Restless Leg Disorders in Kids with ADHD

If you have a child with attention-deficit/hyperactivity disorder (ADHD), you probably know that your youngster sometimes has trouble paying attention, sitting still, or controlling his or her impulsive behaviors. What may be less obvious is that your child may also have problems sleeping.

Research suggests that as many as 30% of children with ADHD suffer from sleep disorders. These include insomnia, daytime sleepiness, difficult or abnormal breathing during sleep (sleep apnea), and delayed sleep. Two of the most common sleep disorders linked with ADHD are periodic limb movements (PLMS) and restless legs syndrome (RLS). For these reasons, kids with ADHD are more likely to suffer from daytime drowsiness than those without ADHD.

Restless legs syndrome

RLS commonly occurs in children with ADHD, including many of those already plagued by nighttime cramping and jerking in their arms or legs. Symptoms of RLS include an uncomfortable tingling, burning, or crawling sensation in the legs when the child lies down to sleep. This causes an almost uncontrollable need to twitch, move the legs, or thrash around. Among those who have RLS, as many as 80% also have symptoms of PLMS.

Periodic leg/limb movements during sleep

This sleep disorder causes your children's arms or legs to cramp and jerk during sleep. The sudden movements may wake them up. Because these movements often jolt children awake before deep REM sleep, they can cause difficulty falling back asleep or staying asleep.

Episodes of PLMS can last from a few seconds to nearly 2 minutes. They may happen frequently, too. The episodes may occur again and again over a period of several hours, severely disrupting sleep.

If your child with ADHD is losing sleep from these involuntary movements, the resulting sleep loss can affect his or her mood. Behavior problems and irritability are common. Children with PLMS may also have symptoms of RLS as they try to sleep.

Causes

Experts do not yet fully understand the causes of PLMS and RLS. But they are investigating a possible association with the central nervous system. Studies suggest that RLS is linked to a lack of iron or difficulty processing iron, a mineral important to many brain activities. It has also been tied to nerve damage; conditions such as diabetes; and certain medicines, such as antidepressants and allergy pills that contain antihistamines. In some cases, symptoms of RLS will improve when the medication is stopped. RLS has also been found to run in families.

Less is known about the cause of PLMS, but it also appears to be linked to iron deficiency and anemia. Kidney disease and diabetes may also contribute.

Researchers don't know why ADHD seems so often connected to these sleep disorders. They are trying to better understand the tie between the two.

How these sleep conditions affect children

Children who don't get enough sleep can suffer in daily life and struggle to pay attention in school or have aggressive outbursts. Unlike adults, who tend to slow down when sleep deprived, kids become more hyperactive the more tired they are.

In kids with ADHD, lack of sleep tends to worsen their symptoms. One study examined the impact of improving sleep in children with ADHD. It found that consistently good sleep helped to limit and, in some cases, even completely control symptoms of hyperactivity and inattention.

Managing ADHD and sleep problems

Medications are commonly used to manage ADHD. But the stimulant medications that are effective in controlling symptoms can often cause sleep problems, such as insomnia. Because insomnia can worsen ADHD, some parents elect to skip medications for their ADHD child entirely and focus on therapy, counseling, and social skills training to change behavior. It's important for a child who takes stimulant medication twice a day to take the second dose no later than 2 p.m., so that it's less likely to cause sleep problems.

These are other steps parents can take to control and prevent symptoms and help children with ADHD sleep better:

• Massage, including massaging the affected limbs when they hurt

• Stretching

• Keeping up an inviting bedtime ritual and consistent time for sleep

• Regular exercise

• Removing the TV, video games, phone, and computer from the child's bedroom to create a distraction-free sleep environment 

   

  For more information go to www.riversidehealthcare.org/restless-legs-syndrome.html