Study: Children with ADHD benefit from treating sleep problems

A study shows that children with ADHD benefit from treating underlying sleep problems.

Addressing sleep problems often improves psychiatric symptoms in children and teens, including those with attention-deficit/hyperactivity disorder and chronic pain.

Sleep-focused treatment improves mood and quality of life in children with attention-deficit/hyperactivity disorder (ADHD), asthma, chronic pain, and cancer, according to speakers at symposium on sleep in children with chronic health conditions at the annual meeting of the American Academy of Sleep Medicine and Sleep Research Society in Minneapolis in June.

Children with ADHD are two to three times more likely to have trouble sleeping than children without the disorder, said Penny Corkum, Ph.D., a professor of psychology and neuroscience at Dalhousie University in Halifax, Nova Scotia. Their sleep problems may undermine daytime performance, said Corkum, who directs research and training at Colchester Regional Hospital’s ADHD Clinic.

In research reported at the meeting, she and colleagues assessed sleep in 30 children newly diagnosed with ADHD and 30 age- and sex-matched typically developing controls. The children’s mean age was about 8.5. At baseline, children with ADHD took 47 minutes to fall asleep in the sleep laboratory, while controls took 24 minutes. Children with ADHD slept about 30 minutes less than controls.

In a four-week medication trial, the researchers gave the 30 children with ADHD either a standard single daily morning dose of methylphenidate or a placebo, in random order for two weeks. While children took longer to fall asleep and slept less when taking the stimulant than when taking the placebo, parents and teachers said their behavior improved.

Children being evaluated for problems with attention, Corkum said, should also be screened for sleep disorders. Consequences of sleep disorders such as obstructive sleep apnea, insomnia, and periodic limb movement disorder/restless leg syndrome may mimic symptoms of ADHD.

Children with and without ADHD, she added, benefit from having a consistent bedtime, learning to fall asleep on their own, sleeping in a dark room, and avoiding television, computers, telephones, and other electronic devices near bedtime.

Children and adolescents with persistent pain commonly report difficulty falling or staying asleep or complain of poor quality sleep, said symposium speaker Tonya Palermo, Ph.D., a professor of anesthesiology and pain medicine at the University of Washington, Seattle.

About 5 percent to 8 percent of children and adolescents in community samples experience moderate to severe disability from persistent pain, most often in the head, abdomen, or limbs, she noted. Common causes include headache disorders, juvenile arthritis, and sickle-cell disease.

Some have depression. Their pain medications may be sedating. These youngsters often say, “I’m always tired,” Palermo noted. Many take frequent and often long naps that may interfere with school or social activities. Concerned parents may allow children to stay in bed late in the morning.

Engaging children and adolescents in self-assessment, Palermo said, may foster improved sleep habits. She asks them to abstain from watching television in their bedroom for a week, for example, to see how that affects their sleep. She also encourages them to use an alarm clock and get up on their own and to maintain a consistent weekday/weekend schedule.

Palermo and colleagues also found that poor sleep diminishes the effectiveness of cognitive-behavioral therapy for chronic pain. She said sleep-specific intervention may need to be delivered before pain-focused behavioral therapy starts.

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Pediatric Sleep Disorders

This article discusses all about pediatric sleep disorders and indicates when it is necessary to get help to treat them.

Bedwetting, sleepwalking, night terrors. Sleep disturbances that cause concern when seen in adults can actually be “part of the normal developmental process in children,” according to Dr. Kirk Watkins of the Intermountain Dixie Regional Sleep Disorder Center.

“In most instances, nothing is wrong with the child and they will grow out of it in time,” said Watkins.

But even things that are normal can be disruptive to families. When should you seek treatment for your child’s sleep disorder?

“When it begins to cause bigger problems,” said Watkins. He lists three examples:

• When it affects the safety of the child. For instance, if you find a sleepwalking child “on the next block walking down the middle of the street.”

• When it affects the child’s daytime function in terms of behavior, personality changes, or schoolwork.

• When lack of sleep disrupts regular family routines.

In those instances, “Pediatricians and family practice physicians have a lot of experience helping families deal with sleep disorders. They can reassure parents and help find the reason the child is aroused from sleep,” said Watkins.

When the usual methods fail, it may be time to seek help from a sleep specialist. According to Watkins, the three most common causes of parasomnia (abnormal or disruptive sleep disorders) in children he treats include:

• Obstructive sleep apnea. “Sleep apnea is not widely recognized in children because if a kid snores, the general practice is to perform a tonsillectomy. In about 65 percent of cases, it works. For the rest, it is really hard for anybody to objectively pick up from a child that excessive sleepiness is going on, so we often have to rely on other indicators. By middle school kids who snore will lose 1.5 grade points on average. They can cause social disturbances at home. A child with obstructive sleep apnea may be seen as always causing trouble, but is not typically defiant. Often they will sleep on their hands and knees with the rear end in the air. They may tear the entire bed apart at night. Mouth breathing at night in children who don’t have congestion during the day is also a classic symptom.

• Acid reflux at night. “Acid reflux is a significant pathology that should always be addressed. Again, it can be hard for a child to verbalize their symptoms, but if they had acid reflux as an infant and now wake up screaming every night, resuming treatment may help.”

• Restless leg syndrome. “Restless leg is the sleep disorder with the highest association with ADHD. Symptoms can be vague in children, and are sometimes described as ‘growing pains.’ Often restless leg is associated with iron deficiency that is easily treatable. If not, there are medications that while not well studied in children can sometimes be effective.”

Chronic sleep disorders in children can cover “the compendium of a parent’s worst nightmares,” acknowledged Watkins. “In most cases, however, they are very treatable.”

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