Mental Health

Insomnia in Children With ADHD

Insomnia in Children With ADHD

Melatonin Treatment for Insomnia in Pediatric Patients with Attention-

Deficit/Hyperactivity Disorder

1/25/2010– Children with ADHD often have pediatric insomnia, which affects academic and social functioning, overall health, and family life. After other diagnoses have been ruled out, first-line treatment includes optimizing ADHD treatment with stimulants, and implementing good sleep hygiene and behavioral therapy. Melatonin, which regulates circadian rhythm sleep disorders such as sleep-onset insomnia, is often prescribed as adjuvant pharmacotherapy.

 

Melatonin Treatment for Insomnia in Pediatric Patients with Attention-

Deficit/Hyperactivity Disorder

  1/25/2010– Children with ADHD often have pediatric insomnia, which affects academic and social functioning, overall health, and family life. After other diagnoses have been ruled out, first-line treatment includes optimizing ADHD treatment with stimulants, and implementing good sleep hygiene and behavioral therapy. Melatonin, which regulates circadian rhythm sleep disorders such as sleep-onset insomnia, is often prescribed as adjuvant pharmacotherapy.

The goal of this literature review and meta-analysis was to assess the efficacy and safety of melatonin for treating insomnia in children with attention-deficit/hyperactivity disorder (ADHD). The reviewers searched MEDLINE® from 1948 through August 2009, EMBASE® from 1950 through August 2009, and Scopus™ from 1960 through August 2009, as well as bibliographies of identified articles. Results were summarized from all 5 identified randomized trials (1 safety study, 1 long-term follow-up study, 1 post hoc retrospective analysis, 2 meta-analyses), 9 review articles, and 1 letter.

When given at doses ranging from 3 to 6 mg within a few hours of a scheduled bedtime, melatonin was associated with improvement in sleep onset and sleep latency in 4 studies in children aged 6-14 years with ADHD and insomnia. Adverse events were transient and mild in all studies.

Viewpoint

Limitations of this review are those inherent in the available studies, including small sample size, short duration; variable sleep-onset insomnia criteria, ADHD criteria, and treatment assessments; and lack of generalizability. Nonetheless, studies to date suggest that melatonin is well-tolerated and effective as a treatment for pediatric patients with chronic sleep-onset insomnia and ADHD. To determine optimal dosing regimens and long-term safety, regulated melatonin products tested in larger, well-designed trials are needed.

 

Authors and Disclosures

Author(s)

Laurie Barclay, MD

Freelance writer and reviewer, Medscape, New York, NY

Disclosure: Laurie Barclay, MD, has disclosed no relevant financial relationships.

Medscape Psychiatry & Mental Health © 2010 WebMD, LLC

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