The Effects of Extended-Release Stimulant Medication on Sleep in Children with ADHD.

OBJECTIVE: Although stimulant medications, such as methylphenidate hydrochloride (MPH), are effective at reducing the core symptoms of Attention-Deficit/Hyperactivity Disorder (ADHD), they may also disrupt children's sleep. This study aimed to investigate the acute impact of extended-release MPH on sleep using both actigraphy and polysomnography (PSG). METHOD: Participants were 26 medication-naïve newly and rigorously diagnosed children with ADHD (23 males; 3 females) with a mean age of 8 years, 8 months (SD = 24.5mos) who were enrolled in a clinically-administered crossover medication trial with 2 conditions: 2 weeks of placebo and 2 weeks of MPH treatment. The effect of condition on sleep variables as measured by actigraphy (primary outcome) and PSG (secondary outcome) was analyzed using repeated measures MANOVAs. RESULTS: Based on actigraphy data, total sleep time was significantly reduced by 30 minutes and sleep onset latency was significantly increased by 30 minutes in the MPH condition compared to the placebo condition (p<0.001). No differences were found in sleep efficiency. No statistically significant differences were found for the same variables assessed by PSG; however, the means were in the same direction as the actigraphy data. There was a significant increase in the relative percentage of stage N3 sleep by 3.2% during MPH treatment (p<0.05). CONCLUSIONS: Increased sleep onset latency resulting in reduced total sleep time, which has been linked to poorer daytime functioning, is a potential adverse effect of stimulant medication which may require management to optimize outcome.

OBJECTIF: Bien que les médicaments stimulants comme le chlorhydrate de méthylphénidate (MPH) soient efficaces pour réduire les principaux symptômes du trouble de déficit de l'attention avec hyperactivité (TDAH), ils peuvent également perturber le sommeil des enfants. La présente étude visait à rechercher l'effet précis du MPH à libération prolongée sur le sommeil à l'aide d'une actigraphie et d'une polysomnographie (PSG). MÉTHODE: Les participants étaient 26 enfants naïfs de médicaments ayant nouvellement et rigoureusement reçu un diagnostic de TDAH (23 garçons; 3 filles) d'âge moyen de 8 ans et 8 mois (ET = 24,5 mois) qui étaient inscrits dans un essai croisé cliniquement administré sur la médication selon 2 conditions: 2 semaines de placebo et deux semaines de traitement par MPH. L'effet de la condition sur les variables du sommeil telles que mesurées par l'actigraphie (résultat principal) et la PSG (résultat secondaire) a été analysé par des mesures répétées MANOVA. RÉSULTATS: Selon les données de l'actigraphie, le temps de sommeil total était significativement réduit de 30 minutes et la latence d'endormissement était significativement accrue de 30 minutes dans la condition MPH comparativement à la condition placebo (p < 0,001). Aucune différence n'a été notée pour l'efficacité du sommeil. Aucune différence statistiquement significative n'a été observée pour les mêmes variables évaluées par la PSG; cependant, les moyennes suivaient la même direction que les données de l'actigraphie. Il y avait une augmentation significative de 3,2 % du pourcentage relatif au stade N3 du sommeil durant le traitement par MPH (p < 0,05). CONCLUSIONS: La latence d'endormissement accrue entraînant un temps de sommeil total réduit, qui est lié à un mauvais fonctionnement de jour, est un effet indésirable potentiel des médicaments stimulants, qui peut nécessiter une prise en charge afin d'optimiser le résultat.

A framework for the assessment and treatment of sleep problems in children with attention-deficit/hyperactivity disorder.

Children with attention-deficit/hyperactivity disorder (ADHD) have high rates of sleep problems and sleep disorders. It is critical that pediatricians assess for sleep problems during the course of ADHD assessment and when treating children with stimulant medication. Sleep must be considered in the differential diagnosis and in terms of comorbidity with ADHD. The most common sleep problem in children with ADHD is insomnia, and the first line of treatment should be the implementation of behavioral interventions rather than medication. More research is needed to determine if children with ADHD respond to behavioral interventions in a similar manner as typically developing children.

Doing it right: an interdisciplinary model for the diagnosis of ADHD.

OBJECTIVE: This article describes the Colchester East Hants Attention-Deficit/Hyperactivity Disorder Clinic (ADHD Clinic), which uses a best practice, interdisciplinary service model to provide diagnostic assessment and treatment services for children suspected of having ADHD, and presents data about perceived effectiveness of and satisfaction with the clinic's services. METHOD: Interviews were conducted with service providers (N=31) associated with the clinic and survey data was collected from consumers, including parents/guardians (N=46), teachers (N=20), and family physicians (N=12). RESULTS: High levels of satisfaction and positive beliefs about the effectiveness of services were found. CONCLUSION: Implications for the ADHD Clinic and the general importance of interdisciplinary models of mental health service delivery are discussed.

Acute impact of immediate release methylphenidate administered three times a day on sleep in children with attention-deficit/hyperactivity disorder.

OBJECTIVE: To determine the impact of immediate release Ritalin, given three times a day, on sleep quality and quantity in medication-naïve, newly diagnosed children with attention-deficit/hyperactivity disorder (ADHD). METHODS: Children (aged 6-12) rigorously diagnosed with ADHD (n = 21) underwent multiple measurement assessments (i.e., actigraphy, sleep diary, and questionnaires) during a 1-week baseline and then during a 3-week blinded randomized medication trial. RESULTS: Although the medication was effective in reducing ADHD symptoms, analyses of actigraphy and sleep diary data found statistically and clinically significant changes in the children's total sleep time and sleep onset latency in the medication compared to the no medication conditions. No effects on sleep were found based on the sleep questionnaire. CONCLUSIONS: Physicians and parents are encouraged to closely monitor children's sleep when treating ADHD with stimulant medication.