Insomnia, ADHD, and Bad Behavior

A new study on children with ADHD* sheds some light on the problems with insomnia — and then with behavior — that many adults with ADHD have. The surprising conclusion of the study? The use of stimulant medication in children and adolescents with ADHD does not seem to cause or worsen sleep problems.

This large, forward-looking study showed an odds ratio of 1.3 for insomnia among children with ADHD who had taken a stimulant or other form of ADHD medication in the previous year. That odds ratio is not statistically significant. Translation: the chances of insomnia are only slightly higher in children and teenagers who took meds for their ADHD.

In the study the 225 children and adolescents with ADHD averaged 14.9 years old; the 224 without ADHD had an average age of 16.1. Slightly fewer than half of the subjects were boys or young men (that’s unusual). In the year preceding the study, sixty-one percent of the youngsters with ADHD received a medication for the disorder. Only 6% of the controls received such medication. Other ( “comorbid” ) psychiatric disorders were also present in 51% of the ADHD subjects and only 10% of the controls.

Fully 42% of the youngsters with ADHD reported often having difficulty falling asleep in previous months, compared with 17% of the controls. That was a very significant difference ( the probability value, abbreviated as p, was less than 0.01 ).

We assume that people who sleep poorly don’t function or behave as well as those who are well-rested. We assume that children with ADHD don’t function or behave as well as others do. We might assume as well, then, that children who have both problems are at special risk for bad behavior.

The investigators used the Child Behavior Checklist to check out these assumptions in the study subjects. They found that kids with ADHD and insomnia had significantly more behavior problems than their non-ADHD counterparts who had insomnia.

Eric Mick, ScD, assistant professor of Psychiatry at Harvard Medical School, led the study. He asserts that the most intriguing result he and his colleagues found is the connection between insomnia and behavior problems.

I like studies that support my assumptions, the way this one does. For adults with ADHD, it bolsters the evidence that sleep problems are a basic part of the disorder of ADHD. Here’s the take-home message: treating ADHD, even with stimulants, may not worsen sleep problems.

When we’ve slept badly we do not function at our best ( that’s an understatement, eh? ). The study results prod me to watch for sleep problems among my adult ADHD patients. The study also means that if you have sleep problems, report them to your doctor. They are definitely worth working on. You’ll feel better. Even more important, you may well function better.