Sleep and Autism: Melatonin Study Adds Options for Sleepless Families

This is a guest post from ASF Science Writer Jerri Sparks Kaiser. Jerri, a parent of four children, one of whom has autism, blogs for ASF from a parent’s perspective about the latest autism research. A former Congressional Press Secretary, Jerri is an experienced science writer and has written specifically about autism for many years. Before her life in PR, she was a trained researcher having earned her B.A. in Psychology at UCLA. She currently lives with her family in New York.

By Jerri Sparks Kaiser

Photo: jshj

A new study by researchers at Vanderbilt University about giving melatonin to autistic children to help them sleep was published a few weeks ago and it deserves some attention.  Researchers gave 1 mg to 3 mg of melatonin to children with autism ages 3-9 years and noted improved sleep onset.  They are now trying to conduct larger scale studies.

Sleep difficulties have always been a problem for my son Jared.  One of the first things I noticed about his development was that he didn’t sleep very many hours in a row.  In fact, for the first 4 years he only slept 4 ½ hours at a time and after that it was still just 6 hours.  I don’t recall when he finally began sleeping at least 8 hours at a stretch (perhaps it was around age 7) but I know that it didn’t happen without medications prescribed by doctors.  Sleep deprivation was making it difficult for me and my spouse to conduct our daily lives and we resorted to sleeping in shifts. It is estimated that 50-80% of those with ASD are affected by insomnia and that impacts families as well.

I remember sleepily waiting in the elevator at UCLA Medical Center to take Jared to an early pediatrician appointment. He must have been around 10 weeks old.  Beside me in the elevator was another couple with a young infant like my son and we exchanged pleasantries about each baby’s cuteness and then I asked them how they were coping with the lack of sleep.  They smiled at each other and said “She’s already sleeping six hours in a row…”  It was the first of many moments where I sought solace in parents going through the same thing I was going through only to have that hope – that need – dashed.[

Since that time my son has gradually learned to sleep a lot longer, but his sleep is still shallow at times.  The slightest noise can wake him and then he’s up for the day no matter how little sleep he had before he was awakened.  When he is particularly excited about something that’s happening the next day he can’t sleep and will stay awake for 24 hours or more until the anticipated event has occurred.  We are searching for something to help him with this latest symptom, not only for his own health but also for the sake of our family.  Sleep disturbance affects everyone, not just the person experiencing it.  I never thought I’d still be going through sleep deprivation 14 years later.

We did try melatonin for Jared when he was much younger.  I remember it working but as fate would have it, other symptoms, such as running away and behavioral outbursts, took precedence over his sleep supplement and so we had to remove melatonin from his treatment.  The new medications he was placed on took care of his sleep issue until just recently.  This new study makes me wonder if perhaps we could introduce melatonin into his treatment once again and I am going to call his doctor about this.

Recently Jared asked me why he couldn’t sleep.  This is an emerging behavior because Jared is just now beginning to let us into his inner thoughts.  It’s very exciting!  The fact that he’s wondering about his own behaviors is encouraging to me.  I didn’t know what to tell him so I said the only thing a mother can say when she doesn’t have the answer yet: “I don’t know honey, but I’m going to find out and make it all better.”  And I will, someday, somehow.

IMFAR Travel Grants Funds Enable Autism Stakeholders to Attend the Leading Autism Research Conference

We are now accepting applications for travel grants to send a limited number of parents of children with autism, individuals with autism, special education teachers, and other stakeholders to attend the International Meeting for Autism Research (IMFAR). This year the conference will be held in Toronto, Canada from May 17-19.

The awards cover up to $1,000 of expenses to be used for registration, travel, accommodations, meals and other directly related expenses, including childcare or special accommodations to enable individuals with autism to participate. Grantees are responsible for obtaining international travel documents.

Applications must be received by February 29, 2012.

IMFAR is an annual scientific meeting, convened each spring, to promote, exchange and disseminate the latest scientific findings in autism research and to stimulate research progress in understanding the nature, causes, and treatments for autism spectrum disorders. IMFAR is the annual meeting of the International Society for Autism Research (INSAR).

“We are thrilled to be able to offer this program for the third year in a row and to give back to the autism stakeholder community in a research-focused way,” said Alison Singer, president of the Autism Science Foundation.

“These scholarships are a wonderful opportunity to bring more stakeholders to IMFAR and enhance discussion and interactions among all key constituencies”, said Dr. Helen Tager-Flusberg, President of INSAR and Professor of Psychology, Anatomy & Neurobiology and Pediatrics, Boston University.

For details on how to apply visit the Apply for IMFAR Travel Grant page on our website.

Interview: Dr. Karen Piece Discusses the Success of the 1-Year Well-Baby Check-Up Approach

Dr. Karen Pierce is an Assistant Professor in the Department of Neurosciences at the University of California San Diego, and the Director of Clinical and Functional Brain Imaging Research at the UCSD Autism Center of Excellence (ACE). An autism researcher for over 20 years, Dr. Pierce researches early clinical and neurobiological signatures of autism. Her “1-Year Well-Baby Check-Up Approach” has been embraced by over 170 pediatricians in the San Diego area, as it provides a non-invasive screening tool for babies around their first birthday. Over 20,000 babies have been given the 24-question screen.

Jonathan Carter spoke with Dr. Pierce about her work. 

You’ve developed an early detection technique named the 1-Year Well-Baby Check-Up Approach. Can you describe how you developed the approach?

For me, the motivation was twofold and contained both clinical and research roots. First, I wanted to detect autism early to get kids into treatment as soon as possible. The second motivation was purely scientific.  Autism is a neurobiological disorder, and if we want to make the big discoveries about what’s going on, we have to study the disorder while the symptoms are unfolding.  So I needed to figure out a way to study autism as early as possible.

But then we are left with a problem: How do you study autism during the first year or two of life if a diagnosis doesn’t come until 2, 3 or even 4? So I decided the best way to address this issue is to implement a really simple, broadband screen.

Obviously symptoms of autism aren’t glaring over the first year of life. If they were, people would be diagnosing autism at that year of age. But, there are some signs that I thought would be caught by broadband screens. There is a really excellent broadband screen developed by Amy Wetherby and Barry Prizant, called the CSBS DP IT Checklist, but the screen had never been used as standard of care in a doctor’s office before. I started with my own pediatrician and asked her if she could spend a couple extra minutes during the one-year exam giving this screen to all of her patients. She tried it and it worked well, leading the other three doctors in her practice to do it. It all started with just four pediatricians. And it worked really well with those four, so I went out and started taking with other pediatricians around San Diego. By the time I hit 30 pediatricians word had spread far enough that I began to have pediatricians calling me asking to get into our program.   Today over 170 pediatricians in San Diego are screening for autism and other delays at the 1-year check up using my program.

How does the program work?

It’s quite simple: I go into the pediatrician’s office and tell them about the importance of early screening in autism. I then show and teach the staff the screening tool and how to score it.

The reason that the screen works is that it has to be done at the actual checkup. The mother or father fills out the CSBS, which is fairly short, just one page. She fills it out while in the waiting room and hands it off to the receptionist, who then hands it off to the nurse or medical assistant who grades it right then and there. This allows the doctor to look at it quickly and reveals whether the child is at risk of having delays. The score allows the doctor to probe further during the one-year exam. If the baby is showing a delay they are then referred to UCSD or other qualified location. Once they get here, we do a full, in-depth evaluation.  We do the ADOS and the Mullen Scales of Early Learning to look for cognitive delays. We perform several experimental assessments such as my “geometric preference test for autism” that evaluates eye gaze patterns. We also take a blood sample to look for blood-based autism markers, and then we also do a free MRI scan to examine brain development. 

Blinking Study Sheds New Light on My Anecdotal Findings as a Parent

ASF welcomes Jerri Sparks Kaiser as our newest Science Writer. Jerri, a parent of four children, one of whom has autism, will blog for ASF from a parent’s perspective about the latest autism research. A former Congressional Press Secretary, Jerri is an experienced science writer and has written specifically about autism for many years. Before her life in PR, she was a trained researcher having earned her B.A. in Psychology at UCLA. She currently lives with her family in New York.

By Jerri Sparks Kaiser

A promising new study about blinking rates in autistic children caught my attention this week.  As the mother of an autistic son and three other typically developing children, I can attest to the differences in their social behavior but it had never occurred to me to measure and compare their blinking rates.

The new study, which appears in the Proceedings of the National Academy of Sciences, found that when autistic individuals watch a video of a boy and girl playing they decrease their blinking rate when watching the physical movements whereas typically developing individuals did just the opposite – they decreased their blinking rate while watching the emotional content.  That is, typically developing children are intrigued by emotional interactions (since decreased blinking rate indicates interest) and autistic individuals show interest in the physical interactions.

This makes perfect sense to me.  When my son was an infant I was studying psychology at UCLA and I kept notes of his daily life from conception until he was about 3 ½ years old.

One thing I noted was how when anyone was upset he watched their mouths move instead of their entire face.  He rarely looked at their eyes.  It was as if he couldn’t hear the conversation so he found the silent movements of their mouths humorous.  He would stare intently at people’s mouths and then begin laughing.  Later on he would become excited by this and tip forward on his toes, waving his arms excitedly as he watched.

I remember thinking he might be deaf so I had his hearing checked but it was fine.  In fact, Jared can hear very well, from distant trains to the fluorescent bulbs in the kitchen.  For some reason though he compartmentalizes his sensory input, instead of processing the whole he catches the visual, then the audio.  He would watch sand fall in front of his face and ignore my pleas to come out of the sandbox.  His visual system has always over rode his auditory, so much so that I began covering his eyes if I wanted him to pay attention to what I was saying.

This study could lead to much earlier diagnosis and treatment of autism.  Infants have gaze patterns at birth, an early indicator of bonding.  If it could be found that children as young as 6 months of age demonstrate particular blinking rates or patterns then it could indicate which children are good candidates for early intervention services.  This could improve overall long-term outcomes and gives the term “early intervention” a much more powerful meaning.

My son did not receive services until he was 3 years old because I couldn’t get a diagnosis before that, even though I knew as his mother that something was not right.  There simply weren’t relative tests for any earlier periods of development 14 years ago when my son was born.

I did, however, instinctively model emotional interactions for my son in a heightened way.  Because I knew he acted deaf I often overplayed when I was hurt so as to elicit a nurturing response from him.  When that didn’t work at first I intensified my reactions to when he was hurt.  Eventually it worked and today my son is very empathetic when others are hurt or upset.  He needs to “fix” them.  While it may not be the same kind of empathy as typically developing people exhibit or even feel, his nurturing instinct has been developed and is intact.  The earlier parents know to utilize tools such as this the better the future is for their children.