The effect of treatment of sleep disorders on symptom severity in children with ADHD: a selective review.
Houdt, C.A. van
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Background: ADHD is a disorder with a high comorbidity rate and one of the frequent co-occuring disorders are sleep disorders. Sleep deprived children show a range of problem behaviors including inattentive and hyperactive behavior. Since these behaviors are very similar to core ADHD symptoms, sleep problems might aggravate ADHD symptomatology or mimic ADHD symptoms, thus leading to misdiagnosis. This suggests that treating sleep disorders in children with ADHD might reduce ADHD symptom severity. Objective: to investigate whether treatment of sleep disorders (sleep-onset insomnia, restless legs syndrome or sleep disordered breathing) in children with ADHD reduces ADHD symptom severity. Methods: PubMed was searched using descriptions of sleep disorders or specific sleep disorders (i.e. sleep disorder, sleep disturbance, sleep problems, sleep-onset insomnia, restless legs syndrome, sleep disordered breathing, obstructive sleep apnea) and ADHD (i.e. attention-deficit/hyperactivity disorder, hyperactivity). Furthermore, references of found articles were checked for more relevant papers. Results: there seems to be some evidence suggesting that the treatment of sleep disorders in children with ADHD reduces ADHD symptom severity. Conclusion: regarding all three sleep disorders investigated, studies using longer baseline to follow-up designs seem to show more promising results. This suggests that ADHD symptoms do not suddenly appear after short periods of sleep deprivation and suddenly disappear after short periods of normal sleep, but that ADHD symptoms grow over a longer period of sleep deprivation in children and therefore also disappear gradually over a longer period of normal sleep, regardless of what is causing the sleep deprivation. However, larger, double-blind placebo-controlled studies with a longer baseline to follow-up design should be carried out to generate more robust and unbiased findings. Designs for two such studies are proposed.