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We are pleased to announce a new column, Medical Practice Updates by Richard Rubin, MD. Each month Dr. Rubin will discuss recent findings in the treatment of ADHD that will impact practitioners.
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Medical Practice Updates
by
Richard L. Rubin, MD
Clinical Associate Professor, University of Vermont College of Medicine
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The ADHD and Sleep Conundrum
With concern that sleep problems are reported to doctors in 25 to 50% of children and adolescents with ADHD, Judith A. Owens, MD, MPH, reviewed the current evaluation and treatment knowledge in Developmental and Behavioral Pediatrics, August, 2005. The conundrum puzzle comes from the possible interaction of multiple factors: 1) primary sleep disorders (obstructive apnea, restless legs, narcolepsy, etc) may cause ADHD-like symptoms; 2) ADHD itself creates sleep problems; 3) common disorders combined with ADHD (oppositional defiance, anxiety, etc) add sleep difficulties; and 4) medicines treating ADHD may cause insomnia (stimulants) or daytime sleepiness (noradrenergics). The common use of several unapproved medicines for sedation of sleep-onset problems (clonidine, trazodone, antihistamines, melatonin) has very limited safety and efficacy data support.
In practice, this conundrum warrants conscientious screening evaluation of sleep, such as inquiry according to the acronym BEARS: Bedtime resistance, Excessive daytime sleepiness, Awakenings during the night, Regularity of sleep pattern, and Snoring.
Subsequent interventions and treatments driven by appropriate diagnosis may be: 1) Behavioral training and schedule structuring techniques; 2) Education of parents about normal sleep development and hygiene; 3) choice of ADHD medicine and dosing that minimizes sleep side effects; 4) psychotherapeutic and medication relief of concomitant emotional and behavioral disorders; and/or 5) other specific treatment of a primary sleep disorder.
Dr. Rubin practices Child and Adult Psychiatry, directs The Clinical Study Center in Burlington Vermont, and serves as Clinical Associate Professor at the University of Vermont College of Medicine. Click here for more information about Dr. Rubin and ADHD.
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Click here for other great articles on ADHD from ADDitude Magazine!
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March's Featured Tools
In this month's Medical Practice Updates column, Dr. Richard Rubin referred to the co-morbidity of ADHD and sleep disorders in children.
The National Sleep Foundation (www.sleepfoundation.org) offers many educational brochures, tools, and worksheets for understanding, evaluating, and treating sleep problems in children and adolescents.
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The Sleep Diary , for example, explains to children why sleep is important to stay healthy and safe and offers tips to help children get a good night's sleep.
One section of the diary asks children to track how much caffeinated drinks they had each day of the week and the activities they participated in one hour before going to bed.
Another section iquires about how well they slept, if they had trouble falling asleep, and what disturbed their sleep each night. In this section, the child charts how much sleep he or she got last night.
The next section of the Sleep Diary asks how the child felt at the end of the day, i.e. whether he or she was full of energy, alert, able to pay attention in school, etc.
Another section encourages the child to compare how he or she felt on days when sleep problems occurred versus when sleep was fine.
You can view the National Sleep Foundation's Sleep Diary .
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For additional articles and resources on ADHD visit these sites:
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myADHD.com news is an e-publication of Health Link Systems, Inc. This publication is sponsored by myADHD.com, A.D.D. WareHouse, and the National Association for Continuing Education. Information presented here is not intended to replace the advice of a physician or other health care professional. Placement of an advertisement in this e-newsletter does not represent an endorsement of any advertised products or services or the validity of any claims advertised. Copyright 2006 by Health Link Systems, Inc. For comments or information, please send an email to: info@myadhd.com, subject line: myADHD.com News.
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