For some kids with attention-deficit/hyperactivity disorder (ADHD), stimulant medications used to control symptoms may keep them from getting the sleep they need, a new research review confirms.
Cole Mariano used to be one of them. The 11-year-old has a prescription to treat his ADHD, and while he is now able to fall asleep at night, that wasn't always the case.
"I would come in crying to my mom and dad's room and be like, 'I can't go to sleep. I want to sleep, but I can't,'" he told CBS News.
He's not alone. The new analysis, published in the journal Pediatrics, addressed decades of conflicting evidence on the topic, and found that children on these medications take significantly longer to fall asleep, have poorer quality sleep and sleep for shorter periods.
"It can be a delay in sleep onset, sleep duration so kids are not getting as much sleep through the course of the night and having a bit more difficulty falling asleep," said Dr. Andrew Adesman of North Shore-LIJ's Cohen Children's Medical Center of New York.
Recent research suggests that 7 percent of children worldwide have ADHD, a chronic condition that includes attention difficulty, hyperactivity and impulsiveness. In the U.S., estimates vary, with the American Psychiatric Association reporting 5 percent of kids live with the condition while the Centers for Disease Control and Prevention suggest the number may be as high as 11 percent.
About 3.5 million of these children are prescribed stimulant medications like Ritalin and Adderall, the most common form of ADHD treatment.
The analysis showed that both methylphenidate drugs like Ritalin and amphetamines like Adderall cause troubled sleep in kids.
For the study, researchers from the University of Nebraska-Lincoln screened thousands of articles before selecting nine studies of sufficient scientific rigor to review in depth.
The researchers also found that the drugs tend to cause more sleep problems for boys, and that while the problems can subside over time, they never completely go away.
Experts recommend pediatricians closely monitor sleep problems in kids with ADHD. "If children are on medicine, you want to try to use the lowest does possible and in some cases perhaps changing the medicine might also help," Adesman said.
The study authors also suggest considering behavioral treatments, including parental training and changes to classroom procedures and homework assignments, to help with the negative consequences of living with ADHD.
"We're not saying don't use stimulant medications to treat ADHD," Timothy Nelson, an associate professor of psychology the University of Nebraska-Lincoln involved in the study, said in a statement. "They are well tolerated in general and there is evidence for their effectiveness. But physicians need to weigh the pros and cons in any medication decision, and considering the potential for disrupted sleep should be part of that cost-benefit analysis with stimulants."
As for Cole, he is now on medication that allows him to focus at school, and then wind down for a good night's sleep. "You just really have to see what works best for your child," his mother Loretta said.