Report and Actigraphy Related and Affected by Sleep Education? 2016

Veatch, Olivia J / Reynolds, Ann / Katz, Terry / Weiss, Shelly K / Loh, Alvin / Wang, Lily / Malow, Beth A. ·a Sleep Disorders Division, Department of Neurology , Vanderbilt University Medical Center , Nashville , Tennessee , USA. · b Department of Pediatrics , Anschutz Medical Campus, University of Colorado School of Medicine, University of Colorado Denver , Aurora , Colorado , USA. · c Hospital for Sick Children, University of Toronto , Toronto , Ontario , Canada. · d Surrey Place Centre , Toronto , Ontario , Canada. · e Department of Biostatistics , Vanderbilt University , Nashville , Tennessee , USA. ·Behav Sleep Med · Pubmed #26619899.

ABSTRACT: Sleep disturbance is common in children with autism, resulting in a great need for effective treatments. To evaluate treatments for sleep disturbance in this population, it is critical to understand the relationship between measures of sleep captured by parent report and objective measures. The Children's Sleep Habits Questionnaire (CSHQ) and actigraphy-measured data from 80 children with autism and sleep-onset delay were evaluated. Reported problems with sleep-onset delay were concurrent with sleep duration problems in 66% of children, night wakings in 72% of children, and bedtime resistance in 66% of children; 38% of children were reported to have problems with all CSHQ insomnia domains. Actigraphy-measured sleep duration was correlated with estimates using CSHQ-reported bed and wake times.

12 Article Melatonin in Children with Autism Spectrum Disorders: How Does the Evidence Fit Together? 2015

Veatch, Olivia J / Goldman, Suzanne E / Adkins, Karen W / Malow, Beth A. ·Sleep Disorders Division, Department of Neurology, Vanderbilt University Medical Center, Nashville, TN, USA. · South Sound Pulmonary & Sleep Medicine, Olympia, WA, USA. ·J Nat Sci · Pubmed #26120597.

ABSTRACT: Autism spectrum disorders (ASD) are prevalent neurodevelopmental conditions, affecting 1 in 68 children in the United States alone. Sleep disturbance, particularly insomnia, is very common in children diagnosed with ASD, with evidence supporting overlapping neurobiological and genetic underpinnings. One of the most well studied mechanisms related to ASD and insomnia is dysregulation of the melatonin pathway, which has been observed in many individuals with ASD compared to typically developing controls. Furthermore, variation in genes whose products regulate endogenous melatonin modify sleep patterns in humans and have also been implicated in some cases of ASD. However, the relationship between comorbid insomnia, melatonin processing, and genes that regulate endogenous melatonin levels in ASD is complex and requires further study to fully elucidate. The aim of this review is to provide an overview of the current findings related to the effects of genetic variation in the melatonergic pathway on risk for expression of sleep disorders in children with ASD. In addition, functional findings related to endogenous levels of melatonin and pharmacokinetic profiles in this patient population are evaluated.

13 Article Genetic variation in melatonin pathway enzymes in children with autism spectrum disorder and comorbid sleep onset delay. 2015

Veatch, Olivia J / Pendergast, Julie S / Allen, Melissa J / Leu, Roberta M / Johnson, Carl Hirschie / Elsea, Sarah H / Malow, Beth A. ·Sleep Disorders Division, Department of Neurology, Vanderbilt University Medical Center, 1161 21st Ave. S., Nashville, TN, 37232, USA, olivia.j.veatch@vanderbilt.edu. ·J Autism Dev Disord · Pubmed #25059483.

ABSTRACT: Sleep disruption is common in individuals with autism spectrum disorder (ASD). Genes whose products regulate endogenous melatonin modify sleep patterns and have been implicated in ASD. Genetic factors likely contribute to comorbid expression of sleep disorders in ASD. We studied a clinically unique ASD subgroup, consisting solely of children with comorbid expression of sleep onset delay. We evaluated variation in two melatonin pathway genes, acetylserotonin O-methyltransferase (ASMT) and cytochrome P450 1A2 (CYP1A2). We observed higher frequencies than currently reported (p < 0.04) for variants evidenced to decrease ASMT expression and related to decreased CYP1A2 enzyme activity (p ≤ 0.0007). We detected a relationship between genotypes in ASMT and CYP1A2 (r(2) = 0.63). Our results indicate that expression of sleep onset delay relates to melatonin pathway genes.

14 Article Melatonin in children with autism spectrum disorders: endogenous and pharmacokinetic profiles in relation to sleep. 2014

Goldman, Suzanne E / Adkins, Karen W / Calcutt, M Wade / Carter, Melissa D / Goodpaster, Robert L / Wang, Lily / Shi, Yaping / Burgess, Helen J / Hachey, David L / Malow, Beth A. ·Departments of Neurology and Pediatrics Burry Chair in Cognitive Childhood Development, Sleep Disorders Division, Vanderbilt University Medical Center, 1161 21st Avenue South, Room A-0116, Nashville, TN, 37232-2551, USA. ·J Autism Dev Disord · Pubmed #24752680.

ABSTRACT: Supplemental melatonin has been used to treat sleep onset insomnia in children with autism spectrum disorders (ASD), although the mechanism of action is uncertain. We assessed endogenous and supplemental melatonin profiles in relation to sleep in nine children with ASD. In endogenous samples, maximal melatonin concentration (C(max)) and time to peak concentration (T(max)) were comparable to those previously published in the literature for typically developing children, and dim light melatonin onsets were captured in the majority of children. In treatment samples (supplemental melatonin), melatonin parameters were also comparable to those previously published for typically developing children. Our findings support that children with ASD and insomnia responsive to low dose melatonin treatment have relatively normal profiles of endogenous and supplemental melatonin.

15 Article Parent-based sleep education for children with autism spectrum disorders. 2014

Malow, Beth A / Adkins, Karen W / Reynolds, Ann / Weiss, Shelly K / Loh, Alvin / Fawkes, Diane / Katz, Terry / Goldman, Suzanne E / Madduri, Niru / Hundley, Rachel / Clemons, Traci. ·Sleep Disorders Division, Department of Neurology and Vanderbilt Kennedy Center, Vanderbilt University School of Medicine, 1161 21st Avenue South, Room A-0116, Nashville, TN, 37232, USA, beth.malow@vanderbilt.edu. ·J Autism Dev Disord · Pubmed #23754339.

ABSTRACT: This study provided sleep education to parents of children with autism spectrum disorder (ASD) to determine whether an individual or group format was more effective in improving sleep and aspects of daytime behavior and family functioning. Eighty children, ages 2-10 years, with ASD and sleep onset delay completed the study. Actigraphy and parent questionnaires were collected at baseline and 1 month after treatment. Mode of education did not affect outcomes. Sleep latency, insomnia subscales on the Children's Sleep Habits Questionnaire, and other outcomes related to child and family functioning improved with treatment. Parent-based sleep education, delivered in relatively few sessions, was associated with improved sleep onset delay in children with ASD. Group versus individualized education did not affect outcome.

16 Article Gabapentin shows promise in treating refractory insomnia in children. 2013

Robinson, Althea A / Malow, Beth A. ·1Department of Neurology, Sleep Disorders Division, Vanderbilt University, Nashville, TN, USA. ·J Child Neurol · Pubmed #23112238.

ABSTRACT: Insomnia is prevalent in pediatrics, particularly in those with neurodevelopmental disorders. Gabapentin has shown promise in treating insomnia in adults. The purpose of our study was to review our experience with using gabapentin to treat insomnia in children. We identified 23 children, seen by the authors in our Pediatric Sleep Clinic from January 2009 to March 2012. The mean age was 7.2 years and 70% were male. The majority (87%) had been given diagnoses of neurodevelopmental or neuropsychiatric disorders. All parents received education in sleep behavioral interventions. The majority of children (70%) had both sleep-onset and sleep maintenance insomnia. The average starting dose of gabapentin was 5 mg/kg every bedtime and the maximal dose was 15 mg/kg every bedtime. At follow-up, improved sleep was noted in 78% of children. Adverse effects were noted in 6 children.

17 Article Effects of a standardized pamphlet on insomnia in children with autism spectrum disorders. 2012

Adkins, Karen W / Molloy, Cindy / Weiss, Shelly K / Reynolds, Ann / Goldman, Suzanne E / Burnette, Courtney / Clemons, Traci / Fawkes, Diane / Malow, Beth A. ·Sleep Disorders Division, Vanderbilt University Medical Center, Nashville, Tennessee 37232, USA. ·Pediatrics · Pubmed #23118244.

ABSTRACT: OBJECTIVE: Sleep difficulties are common reasons why parents seek medical intervention in children with autism spectrum disorders (ASDs). We determined whether a pamphlet alone could be used by parents to help their child's insomnia. METHODS: Thirty-six children with ASD, ages 2 to 10 years, were enrolled. All had prolonged sleep latency confirmed by actigraphy showing a mean sleep latency of 30 minutes or more. Parents were randomly assigned to receive the sleep education pamphlet or no intervention. Children wore an actigraphy device to record baseline sleep parameters, with the primary outcome variable being change in sleep latency. Actigraphy data were collected a second time 2 weeks after the parent received the randomization assignment and analyzed by using Student's t test. Parents were also asked a series of questions to gather information about the pamphlet and its usefulness. RESULTS: Although participants randomized to the 2 arms did not differ statistically in age, gender, socioeconomic status, total Children's Sleep Habits Questionnaire score, or actigraphy parameters, some differences may be large enough to affect results. Mean change in sleep-onset latency did not differ between the randomized groups (pamphlet versus no pamphlet). Parents commented that the pamphlet contained good information, but indicated that it would have been more useful to be given specific examples of how to take the information and put it into practice. CONCLUSIONS: A sleep education pamphlet did not appear to improve sleep latency in children with ASDs.

18 Article Sleep in children and adolescents with Angelman syndrome: association with parent sleep and stress. 2012

Goldman, S E / Bichell, T J / Surdyka, K / Malow, B A. ·Sleep Disorders Program, Department of Neurology, Vanderbilt University Medical Center, Nashville, TN 37232-2551, USA. suzgoldman@gmail.com ·J Intellect Disabil Res · Pubmed #22044653.

ABSTRACT: BACKGROUND: Sleep concerns are common in children with Angelman syndrome, with 20-80% of individuals having a decreased sleep need and/or abnormal sleep-wake cycles. The impact of these sleep behaviours on parental sleep and stress is not known. METHOD: Through the use of standardised questionnaires, wrist actigraphy and polysomnography, we defined the sleep behaviours of 15 children/adolescents with Angelman syndrome and the association of the child/adolescents sleep behaviours on parental sleep behaviours and parental stress. RESULTS: Both children/adolescents and their parents exhibited over 1 h of wake time after sleep onset and fragmented sleep. Prolonged sleep latency in the child was associated with parent insomnia and daytime sleepiness. Additionally, variability in child total sleep time was associated with parental stress. CONCLUSIONS: Poor sleep in children/adolescents with Angelman syndrome was associated with poor parental sleep and higher parental stress. Further work is warranted to identify the underlying causes of the poor sleep, and to relate these findings to daytime functioning, behaviour and the family unit.