Learn about medications for ADHD in child psychology – Aurora Technology Time


ADHD meds may cause sleep problems in kids

Cole Mariano used to be one of them. The 11-year-old has a prescription to treat his ADHD, and while he is now able to fall asleep at night, that wasn’t always the case.

“I would come in crying to my mom and dad’s room and be like, ‘I can’t go to sleep. I want to sleep, but I can’t,’” he told CBS News.

He’s not alone. The new analysis, published in the journal Pediatrics, addressed decades of conflicting evidence on the topic, and found that children on these medications take significantly longer to fall asleep, have poorer quality sleep and sleep for shorter periods.

“It can be a delay in sleep onset, sleep duration so kids are not getting as much sleep through the course of the night and having a bit more difficulty falling asleep,” said Dr. Andrew Adesman of North Shore-LIJ’s Cohen Children’s Medical Center of New York.

Recent research suggests that 7 percent of children worldwide have ADHD, a chronic condition that includes attention difficulty, hyperactivity and impulsiveness. In the U.S., estimates vary, with the American Psychiatric Association reporting 5 percent of kids live with the condition while the Centers for Disease Control and Prevention suggest the number may be as high as 11 percent.

About 3.5 million of these children are prescribed stimulant medications like Ritalin and Adderall, the most common form of ADHD treatment.

The analysis showed that both methylphenidate drugs like Ritalin and amphetamines like Adderall cause troubled sleep in kids.

For the study, researchers from the University of Nebraska-Lincoln screened thousands of articles before selecting nine studies of sufficient scientific rigor to review in depth.

The researchers also found that the drugs tend to cause more sleep problems for boys, and that while the problems can subside over time, they never completely go away.

Experts recommend pediatricians closely monitor sleep problems in kids with ADHD. “If children are on medicine, you want to try to use the lowest does possible and in some cases perhaps changing the medicine might also help,” Adesman said.

The study authors also suggest considering behavioral treatments, including parental training and changes to classroom procedures and homework assignments, to help with the negative consequences of living with ADHD.

“We’re not saying don’t use stimulant medications to treat ADHD,” Timothy Nelson, an associate professor of psychology the University of Nebraska-Lincoln involved in the study, said in a statement. “They are well tolerated in general and there is evidence for their effectiveness. But physicians need to weigh the pros and cons in any medication decision, and considering the potential for disrupted sleep should be part of that cost-benefit analysis with stimulants.”

As for Cole, he is now on medication that allows him to focus at school, and then wind down for a good night’s sleep. “You just really have to see what works best for your child,” his mother Loretta said.

Do Stimulant Meds Keep Kids With ADHD up all Night?

Stimulant medication for attention deficit hyperactivity disorder (ADHD) had a negative effect on a child’s ability to get to sleep and resulted in overall less sleep time, a small meta-analysis measuring the impact of stimulants on a child’s sleep found.

Katherine M. Kidwell, MA, of the University of Nebraska in Lincoln, and colleagues, examined nine total studies. The seven studies that addressed the effect of stimulant medication on sleep latency, or time to onset of sleep, for children with ADHD found a significant and moderate adjusted effect size of 0.54 (95% CI 0.28-0.81; P<0.001).

This means that based on a Hedges’ g effect size, the difference between medicated and unmedicated sleep were 0.54 standard deviations apart. These effects were defined as being in the medium range.

Frequency of medication was a significant moderator of the sleep latency effect, as every additional time the medication was given, the effect size became greater by 0.42 standard deviations, the authors reported in Pediatrics.

In an interview with MedPage Today, Kidwell said there were so few studies included because she and her team only wanted to include randomized controlled trials or studies that used objective measures of sleep (as opposed to checklists filled out by parents about insomnia and adverse effects).

“While our study summarizes the current state of the literature, we really need more quality research,” she said. “Those studies that are really delving into sleep are kind of few and far between.”

Kidwell’s team also looked at sleep efficiency, or the proportion of time one is actually sleeping, and found stimulant medication had a significant and small-to-moderate adjusted effect size of -0.32 standard deviations (95% CI -0.63 to -0.01; Q[6]=41.75; P<0.001).

Several moderating variables had an impact on the results. Studies using polysomnography (PSG) to assess sleep efficiency had an effect size that was more negative by 0.81 standard deviations compared with studies using actigraphy (a sensor measuring human rest/activity cycles), indicating that stimulant use was more apparent when assessed via PSG.

But increases in length of time that youth were on the medication and an increase in the number of nights that sleep was assessed resulted in less negative effect sizes of 0.05 and 0.04 standard deviations, respectively. Sex also played a role, as stimulant medication had more of an impact on boys’ sleep efficiency. For every 1-percentage point increase in the proportion of male subjects in the sample, the effect size became more negative by 0.02 standard deviations, the authors wrote.

The seven studies examining the effect of stimulant medications on total sleep time for children with ADHD had similar results. There was an overall effect size of -0.59 standard deviations (95% CI -0.84 to -0.35; P<0.001; I²=82.67%) that was moderate and significant.

Kidwell said that the study provides important information about the potential “cost” of using stimulant medication to treat children with ADHD, which should be factored into a clinician’s decision about whether to prescribe this type of medication for certain patients.

“We’re not saying that pediatricians should not prescribe stimulants – they’re really beneficial for many kids and they’re generally well tolerated, but this study just provides one potential cost that should be weighed, especially for children who are already having problems with sleep,” she said.

Researchers examined nine total studies with total enrollment of 246 children/adolescents with ADHD who had been randomly assigned to stimulants and objective sleep measurement (actigraphy or PSG). Studies not including information about the key variables were excluded.

Limitations to the meta-analysis include the publication bias that existed for sleep latency and sleep efficiency effect sizes, which have underestimated the impact of stimulant medication on children with ADHD. The authors also note that due to the small number of studies, the relationships between moderators and effect sizes may not be truly representative of actual relationships between the constructs and that inconsistent reporting of similar variables across studies prevented the completion of multiple regression analyses.

Kidwell would like to see more research, particularly using objective methods to measure sleep such as PSG and actigraphy (only two studies used PSG, which is considered the “gold standard” for sleep measurement).

“I think if we had those really high level, rigorous methods in place, it would shed a lot more light on what’s going on with these children,” she concluded.

Children taking ADHD meds may have sleep problems

Stimulant medications that treat attention deficit hyperactivity disorder (ADHD) in children can interfere with their slumber, say researchers from the University of Nebraska-Lincoln. The study was published online on Nov. 23, 2015, by the journal Pediatrics.

Past studies within the past 30 years have studied the impact of ADHD drugs had conflicting opinions and evidence on how the meds affect sleep. Katie Kidwell, a psychology doctoral student and lead author of the current study selected 167 full texts for review and then focused on nine studies. The researchers combined and analyzed past data and found that children who were treated with ADHD medications took much longer to fall asleep, had poorer quality slumber, and slept for shorter periods.

The analysis found that amphetamines such as Adderall and methylphenidate medications such as Ritalin do cause sleep problems. The researchers were not able to gauge how various dosage amounts affect children’s slumber, but they did find that children treated with more frequent dosages had difficulty falling asleep. Boys taking ADHD meds tended to have more problems falling asleep. The sleep issues decreased over a long time of being treated for ADHD but did not completely disappear.

Some past studies found that ADHD medications do interfere with sleep, especially if they are taken later in the day. Other researchers felt that the medications relieved ADHD symptoms and reduced the child’s resistance to bedtime, improving the study participant’s ability to catch some ZZZs. Others suggest that ADHD medications wear off close to bedtime, causing withdrawal symptoms that can cause sleep problems.

“One reason we did the study is that researchers have hypothesized different effects, and there are some conflicting findings in the literature,” said Timothy Nelson, an associate professor of psychology. “This is when a meta-analysis is most useful. By aggregating and summarizing previous research in a rigorous and statistical way, we can identify the main findings that we see across all these studies. It’s essentially a study of studies.”

“Sleep impairment is related to many cognitive, emotional and behavioral consequences, such as inattention, irritability and defiance,” Kidwell said. “Sleep adverse effects could undermine the benefits of stimulant medications in some cases. Pediatricians should carefully consider dosage amounts, standard versus extended release, and dosage frequencies to minimize sleep problems while effectively treating ADHD symptoms.”

“We’re not saying don’t use stimulant medications to treat ADHD,” Nelson said. “They are well tolerated in general and there is evidence for their effectiveness. But physicians need to weigh the pros and cons in any medication decision, and considering the potential for disrupted sleep should be part of that cost-benefit analysis with stimulants.”


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