Saturday, December 28, 2019

CBD without THC and Children? What can a parent do?

How does one pick a CBD product?

There are many people or families who want to try CBD without THC.

Keep in mind that these products are as regulated as your coffee.

Here is a reasonable pop article on the topic Link here

FDA tests CBD products and sends warning letters.

I have listed some criteria that seem important:
  • Compliance WITH All Laws 
  • Transparency in labeling (Can I calculate how many mg of CBD per ml)
  • Testing by a third party (Can I verify dosing)
  • Neutral taste or at least tolerable taste?
  • Economy (how many cents per mg CBD?)
CBD WITHOUT THC? Here is one example of a CBD that is:
1) Open about test results
2) Neutral Taste
3) Economical. #veterandiscount

One CBD Example

“It is important to note that CBD products are not approved by FDA for the diagnosis, cure, mitigation, treatment, or prevention of any disease. Consumers should beware purchasing and using any such products.” ... From FDA

Monday, December 09, 2019

Vayarin is Found! Its...Called Zoom

OK. Zoom is vayarin. Zoom is distributed in Israel by Teva. 
I ordered some from Israel. Indeed,  it works (and it smells) like good old vayarin. I read the ingredients and the box and it appears to be the same (except in Hebrew). 

So I called the pharmacy below and met Jeff (he’s Canadian).

Zoom is Vayarin. Free shipping details on my blog.
Jeff will send Vayarin to you if you send your prescription to the contacts below (a medical food, remember).

Use the discount code DrJosh” - they will ship a 3 month order for free.

(Btw ... I get no special payment from anyone ... except the thrill of having a discount code with my name). by fax and by email. The prescription must be faxed (toll-free Fax 
  1. 1-866-544-8993) or emailed ( to us.

Tuesday, December 03, 2019

Adult Neurology Disorders and Low THC CBD in Texas

Adult Neurology Disorders Qualifying for THC Cannabis - Altzheimer Parkinsons CTE

The rule is published and effective 5 Dec 2019 

§1.61. Incurable Neurodegenerative Diseases.
(a) An incurable neurodegenerative disease is a condition, injury, or illness:
          (1) that occurs when nerve cells in the brain or peripheral nervous system lose function over time; and
          (2) for which there is no known cure.
(b) A qualifying physician under Texas Occupations Code, Chapter 169, may prescribe low-THC cannabis to a patient with a documented diagnosis of one or more of the following incurable neurodegenerative diseases:

          (1) Incurable Neurodegenerative Diseases with Adult Onset:
                   (A) Motor Neuron Disease:
                             (i) Amyotrophic lateral sclerosis;
                             (ii) Spinal-bulbar muscular atrophy; and
                             (iii)  Spinal Muscular Atrophy.
                   (B) Muscular Dystrophies:
                             (i) Duchenne Muscular Dystrophy;
                             (ii) Central Core; and
                             (iii) Facioscapulohumeral Muscular Dystrophy.
                   (C) Freidrich’s Ataxia.
                   (D) Vascular dementia.
                   (E) Charcot Marie Tooth and related hereditary neuropathies.
                   (F) Spinocerebellar ataxia.
                   (G) Familial Spastic Paraplegia.
                   (H) Progressive dystonias DYT genes 1 through 20.
                   (I) Progressive Choreas: Huntington’s Disease.
                   (J) Amyloidoses:
                             (i) Alzheimer’s Disease;
                             (ii) Prion Diseases:
                                      (I) Creutzfeldt-Jakob Disease;
                                      (II) Gerstmann-Strausller-Scheinker Disease;
                                      (III) Familial or Sporadic Fatal Insomnia; and
                                      (IV) Kuru.
                   (K) Tauopathies.
                             (i) Chronic Traumatic Encephalopathy:
                             (ii) Pick Disease;
                             (iii) Globular Glial Tauopathy;
                             (iv) Corticobasal Degeneration;
                             (v) Progressive Supranuclear Palsy;
                             (vi) Argyrophilic Grain Disease;
                             (vii) Neurofibrillary Tangle dementia, also known as Primary Age-related Tauopathy; and
                             (viii) Frontotemporal dementia and parkinsonism linked to chromosome 17 caused by mutations in MAPT gene.
                   (L) Synucleinopathies:
                             (i) Lewy Body Disorders:
                                      (I) Dementia with Lewy Bodies; and
                                      (II) Parkinson’s Disease; and
                             (ii) Multiple System Atrophy.
                   (M) Transactive response DNA-binding protein-43 (TDP-43) Proteinopathies:
                             (i) Frontotemporal Lobar Degeneration;
                             (ii) Primary Lateral Sclerosis; and
                             (iii) Progressive Muscular Atrophy.

Pediatric Neurology Disorders Qualifying for Low THC Cannabis in Texas

Texans... here is the published pediatric  list....  

Low 'THC Cannabis for Pediatric Neurology Disorders

The rule is published and effective 5 Dec 2019 

§1.61. Incurable Neurodegenerative Diseases.
(a) An incurable neurodegenerative disease is a condition, injury, or illness:
          (1) that occurs when nerve cells in the brain or peripheral nervous system lose function over time; and
          (2) for which there is no known cure.
(b) A qualifying physician under Texas Occupations Code, Chapter 169, may prescribe low-THC cannabis to a patient with a documented diagnosis of one or more of the following incurable neurodegenerative diseases:

Incurable Neurodegenerative Diseases with Pediatric Onset:
                   (A) Mitochondrial Conditions:
                             (i) Kearn Sayers Syndrome;
                             (ii) Mitochondrial Encephalopathy Ragged Red Fiber;
                             (iii) Mitochondrial Encephalopathy Lactic Acidosis Stroke;
                             (iv) Neuropathy, Ataxia, and Retinitis Pigmentosa;
                             (v) Mitochondrial neurogastrointestinal encephalopathy;
                             (vi) Polymerase G Related Disorders:
                                      (I) Alpers-Huttenlodcher syndrome;
                                      (II) Childhood Myocerebrohepatopathy spectrum;
                                      (III) Myoclonic epilepsy myopathy sensory ataxia; and
                                      (IV) Ataxia neuropathy spectrum;
                             (vii) Subacute necrotizing encephalopathy, also known as Leigh syndrome;
                             (viii) Respiratory chain disorders complex 1 through 4 defects: Co Q biosynthesis defects;
                             (ix) Thymidine Kinase;
                             (x) Mitochondrial Depletion syndromes types 1 through 14:
                                       (I) Deoxyguanisine kinase deficiency;
                                      (II) SUCLG1-related mitochondrial DNA depletion syndrome, encephalmyopathic form with methylmalonic aciduria; and
                                      (III) RRM2B-related mitochondrial disease.
                   (B) Creatine Disorders:
                             (i) Guanidinoacetate methytransferase deficiency;
                             (ii) L-Arginine/glycine amidinotransferase deficiency; and
                             (iii) Creatine Transporter Defect, also known as SLC 6A8.
                   (C) Neurotransmitter defects:
                             (i) Segawa Diease, also known as Dopamine Responsive Dystonia;
                             (ii) Guanosine triphosphate cyclohydrolase deficiency;
                             (iii) Aromatic L-amino acid decarboxylase deficiency;
                             (iv) Monoamine oxidase deficiency;
                             (v) Biopterin Defects:
                                      (I) Pyruvoyl-tetahydropterin synthase;
                                      (I) Sepiapterin reductase;
                                      (III) Dihydropteridine reductase; and
                                      (IV) Pterin-4-carbinolamine dehydratase.
                                      (D) Congenital Disorders of Glycosylation.
                   (E) Lysosomal Storage Diseases:
                             (i) Mucopolysaccaridosis:
                                      (I) Mucopolysaccharidosis Type I, also known as Hurler Syndrome or Scheie Syndrome;
                                      (II) Mucopolysaccharidosis Type II, also known as Hunter Syndrome;
                                      (III) Mucopolysaccharidosis Type III, also known as Sanfilippo A and B; and
                                      (IV) Mucopolysaccharidosis Type IV, also known as Maroteaux-Lamy; and
                                      (V) Mucopolysaccharidosis Type VII, also known as Sly.
                             (ii) Oligosaccharidoses:
                                      (I) Mannosidosis;
                                      (II) Alpha-fucosidosis;
                                      (III) Galactosialidosis;
                                      (IV) Asparylglucosaminuria;
                                      (V) Schindler; and
                                      (VI) Sialidosis;
                             (iii) Mucolipidoses:
                                      (I) Mucolipidoses Type II, also known as Inclusion Cell disease; and
                                      (II) Mucolipidoses Type III, also known as pseudo-Hurler polydystrophy;
                             (iv) Sphingolipidoses:
                                      (I) Gaucher Type 2 and Type 3;
                                       (II) Neimann Pick Type A and B;
                                      (III) Neimann Pick Type C;
                                      (IV) Krabbe;
                                      (V) GM1 gangliosidosis;
                                      (VI) GM2 gangliosidosis also known as Tay-sachs and Sandhoff Disease;
                                      (VII) Metachromatic leukodystrophy;
                                      (VIII) Neuronal ceroid lipofuscinosis types 1-10 including Batten Disease; and
                                      (IX) Farber Disease; and
                             (v) Glycogen Storage-Lysosomal: Pompe Disease.
                   (F) Peroxisomal Disorders:
                             (i) X-linked adrenoleukodystrophy;
                             (ii) Peroxisomal biosynthesis defects:
                                      (I) Zellweger syndrome:
                                      (II) Neonatal Adrenoleukodystrophy; and
                             (iii) D Bidirectional enzyme deficiency.
                   (G) Leukodystrophy:
                             (i) Canavan disease;
                             (ii) Pelizaeus-Merzbacher disease;
                             (iii) Alexander disease;
                             (iv) Multiple Sulfatase deficiency;
                             (v) Polyol disorders;
                             (vi) Glycine encephalopathy, also known as non-ketotic hyperglycinemia;
                             (vii) Maple Syrup Urine Disease;
                             (viii) Homocysteine re-methylation defects;
                             (ix) Methylenetetrahydrofolate reductase deficiency severe variant;
                             (x) L-2-hydroxyglutaric aciduria;
                             (xi) Glutaric acidemia type 1;
                             (xii) 3-hydroxy-3-methylglutaryl-CoA lyase deficiency;
                             (xiii) Galactosemia;
                             (xiv) Manosidosis alpha and beta;
                             (xv) Salidosis;
                             (xvi) Peripheral neuropathy types 1 through 4;
                             (xvii) Pyruvate Dehydrogenase Deficiency;
                             (xviii) Pyruvate Carboxylase Deficiency;
                             (xix) Refsum Disease; and
                             (xx) Cerebral Autosomal Dominant Arteriopathy with Sub-cortical Infarcts and Leukoencephalopathy.
                   (H) Fatty Acid Oxidation:
                             (i) Trifunctional protein deficiency; and
                             (ii) Long-chain L-3 hydroxyacyl-CoA dehydrogenase deficiency.
                   (I) Metal Metabolism:
                             (i) Wilson Disease;
                             (ii) Pantothenate Kinase Associated Neurodegeneration; and
                             (iii) Neurodegeneration with brain iron accumulation.
                   (J) Purine and Pyrimidine Defects:
                             (i) Adenylosuccinate synthase Deficiency;
                             (ii) 5-aminoimidazole-4-carboxamide ribonucleotide transformylase deficiency;
                             (iii) Hypoxanthine-guanine phosophoribosyltransferase Deficiency also known as Lesch-Nyhan disease;
                             (iv) Dihydropyrimidine dehydrogenase Deficiency; and
                             (v) Dihydropirimidinase Deficiency.

A treating physician of a patient suffering from an incurable neurodegenerative disease not listed in subsection (b) of this section may submit a request to the department to have a disease added.
(e) After review of the submitted documentation, the department may request additional information or make a determination.

Wednesday, September 11, 2019

An open letter to DSHS regarding tcup program.

Dear Governor Abbot and Dr. Hellerstedt,

I am a pediatric neurologist and epilepsy specialist practicing in Houston. I have experience with the TCUP for over 1 year and manage over 80 patients on cannabanoids (including Epidiolex). I am also a parent of a child with a neurogenetic disorder.

Today the DSHS will take public comment on a puzzling list of selected conditions where medical cannabis may be allowed in Texas.

While well-intentioned, the "list" appears to be far from ready to deploy. 
  •  Many illnesses are inexplicably omitted. One glaring omission in my 1 minute review is  ataxias. What is the evidentiary basis for inclusion the list?
  • Pediatric illnesses such as SMA and muscular dystrophies are listed under "Incurable Neurodegenerative Diseases with Adult Onset". Does the adult-pediatric division on the list imply that people with SMA (a pediatric illness) cannot get CBD until they are adults?  The distinction makes no biologic sense.
  • The specificity of this list is problematic. The era of genetic sequencing has opened our eyes to thousands of low denominator disorders that are progressive and incurable.  New conditions are genetically defined rapidly with daily changes. How often will DSHS update this list to keep pace? 
  • Many progressive degenerative disorders are still NOT diagnosed at a level of specificity demanded here.  For instance, people can have a leukodystrophy without a specific diagnosis.   There is no test for these conditions that, in sum, are not rare. If doctors cannot come to a genetic diagnosis, are patients not allowed to seek relief ? Do you really want to commit staff to review charts or trust the doctors?
  • The decision to treat should be one between a doctor and patient.  Conceptually, one wonders why DSHS is deciding that a person with Refsum disease is meritorious but not one with Rett Syndrome? 
Ultimately,  from a policy perspective the list will usher a blizzard of “what about me” requests and an understandable outpouring of accusations of arbitrary insensitivity.

Further, the list is an assault on the practice of medicine. Physicians can prescribe narcotics, chemotherapy and many other toxic agent. But, it seems odd that government will decide who has an incurable neurodegenerative disorder?

Perhaps the list should include a general statement allowing a physician to decide e.g. “All Other neurologic disorders of  genetic, inflammatory, oncologic, metabolic, vascular and/ or idiopathic etiology”? 

Dr. Rotenberg 

Tuesday, September 10, 2019

Texas Medical Cannabis - Does Your illness Qualify? The DSHS will decide.

What are Incurable Neurodegenerative Diseases? 

The DSHS will decide if you or your loved one's illness is important enough to qualify for medical cannabis. DSHS will decide if the condition incurable enough or degenerative enough.  Wow. 

Contact your legislator and governor. JR

Here is a link to the proposed rule

Notice of Public Hearing - Implementation of House Bill 3703

Proposed New Rule Relating to Designating Incurable Neurodegenerative Diseases

The Department of State Health Services (DSHS) will hold a public hearing to accept public comments on the proposed new rules to implement House Bill 3703, relating to designating incurable neurodegenerative diseases.
The public hearing will be from 1:00 p.m. to 3:00 p.m. on September 11, 2019, in the Moreton Building, Room M-100, Department of State Health Services, 1100 West 49th Street, Austin, Texas 78756. If the time allotted does not accommodate the number of persons who register to speak on or before 3:00 p.m., DSHS will extend the public hearing to accommodate those registrants, however, that extension will only be until 5:00 p.m. on that date. 
The public hearing will be structured for the receipt of oral or written comments by interested persons. Individuals may present oral statements when called upon in order of registration. There will be no open discussion during the public hearing. Comment time for each individual will be determined by the total number of persons registered to speak in the time allotted.  If time permits, comments will be limited to 3 minutes per speaker but may be further limited by DSHS if more registrants need to be accommodated.

Saturday, September 07, 2019

Trans Cranial Electric Stimulation Tdcs Literature Library

Tdcs  involves the cortex and subcortical networks 

TDCS Article Library

 Often, patients ask me for the latest literature on transcranial direct stimulation.

 Here are links to my library of abstracts from PUBMED at the National Library of Medicine

 I update the site from time to time so please check back.

Dr Josh

Basics -

Ataxia - LINK to articles on TDCS and ataxia

Autism - LINK to articles on autism and TDCS TES

Brain Injury - LINK to Brain Injury

Cerebral Palsy - LINK to CP Articles

Monday, August 19, 2019

TransCranial Electrical Stimulation - tDCS tACS - What is it?

What is Transcranial Direct Current Stimulation (tDCS)?

Transcranial direct current stimulation (tDCS), is a non-invasive, painless brain stimulation treatment that uses direct electrical currents to stimulate specific parts of the brain.

The therapy works by delivering a low intensity electrical current to part of the brain responsible for abnormal pain sensation. This constant, low intensity current is passed through two electrodes placed over the head which modulates neuronal activity.
The treatment is not surgical and drug free. 
There are two types of stimulation with tDCS: anodal and cathodal stimulation. Anodal stimulation acts to excite neuronal activity while cathodal stimulation inhibits or reduces neuronal activity.

Is Transcranial Direct Current Stimulation (tDCS) Effective?

Recent studies support a therapeutic potential of tDCS in patients with:
  • Ataxia
  • Fibomyalgia
  • Dysautonomia
  • Brain injury
  • Disorders of Consciousness
  • Migraine
  • Dyslexia
  • Spasticity
  • Cerebral Palsy

Chronic neuropathic pain, Parkinson, stroke recovery, tinnitus (ringing in the ears), traumatic spinal cord injury, depression and other illnesses.
TES treatments are complementary - that is they are used after standard therapies have failed.
 tDCS devices have not been approved by the FDA for this application.
Although tDCS is still an evolving form of brain stimulation, it potentially has several advantages over other brain stimulation techniques. It is cheap, non-invasive, painless and safe. It is also easy to administer and the equipment is easily portable.

Thursday, August 15, 2019

Low THC CBD now available in Texas for more conditions.

Low-THC CBD has arrived for more conditions. 

Important news for people and families living with: 
  • Autism
  • Spasticity
  • Epilepsy
  • ALS
  • MS 
The Texas Legislature recently enacted HB 3703  providing additional medical conditions for which low-THC cannabis may be prescribed and increasing the respective specialties in which prescribing physicians may practice.

The Compassionate Use Registry of Texas (CURT) has undergone the modifications necessary to allow prescriptions for the additional medical conditions. 

Autism and spasticity are among these indications.  ANY patient with epilepsy or seizures may be considered.

Dr. Rotenberg is registered with TCUP and I have extensive experience with these agents in children with epilepsy.

If you are interested in learning more. Please speak to Kara Schmidt PA or to me at the next visit.

Dr. Rotenberg

Board Certified in Epilepsy, Brain Injury and Sleep Medicine

Tuesday, May 07, 2019

Medical Cannabis - CBD in Texas goes to the Senate After HB 1365 Passes House

Might Low THC cannabis help someone you love with  medical conditions like cancer, autism, PTSD, Alzheimer’s, Parkinson’s, Huntington’s, Tourettes, Crohn’s, multiple sclerosis and muscular dystrophy? 

Call your Texas senator, LtGovernor, Governor to express your opinion. - JR

By Natalie Hee, FOX 26 News
Posted May 07 2019 11:17AM CDTVideo Posted May 06 2019 10:23PM CDT Updated May 07 2019 11:28AM CDT

HOUSTON (FOX 26) - A rare type of epilepsy is the only way medical cannabis is prescribed in the state. One Houston family says it saved their daughter’s life and now they’re pushing for a bill to help people with other types of conditions.

Lora Taylor says her 37-year-old daughter, Julie, has intractable epilepsy and used to have an average of up to 95 seizures a month. Julie has tried 26 of the 28 medications suitable for her condition. Her options seemed to be running thin until she was prescribed CBD oil by her pediatric neurologist in September.

“I had never seen anything work that well, that effectively in really in 36 years. Most of her seizures were anywhere from 3 to 25 minutes. But after the first 30 days using the CBD oil, that was reduced to two 10-second seizures,” Taylor said.

Over the last eight months, Taylor said there's been dramatic improvement in the frequency and severity of Julie's seizures. She says not only has her mobility improved, Julie’s now able to sleep through the night.

“She used to not be able to move her arms or put her arms down at all,” Taylor said.

Julie's rare form of epilepsy is currently one of the only qualifying types of debilitating medical conditions eligible for medical cannabis under state law.

House Bill 1365, authored by Representative Eddie Lucio, would expand eligibility to include patients with other debilitating medical conditions like cancer, autism, PTSD, Alzheimer’s, Parkinson’s, Huntington’s, Tourettes, Crohn’s, multiple sclerosis and muscular dystrophy. The bill would also establish a Cannabis research program and review board.

Dr Joshua Rotenberg, a pediatric neurologist who specializes in epilepsy, said the low-THC cannabis isn't a one-size-fits-all answer for these conditions. He said the success rate can vary from patient to patient but rather, it's having the option available for families like the Taylors who feel like they're running out of time.

“Instead of being hung up about the diagnoses, it opens it up for discussion and application,” Dr. Rotenberg said.

HB 1365 was voted and approved by the House Monday. The bill will head to the Senate next for consideration.


Saturday, April 06, 2019

Treatment for Ataxia - TDCS

A treatment where there are none. JR

Cerebello-spinal tDCS in ataxia

A randomized, double-blind, sham-controlled, crossover trial

Conclusions A 2-week treatment with cerebello-spinal tDCS reduces symptoms in patients with ataxia and restores motor cortex inhibition exerted by cerebellar structures. Cerebello-spinal tDCS might represent a promising future therapeutic and rehabilitative approach in patients with neurodegenerative ataxia, still an orphan disorder of any pharmacologic intervention.

Friday, March 29, 2019

Cannabinoids and Sleep. What is the data?

A working list of  published TRIALS in peer reviewed publications related to cannabinoids /  CBD and insomnia

There are no FDA approved medications for insomnia in children. 

1 trial in clonidine  for autism and one for ADHD.

While I am not advocating CBD for every child with ADHD, I am linking   ONE relevant clinical article supporting the widespread use of CLONIDINE. its hardly a rich database of clinical data. 

Dr Josh 

Cannabidiol and Sleep

Barchel D, Stolar O, De-Haan T, Ziv-Baran T, Saban N, Fuchs DO, Koren G, Berkovitch M.
Front Pharmacol. 2019 Jan 9;9:1521. doi: 10.3389/fphar.2018.01521. eCollection 2018.
Free PMC Article

Shannon S, Lewis N, Lee H, Hughes S.
Perm J. 2019;23:18-041. doi: 10.7812/TPP/18-041.

4.  2018 Aug;33(9):565-571. doi: 10.1177/0883073818773028. Epub 2018 May 16.

Medical Cannabis for Pediatric Moderate to Severe Complex Motor Disorders.


A complex motor disorder is a combination of various types of abnormal movements that are associated with impaired quality of life (QOL). Current therapeutic options are limited. We studied the efficacy, safety, and tolerability of medical cannabis in children with complex motor disorder. This pilot study was approved by the institutional ethics committee. Two products of cannabidiol (CBD) enriched 5% oil formulation of cannabis were compared: one with 0.25% δ-9-tetrahydrocannabinol (THC) 20:1 group, the other with 0.83% THC 6:1 group. Patients aged 1 to 17 years (n = 25) with complex motor disorder were enrolled. The assigned medication was administered for 5 months. Significant improvement in spasticity and dystonia, sleep difficulties, pain severity, and QOL was observed in the total study cohort, regardless of treatment assignment. Adverse effects were rare and included worsening of seizures in 2 patients, behavioral changes in 2 and somnolence in 1.


CBD; THC; cannabis; cerebral palsy; dystonia; movement disorders; spasticity
Autism and Sleep

Mazzone L, Postorino V, Siracusano M, Riccioni A, Curatolo P.
J Clin Med. 2018 May 3;7(5). pii: E102. doi: 10.3390/jcm7050102. Review.
Free PMC Article
Johnson CR, Smith T, DeMand A, Lecavalier L, Evans V, Gurka M, Swiezy N, Bearss K, Scahill L.
Sleep Med. 2018 Apr;44:61-66. doi: 10.1016/j.sleep.2018.01.008. Epub 2018 Feb 1.
Köse S, Yılmaz H, Ocakoğlu FT, Özbaran NB.
Sleep Med. 2017 Dec;40:69-77. doi: 10.1016/j.sleep.2017.09.021. Epub 2017 Oct 13.
Moore M, Evans V, Hanvey G, Johnson C.
Children (Basel). 2017 Aug 8;4(8). pii: E72. doi: 10.3390/children4080072. Review.
Free PMC Article
Souders MC, Zavodny S, Eriksen W, Sinko R, Connell J, Kerns C, Schaaf R, Pinto-Martin J.
Curr Psychiatry Rep. 2017 Jun;19(6):34. doi: 10.1007/s11920-017-0782-x. Review.
Free PMC Article
Malow BA, Katz T, Reynolds AM, Shui A, Carno M, Connolly HV, Coury D, Bennett AE.
Pediatrics. 2016 Feb;137 Suppl 2:S98-S104. doi: 10.1542/peds.2015-2851H.
Free Article
Yang Z, Matsumoto A, Nakayama K, Jimbo EF, Kojima K, Nagata K, Iwamoto S, Yamagata T.
Brain Dev. 2016 Jan;38(1):91-9. doi: 10.1016/j.braindev.2015.04.006. Epub 2015 May 6.
 2014 Apr;15(4):472-5. doi: 10.1016/j.sleep.2013.10.018. Epub 2014 Feb 7.

Use of sleep medication in children with ADHD.



Sleep problems are common in children with attention-deficit/hyperactivity disorder (ADHD), yet little is known about sleep medication use in this population. The aim of this study was to describe sleep medication use, as well as associated child and family characteristics in school-aged children with ADHD.


Sleep medication use was ascertained using a prospective parent-completed seven-night sleep and medication log. Exposure variables included socio-demographic characteristics, total sleep problem severity (Children's Sleep Habits Questionnaire), ADHD severity and subtype (ADHD Rating Scale IV), ADHD medication use, internalising and externalising co-morbidities (Anxiety Disorders Interview Schedule for Children/Parent version IV) and parent mental health (Depression Anxiety Stress Scale).


Two hundred and fifty-seven children with ADHD participated and of these 57 (22%) were taking sleep medication (melatonin 14% and clonidine 9%). Sleep medication use was associated with combined-type ADHD and ADHD medication use. The presence of co-occurring internalising and externalising co-morbidities was also associated with sleep medication use in ad hoc analyses.


Sleep medication use is common in children with ADHD and is associated with combined-type ADHD and use of ADHD medication. Further research is needed on the broad functional benefits and long-term safety of sleep medication in this population.


Attention deficit hyperactivity disorder; Child; Medication therapy management; Melatonin; SleepSleep initiation and maintenance disorders