Sleeping problems common in kids with ADHD

By Will Boggs MD

NEW YORK (Reuters Health) - Nearly 50% of children with attention deficit hyperactivity disorder experience transient sleeping problems, and another 10% have persistent sleeping problems, new research shows.

"We were surprised that over half had a sleep problem at least once over the 12 month period and also by the broad range of sleep problems experienced, including bedtime resistance, night waking, and sleep anxiety," Kate Lycett from The University of Melbourne, Parkville, Victoria, Australia told Reuters Health by email.

Children with ADHD are two to three times more likely than typically developing children to experience sleep problems, but their persistence remains largely unknown.

Lycett and colleagues used data from 21 pediatric practices across Victoria to examine behavioral sleep problem trajectories over a 12-month period in 270 children with ADHD.

Forty-nine percent experienced transient sleep problems, and 10% experienced sleep problems at all three time points studied (baseline, six months, and 12 months). The other 41% of children with ADHD never experienced sleep problems.

As reported online June 25th in Sleep Medicine, about a quarter of parents reported seeking help for their child's sleep over the course of the study: 8% in the never group, 36% in the transient group, and 35% in the persistent group.

The presence of co-occurring internalizing and externalizing comorbidities markedly increased the odds of transient and persistent sleep problems. Other contributors to sleep problems included higher ADHD symptom severity, poorer caregiver mental health, and higher caregiver disadvantage ratings.

ADHD medication use was also associated with persistent sleep problems.

"Given that sleep problems are so common in children with ADHD, it is essential that clinicians assess for sleep problems at each consultation," Lycett said. "A brief question can be used, such as 'Has your child experienced a sleep problem over the past four weeks?'"

"Small pilot trials have demonstrated that behavioral strategies can be used to manage sleep problems in children with ADHD that are of a behavioral nature," Lycett said. "A number of large scale trials are underway examining the effectiveness of behavioral treatments in improving sleep and broader child and family wellbeing in children with ADHD. Results from these trials will be released shortly. Other treatment options include sleep medication (e.g., melatonin) particularly for difficulties falling asleep at night."

"It is likely that sleep problems have negative flow on effects to other areas of functioning for children with ADHD (e.g., learning, quality of life); thus the assessment and management of sleep problems is essential," Lycett said.

Dr. Maha K. Abou-Khadra from Cairo University in Giza, Egypt has published research on sleep problems in children with ADHD. She told Reuters Health, "The relationship between sleep disorders and ADHD should be considered by pediatricians. They should educate caregivers about proper sleep hygiene to prevent sleep problems."

"They should screen for sleep problems by using a variety of screening tools (e.g. BEARS, CSHQ, or other available screening questionnaires)," Dr. Abou-Khadra said. "They should refer ADHD children with sleep problems to pediatric sleep specialist for further examination and treatment."

SOURCE: http://bit.ly/1rI5DSV

Sleep Medicine 2014.

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