Children with ADHD May Just Need Sleep

Newswise — Is it really ADHD or just a lack of quality sleep? That's the question researchers at the Technion-Israel Institute of Technology Sleep Laboratory say doctors should ask before prescribing Ritalin and other drugs used to treat Attention Deficit/Hyperactive Disorder (ADHD).

ADHD is considered an issue of overalertness and nervousness, with affected children being fidgety and overstimulated. Yet, the use of stimulant medications (such as Ritalin) has been shown to be the most effective method for reducing ADHD symptoms in the majority of children.

This seeming paradox led researcher Dr. Giora Pillar of the Technion Faculty of Medicine to question whether some children diagnosed with ADHD may in fact be sleepy, and their excessive motor activity merely a tool to stay alert. He says this could explain why stimulants " which induce alertness by increasing activity in the central nervous system " are effective for treating children with ADHD.

"Sleepy children, unlike sleepy adults, may demonstrate hyperactivity and attention-deficit behavior rather than excessive daytime sleepiness," said Pillar. "This theory is supported by parental reports that children, when extremely tired, tend to be cranky, overactive, angry and aggressive."

Pillar and his team studied 66 children with an average age of 12; 34 had already been diagnosed with ADHD, and the rest served as a control group. The researchers found the ADHD-diagnosed children had significantly higher levels of sleepiness during the day than those in the control group.

Half of the test subjects with ADHD (vs. 22% of the control group) were found to suffer from some degree of sleep-disordered breathing (such as sleep apnea, which is characterized by interruptions in breathing during sleep that last 10 seconds or more, at least five times per hour). And 15% (vs. none in the control group) had Periodic Limb Movement Disorder (PLMD), a relatively uncommon disorder among children.

Pillar said studies have shown that treatment of these sleep disorders in children often leads to substantial improvements in behavior and cognitive achievements, and a significant reduction in irritability, bad moods, anger and fear. For example, school performance " which is low in children with sleep apnea " is substantially improved following the removal of adenoids and tonsils to correct the disorder.

The researchers urge parents of hyperactive and attention-deficit children diagnosed with sleep disorders to have breathing irregularities and limb movements treated, to enforce good sleeping habits and avoid giving them caffeinated drinks at night. Only if these steps do not work, they say, should parents consider medication for ADHD.

These findings were published in the February 2004 issue of the journal SLEEP.

The U.S. Centers for Disease Control now estimates that 8 percent of U.S children suffer from Attention-Deficit/Hyperactive Disorder (ADHD), and more than half of them are being treated with drugs.

The Technion-Israel Institute of Technology is Israel's leading science and technology university. Home to the country's winners of the Nobel Prize in science, it commands a worldwide reputation for its pioneering work in nanotechnology, computer science, biotechnology, water-resource management, materials engineering, aerospace and medicine. The majority of the founders and managers of Israel's high-tech companies are alumni. Based in New York City, the American Technion Society is the leading American organization supporting higher education in Israel, with 17 offices around the country.