When your child’s ADHD meds keep him up at night

It may not be surprising that drugs given to children with ADHD can cause problems with sleep. After all, two of the most common prescription drugs used to treat the disorder – Ritalin and Adderall – are stimulants. To someone unfamiliar with their use, these drugs might seem the opposite of what should be given to hyperactive kids.

But according to Sandwich pediatrician Elise J. Branca, MD, stimulants can help children with ADHD stay focused, and sleep problems in children with the condition often exist before any medicine may be prescribed.

“Children with ADHD tend to have difficulty sleeping at night at baseline prior to treatment, as they tend to have difficulty self-regulating,” she wrote in an email response to questions about a recent study published in the journal Pediatrics. “The first coping mechanism I advise is a bedtime routine which is the same each night and allows the child to calm down prior to going to bed.”

Stimulants have been used for decades to treat ADHD, and many articles have been published on whether or not they interfere with sleep. The new study, by University of Nebraska-Lincoln researchers, was a meta-analysis of nine studies selected from 9,927 articles. They were chosen because they were peer-reviewed and relied on objective measurements and not parental observations.

The analysis found that children and adolescents with ADHD who took stimulant drugs took longer to fall asleep and experienced sleep that was poorer in quality and shorter in duration. Researchers reported the problems lessened with the length of time children were on the drugs, and that boys seemed more affected. They also noted that time-release versions of the drugs or taking doses late in the day seemed to worsen the effects on sleep.

The study authors recommended that pediatricians monitor sleep problems in their ADHD patients, and consider how to limit interference with sleep when prescribing medications and dosage schedules.

Dr. Branca, who will open a new branch of her Cape Cod Pediatrics practice at Fontaine Outpatient Center in Harwich on January 5, said some families find that adding the stimulant at breakfast time improves the child’s ability to self-regulate throughout the day and therefore they are able to sleep better at night.

“Other families experience the side effect of the stimulant interfering with sleep at bedtime. This side effect varies with each child and with the dose of medication. If a family finds the medication interferes with the onset of sleep at night, then I try a different medication,” she said.

She identified guanfacine and atomoxetine as two medications that aren’t stimulants and can be used to treat ADHD.

Medication is just one tool and not always required to treat ADHD, she said.

“Behavior techniques and coping mechanisms are very important in managing ADHD symptoms,” she said. ”In some cases stimulant medications are not needed when behavioral techniques are in place at school and at home.”

Dr. Branca takes an individual approach to each ADHD case.

“Each child responds differently to treatment options. In my experience, behavioral techniques, which help to organize the patient’s time and physical space both at home and school, are very effective. These techniques provide concrete timeframes for patients to complete tasks, as well as organize the patient’s environment, which minimizes distractions for the patient,” she said. “I have good responses to these techniques, but some children also require a medication to help with focus, in addition to these techniques.”