Sleep Problems Common in Children With ADHD
Marlene Busko
April 10, 2008 ? A survey of Australian children with attention-deficit/hyperactivity disorder (ADHD) found that 73% had mild to severe sleep disturbances, which affected both the children and their parents. Most often, the children had difficulty falling asleep, resisted going to bed, and were tired upon awakening.
The study is published in the April issue of the Archives of Pediatrics & Adolescent Medicine.
This was the first study to demonstrate that among children with ADHD, those with sleep problems had a poorer quality of life and school attendance, and their caregivers had poorer mental health and work attendance, lead author Valerie Sung, MBBS, from the Royal Children's Hospital, in Melbourne, Australia, told Medscape Psychiatry.
"Pediatricians should ask about sleep issues during the assessment and management of every child with ADHD," she said.
ADHD is the most common mental health disorder in children, affecting up to 11% of Australian children aged 6 to 17 years old, the group writes. Up to 50% of parents of children with ADHD report that their children have difficulty in initiating and maintaining sleep, they add.
The group sought to determine the prevalence of sleep problems in a sample of Australian schoolchildren with clinician-diagnosed ADHD and to see how sleep problems affected child and caregiver functioning and family life. The team also wanted to look at whether pediatricians routinely asked about sleep problems in children with ADHD.
The researchers analyzed data from a survey of primary caregivers of 239 schoolchildren with ADHD. The children had a mean age of 11.7 years (range, 5 ? 18 years), and 90% were boys. The main study outcome was the caregiver's report of any sleep problems their child had during the previous 4 weeks. Secondary outcomes included measures of child, caregiver, and family functioning.
Sleep-Deprived Children, Stressed Parents
The caregivers reported that 28.5% of the children (n = 68) had mild sleep problems and 44.8% of the children (n = 107) had moderate or severe problems.
Compared with children with no sleep problems, those with sleep problems had a poorer quality of life and were more likely be late for or miss school; increasing severity of sleep problems were associated with increasing prevalence of poor outcomes.
Only 45% of caregivers (107 caregivers) reported that their pediatricians asked about their children's sleep, and of these, 60% (65 caregivers) reported receiving advice.
Compared with caregivers of children without sleep disorders, those with children who had moderate or severe sleep disorders were more likely to be clinically depressed, stressed, anxious, or often late for work.
"Clinicians Should Ask About Sleep"
Sleep issues such as difficulty falling asleep, resisting going to bed, and tiredness upon awakening could be addressed by behavioral strategies such as setting limits around bedtime resistance, instigating a good sleep routine, and using rewards, said Dr. Sung. Difficulty falling asleep due to anxiety could be managed by anxiety-management techniques such as visual relaxation and self-talk. These strategies are standard clinical care practices for children without ADHD who have sleep problems, but the effectiveness of these approaches in children with ADHD remains to be determined, she observed.
"Symptoms of sleep deprivation in children are similar to those of ADHD, and it is possible that some of the behavioral issues in children with ADHD may be due to sleep problems," said Dr. Sung. "By managing comorbid sleep problems, it is possible that some of the symptoms seen in children with ADHD may improve, and this may reduce the need for medication in some children," she added, noting that this remains to be determined in future research.
"In the meantime, clinicians caring for children should ask about their sleep, and if a problem is present, this should be addressed," the group writes.
Study author Daryl Ephron, MD, from the University of Melbourne, in Parkville, Australia, has been a member of advisory boards for Eli Lilly and Novartis.
Marlene Busko
April 10, 2008 ? A survey of Australian children with attention-deficit/hyperactivity disorder (ADHD) found that 73% had mild to severe sleep disturbances, which affected both the children and their parents. Most often, the children had difficulty falling asleep, resisted going to bed, and were tired upon awakening.
The study is published in the April issue of the Archives of Pediatrics & Adolescent Medicine.
This was the first study to demonstrate that among children with ADHD, those with sleep problems had a poorer quality of life and school attendance, and their caregivers had poorer mental health and work attendance, lead author Valerie Sung, MBBS, from the Royal Children's Hospital, in Melbourne, Australia, told Medscape Psychiatry.
"Pediatricians should ask about sleep issues during the assessment and management of every child with ADHD," she said.
ADHD is the most common mental health disorder in children, affecting up to 11% of Australian children aged 6 to 17 years old, the group writes. Up to 50% of parents of children with ADHD report that their children have difficulty in initiating and maintaining sleep, they add.
The group sought to determine the prevalence of sleep problems in a sample of Australian schoolchildren with clinician-diagnosed ADHD and to see how sleep problems affected child and caregiver functioning and family life. The team also wanted to look at whether pediatricians routinely asked about sleep problems in children with ADHD.
The researchers analyzed data from a survey of primary caregivers of 239 schoolchildren with ADHD. The children had a mean age of 11.7 years (range, 5 ? 18 years), and 90% were boys. The main study outcome was the caregiver's report of any sleep problems their child had during the previous 4 weeks. Secondary outcomes included measures of child, caregiver, and family functioning.
Sleep-Deprived Children, Stressed Parents
The caregivers reported that 28.5% of the children (n = 68) had mild sleep problems and 44.8% of the children (n = 107) had moderate or severe problems.
Compared with children with no sleep problems, those with sleep problems had a poorer quality of life and were more likely be late for or miss school; increasing severity of sleep problems were associated with increasing prevalence of poor outcomes.
Only 45% of caregivers (107 caregivers) reported that their pediatricians asked about their children's sleep, and of these, 60% (65 caregivers) reported receiving advice.
Compared with caregivers of children without sleep disorders, those with children who had moderate or severe sleep disorders were more likely to be clinically depressed, stressed, anxious, or often late for work.
"Clinicians Should Ask About Sleep"
Sleep issues such as difficulty falling asleep, resisting going to bed, and tiredness upon awakening could be addressed by behavioral strategies such as setting limits around bedtime resistance, instigating a good sleep routine, and using rewards, said Dr. Sung. Difficulty falling asleep due to anxiety could be managed by anxiety-management techniques such as visual relaxation and self-talk. These strategies are standard clinical care practices for children without ADHD who have sleep problems, but the effectiveness of these approaches in children with ADHD remains to be determined, she observed.
"Symptoms of sleep deprivation in children are similar to those of ADHD, and it is possible that some of the behavioral issues in children with ADHD may be due to sleep problems," said Dr. Sung. "By managing comorbid sleep problems, it is possible that some of the symptoms seen in children with ADHD may improve, and this may reduce the need for medication in some children," she added, noting that this remains to be determined in future research.
"In the meantime, clinicians caring for children should ask about their sleep, and if a problem is present, this should be addressed," the group writes.
Study author Daryl Ephron, MD, from the University of Melbourne, in Parkville, Australia, has been a member of advisory boards for Eli Lilly and Novartis.
