Is Restless Legs Associated with ADHD/DAMP?
Associated Professional Sleep Societies. 2 aug 2005
RLS in children requires special considerations, with difficulties arising in diagnosis and safety concerns, which limit treatment.
Diagnostic Difficulties in Children
Recent data indicate that children also suffer from RLS, although the signs and symptoms are often different than those reported in adults, according to Daniel Picchietti, MD, from the University of Illinois in Urbana, Ill. Children often come to the attention of sleep specialists because they are not sleeping at night, and are suffering from daytime effects, such as cognitive impairment, ADHD behaviors, irritability, or oppositional behaviors.
URGE Criteria in Children
Arthur S. Walters, MD, from the New Jersey Neuroscience Institute at JFK Medical Center in Edison, NJ, reviewed the NIH Consensus Criteria for diagnosing RLS in children that were published in 2003. These criteria state that either a child must meet all four essential adult URGE criteria and be able to describe the leg sensations in their own words OR the child must meet all four essential adult URGE criteria and have two of the three following: sleep disturbance relative to age, a parent or sibling with documented RLS, or PLMSI > 5/hour of sleep.
Is RLS Associated with ADHD?
Dr. Walters reviewed the theoretic relationships between RLS and ADHD. Children with RLS look like they have ADHD because they cannot sit still due to leg discomfort; chronic sleep disruption from RLS can produce hyperactivity; and both ADHD and RLS/PLMS may share a common dopaminergic deficit based on observations that RLS and ADHD respond to methylphenidate and levodopa. Since sleep problems in children often manifest as behavioral or cognitive problems or irritability, some clinicians believe that correcting the sleep problem, in this case RLS, will correct these other issues.
The relationship, if any, between RLS, PLMS, and ADHD is controversial, according to Rosalia Silvestri, MD, of Brigham and Women's Hospital in Boston, Mass, who led a "Meet the Professor" breakfast session. She reviewed studies by Picchietti and others, who have shown that 20% to 40% of patients with ADHD also have >5 PLMS/hour and that children with more severe ADHD may have even higher levels of PLMS. In a group of 16 children with PLMS > 25, 15 met diagnostic criteria for ADHD, 4 had RLS, 10 had a parent with RLS, all had significant sleep disturbances, and symptoms resolved for both conditions with dopaminergic treatment. Dr. Silvestri suggested that ADHD in children with PLMS may actually be related to coexisting sleep apnea and, therefore, sleep laboratory evaluation may benefit children with ADHD by revealing treatable sleep disorders that, in turn, may help the ADHD.
Treatment of RLS in Children
Clonidine has been used as the cornerstone of treatment in pediatric RLS, but good sleep hygiene and behavior modification are also key components of therapy. Clonazepam is also used for RLS, but should be avoided if there is co-morbid ADHD, because it may have a paradoxical alerting effect. The use of dopaminergic agents for RLS is not recommended for children, although there is an ongoing controlled trial under way to look at this question. Children with RLS may also have iron deficiency, although there are no established guidelines for treating this.
Source: Projects In Knowledge, Inc.
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Hvad er ADHD/DAMP?
Af Niels Bilenberg, over-læge, ph.d.
Opmærksomhedsforstyrrelse er et handicap primært hos børn og unge, som optræ-der med eller uden samtidig over- eller hyperaktivitet. Mange navne og etiketter er blevet påhæftet børn med opmærksomhedsfor-styrrelse og tilknyttede vanskeligheder. Her kan nævnes: MBD-børn, tumler-fumler-børn, hyperkinetiske børn, ADHD og DAMP.
Forstyrrelserne skal være til stede før seks års alderen og skal have varet i mindst seks måneder. Desuden skal de være til stede i flere situationer som skole, hjem og fritidsinstitution, før at der kan være tale om ADHD/DAMP.
Danske og udenlandske undersøgelser har fundet at opmærksomhedsforstyrrelse optræder i betydende grad hos 3-6 procent af alle børn. Drenge rammes hyppigst.
Ofte følger der andre problemer med, såsom motoriske vanskeligheder adfærdsforstyrrelse, gen-nemgribende udviklings-forstyrrelse og depression.
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