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A closer look at study reporting ADHD medications cause sleep problems

A recent study found some ADHD medications led to worse sleep in children, but here's a closer look to see what the findings actually mean.

Warning: a new study concludes that drugs such as Concerta, Adderall and Vyvanse lead to worse sleep in children. But, parents who are considering whether to treat your child's ADHD with stimulant medication, don't let the results scare your pants off. In fact, put them back on and continue reading.

We have long known that about 5 to 10 percent of all children have ADHD and that stimulant medications have conclusively shown to be the most effective treatment for the core symptoms of the disorder. We also know that sleep problems are more common in children with ADHD, whether or not they are taking medication. Moreover, it is common sense that children who do not get enough sleep at night will show increased difficulties in memory, concentration, irritability, and impulsivity — all symptoms any parent of a child with ADHD is familiar with and certainly doesn't want to encounter more of.

Hence a study that reports increased sleep problems in children who take stimulants for ADHD is bound to scare parents. The current study, in top-flight journal Pediatrics, is a meta-analysis — an analysis of already published studies. In it, the researchers chose nine studies of high quality that evaluated the effect of medication on sleep of children with ADHD.

Results of those nine studies were combined using complicated statistics and showed that stimulant medications resulted in significantly longer time to fall asleep, worse sleep efficiency, and shorter total amount of time asleep compared to when children were not taking them.

I use the word significantly because the authors kept using it – making sure that readers of their article understood that the reduced sleep of children on stimulants in those nine studies was highly unlikely to occur by chance.

What the authors did not report, anywhere in the paper, was the plain-English meaning of "significantly.'' In other words, how many actual minutes of sleep were lost.

This was, in my opinion, a glaring omission. If you look at the original papers used in the meta-analysis, the amount of extra time to fall asleep on stimulants was between under a minute to 39 minutes.

And they missed the more important point. Treatment for ADHD (or any condition, for that matter) is often a trade-off. What is the importance of losing a few minutes of sleep if the child has 8 to 12 hours of improved function during the day? When taking stimulants might mean less sleep, but also less impulsivity, less hyperactivity, less getting into trouble, better ability to pay attention in school, and better ability to complete homework and then go out and play?

Furthermore, the article did not advise parents about strategies to help children with ADHD get better sleep. Why not try simple sleep hygiene: no caffeine, no TV or electronics in the bedroom, ironclad bedtimes and wake-up times. Over-the-counter melatonin may facilitate sleep, but check with your physician before trying it. And physicians should be informed about any sleep problems when a child is taking medication for ADHD, because changes in the dose or the time it is given, switching from immediate release to an extended action drug, or using a drug with a shorter duration of action can solve the problem.

Okay, parents of children with ADHD, thank you for reading to the end of this article. Next time you take off your pants, I hope that's because it's time to put on your pajamas and rest easier.

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