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ADHD meds linked to sleep issues in children

Less effective sleep can affect children's cognitive abilities and can cause behavioral issues.

By Stephen Feller

LINCOLN, Neb., Nov. 23 (UPI) -- Stimulants used to counteract some of the symptoms of attention deficit hyperactivity disorder may also prevent children on the drugs from getting restful sleep, which researchers said has the potential to render the drugs less effective.

Although the study shows a potential downside of using medications to treat children with ADHD, researchers said rather than discontinuing treatment doctors should factor in the potential for sleep disruption and its effects on individual patients.

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About 3.5 million children and adolescents are prescribed drugs such as Ritalin and Adderall for ADHD, which one in 14 children has been diagnosed as having.

"Sleep impairment is related to many cognitive, emotional and behavioral consequences, such as inattention, irritability and defiance," said Katie Kidwell, a psychology doctoral student at the University of Nebraska-Lincoln and lead author of the study, in a press release. "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."

The researchers conducted a large analysis of previous studies based on conflicts with use of the drugs, which are often thought to help children fall asleep if dosages are timed properly. In some cases, withdrawal effects, or even just taking a dosage too late in the day, can affect children's ability to fall asleep but this has typically been considered minor disruption.

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Kidwell and researchers at UNL reviewed 167 previous studies, basing their research on nine they felt were rigorous enough in their data. Specifically, the studies chosen by researchers did not rely on parents reporting their children's sleep patterns, instead using clinical sleep studies or wristband monitors for more accurate measurements.

The researchers found stimulants interfered with sleep quality of children, but that size, frequency, and timing of doses changed the magnitude of effects on sleep.

"We're not saying don't use stimulant medications to treat ADHD," said Timothy Nelson, an associate professor of psychology at the University of Nebraska-Lincoln. "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."

The study is published in the journal Pediatrics.

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