The Chicken or the Egg: Poor Sleep and ADHD

Stimulant medications for attention deficit hyperactivity disorder linked to poor sleep in children

/ Author:  / Reviewed by: Jennifer Gershman, PharmD, CPh

(RxWiki News) Kids with ADHD often have trouble sleeping. But which came first — the sleep problems or the medications used to treat ADHD?

A new study found that stimulant drugs used to treat attention deficit hyperactivity disorder (ADHD) may cause kids to have trouble falling and staying asleep.

This study pooled data from several past studies on the subject that, individually, had conflicting findings. Some of these studies found that stimulant use caused insomnia in kids. Others found that stimulant use improved sleep in kids by reducing bedtime-resistant behavior.

ADHD is a childhood behavioral disorder that can continue through adolescence into adulthood. Common symptoms include inattentiveness, impulsiveness and hyperactivity. Treatment for ADHD often includes medication, counseling or a combination of the two.

Stimulants, which work by influencing the availability of certain chemicals in the brain, are the most common type of drug used to treat ADHD. Common stimulants include methylphenidate (brand names Concerta, Ritalin), mixed salts amphetamine (Adderall) and lisdexamfetamine (Vyvanse), among others.

For this study, a team of researchers led by Katherine M. Kidwell, a doctoral candidate in psychology at the University of Nebraska, looked at nine studies on sleep in children and teens with ADHD.

Although these studies had conflicting results, these researchers found that stimulants led to longer sleep delays, worse sleep quality and shorter sleep duration overall. In other words, children and teens often tended to sleep worse when they took stimulants.

Kidwell and team also found that the more times per day a stimulant was taken, the longer it took a child to fall asleep on average. And the more frequently a drug was taken throughout the day, the more likely it was to be in the child’s system when he or she tried to fall asleep — impairing the child's ability to fall asleep.

However, as stimulants were taken for longer periods of time, impaired sleep quality improved. In other words, the children seemed to adjust to the drug over time.

Kidwell and colleagues said pediatricians should watch for sleep problems and monitor medications to promote optimal sleep in children with ADHD.

An estimated 11 percent of US children ages 4 to 17 have been diagnosed with ADHD, according to the Centers for Disease Control and Prevention. And about 6 percent of these children were prescribed a drug to treat their symptoms in 2011.

This study was published Nov. 23 in the journal Pediatrics.

No funding sources or conflicts of interest were disclosed.

Review Date: 
November 19, 2015
Last Updated:
November 23, 2015