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Do ADHD stimulant medications affect children’s sleeping patterns? Is Listol a

viable alternative to the use of stimulants?

Ekom Essien

5 October 2009

 

 

 

Introduction

          Attention deficit/Hyperactivity disorder, also known as ADHD, has received a great deal of media coverage as its prevalence has increased within recent years.  The symptoms of ADHD include inattention, hyperactivity and impulsivity; the Centers for Disease and Prevention provide a complete inventory listing the criteria of each symptom (http://www.cdc.gov/ncbddd/adhd/diagnosis.html).  While there is no cure for ADHD, several treatments to alleviate its symptoms are available. The most common treatment for ADHD is a medicinal stimulant, such as Adderall and Ritalin.  Although these stimulant medications improve many children’s behavior problems and academic performance, patients, parents and researchers have made many claims about their adverse affects on patients’ sleeping cycles.  Do the benefits of medicinal stimulants outweigh the possible sleep disturbances that may come about from the use of these stimulants? Furthermore, is the supplement Listol a viable treatment for ADHD symptoms that allows patients to avoid these possible sleep disturbances?


Childhood ADHD prevalence

        The prevalence of ADHD is estimated to be between 3 and 5% among children and adolescents living in the United States and Europe (Lecendreux, 2000, page 803). 

The Centers for Disease Control and Prevention reports that as of 2006, 4.5 million children aged 5-17 have been diagnosed with ADHD (http://www.cdc.gov/ncbddd/adhd/prevalence.html).  The map, provided by the CDC in its 2003 edition of the National Survey of Children’s Health, gives a visual representation of each state’s percentage of children and adolescents that have ever been diagnosed with ADHD.  Clearly, ADHD is a widespread disorder among children and adolescents.

Treatment of ADHD

          Although there is no cure for ADHD, there are several treatment interventions to help manage its symptoms.  Among these are medications, behavioral intervention strategies, and parent training (Centers for Disease Control and Prevention, 2009).  Many health care professionals prescribe medications to patients with ADHD, and most often, these medications are classified as stimulants.  Between 70-80% of children with ADHD who are prescribed stimulant medications respond positively to the treatment (CDC, 2009). Even though most patients who take medicinal stimulants experience a significant decrease in ADHD symptoms, many report sleep problems or disturbances. Without a doubt, the increased prevalence of childhood ADHD indicates the imperativeness of conducting more research to investigate its etiology and to create safer and more efficient forms of treatment that alleviate symptoms that do not compromise patients’ sleep patterns.

Research

          A large body of research examining the connection between children and adolescents diagnosed with ADHD and sleep disturbances has been conducted, which is reflective of the fact that 25 to 50% of children and adolescents with ADHD have been reported as having difficulties in initiating and maintaining sleep (Owens, 2005). The majority of these studies are observational studies that utilize self-reports submitted by parents concerning their children’s sleep problems.

        One such study was conducted by Ball, Tiernan, Janusz, & Furr (1997).  One hundred and eighty children who were diagnosed as displaying at least 8 out of the 14 symptoms of ADHD for at least 6 months and before the age of 7 participated in the study.  Participant’s parents were given an hour-long interview and each child was individually interviewed.  Questions in the interviews about participants’ sleeping patterns were indirect rather than straight forward (examples include “My child has as much pep and energy as most children,” “My child often gets up at night,” “My child gets exhausted easily,” and “My child frequently has nightmares”).  Ball et al.’s findings replicated prior findings of other studies and indicated that parents perceive children with ADHD to have greater difficulty sleeping than normally developing children.  In addition, Ball and his associates found that parents perceived few differences between the sleep patterns of children with ADHD who were taking stimulant medications and those who were not. 

        Mark A. Stein (1999) published another study that measured parental perceptions of sleep problems in children with ADHD in the Journal of Child and Adolescent Psychopharmacology. In this study, one hundred and forty two children between the ages of 4 and 18 were participants in either the ADHD or the control group.  Stein requested that parents of the participants complete questionnaires that consisted of specific questions concerning sleep behavior, child behavior, and medical history.  The data indicated that 19.3% of children with ADHD reported moderate to severe sleep problems, compared to 6.2% of children in the control group.  In addition, children with ADHD who were treated with stimulants displayed a higher prevalence of nightly severe sleep problems than children with ADHD not treated with stimulants.  This finding stands in stark contrast to those of Ball et al. (1999).

        Despite the fact that the studies discussed above rely on data collected from the observations and perceptions of parents, not the affected patients, and do not provide identical findings, they both converge on a single point: Although a relatively large percentage of youth with ADHD experience sleep difficulties, there is no definite correlation between the two disorders. 

Web claims and motives

          Family members of patients unsuccessfully treated with medicinal stimulants and companies who sold products not regulated by the Food and Drug Administration created the majority of websites that provide Internet users with information about alternative treatments for ADHD symptoms.  One such website promotes Listol, a supplement pill, as an alternative treatment (http://www.progressivehealth.com/ads/listol/index2.html?gclid=CNnvyYDapp0CFU0i2godHmeAqg).  The website provides “extensive” background information about ADHD; however, none of the information is cited from a credible source.  The company, Progressive Health, claims that, “Listol is the most potent alternative to traditional pharmaceuticals, for alleviating attention deficit hyperactivity disorder (ADHD) in adults and children” (2009). Furthermore, the product is entirely endorsed by users, and there are no comments by any certified medical health professionals on the website.  The last strike against Listol and its use to alleviate ADHD symptoms is its absence on the Food and Drug Administration List of Approved Drug products (http://www.accessdata.fda.gov/scripts/cder/drugsatfda/index.cfm).

Conclusion

        Although several studies have examined the possible correlation between the treatment of ADHD symptoms with stimulants and the incidence of sleep problems, the empirical evidence fails to converge on a single identical finding indicating whether the stimulants cause sleep problems.  Despite the shortcoming, several researchers have pointed out improvements to make in the diagnosis and treatment of ADHD. If implemented, these improvements will make the correlation or lack thereof between the use of stimulant medicines for the treatment of ADHD symptoms and sleep disturbances much clearer.  Corkum et al. (1998) suggests that all children with ADHD be assessed for sleep disturbances, as sleep problems in children have been as stressors for parents.  In turn, this parental stress may be redirected the children and can worsen their ADHD symptoms.  Judith Owens, M.D., M.P.H. adds that many attentional difficulties are mistakenly attributed to ADHD rather than an underlying sleep disorder, another promotion for the screening ADHD patients for sleep disorders  (2005). 

        No credible empirical evidence has indicated that Listol is a safe and effective alternative to medicinal stimulants for the treatment of ADHD symptoms.  Until research is conducted to study its use, ADHD patients should not potentially risk their health nor spend money on this product. Should they experience any sleep disturbances or other complications with the prescribed use of a medicinal stimulant they should contact their primary health care provider and discuss a legitimate alternate form of treatment.


References

Ball, J.D., Tiernan, M., Janusz, J., & Furr, A. (1999). Sleep patterns among children with Attention-Deficit Hyperactivity Disorder: A reexamination of parent perceptions. Journal of Pediatric Psychology, 21 (3), 389-398.

Centers for Disease Control and Prevention. (2009). Attention-Deficit/Hyperactivity Disorder (ADHD). Retrieved from http://www.cdc.gov/ncbddd/adhd/index.html.

Corkum, P., Tannock, R., & Moldofsky, H. (1998). Sleep disturbances in children with Attention-Deficit/Hyperactivity Disorder. Journal of the American Academy of Child and Adolescent Psychiatry, 37 (6), 637-646.

Lecendreux, M., Konofal, E., Bouvard, M., Falissard, B., & Mouren-Siméoni, M.C. (2000).  Sleep and alertness in children with ADHD. Journal of Child Psychology and Psychiatry, 41, 803-812.

Owens, J.A. (2005).  The ADHD and sleep conundrum: A review.  Developmental and Behavioral Pediatrics, 26 (4), 312-322.

Progressive Health. (2009). ADD/ADHD Supplement: Listol. Retrieved from http://www.progressivehealth.com/ads/listol/index2.html?gclid=CNnvyYDapp0CFU0i2godHmeAqg.

Stein, M.A. (1999). Unraveling sleep problems in treated and untreated children with ADHD. Journal of Child and Adolescent Psychopharmacology, 9 (3), 157-168.

United States Food and Drug Administration and The Center for Drug Evaluation and Research. (2009). Drugs at FDA. Retrieved from http://www.accessdata.fda.gov/scripts/cder/drugsatfda/index.cfm.

 

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