[Disturbed sleep in children with ADHD: is there a place for melatonin as a treatment option?]

Sleep disorders are common in children with ADHD and they are aggravated by treatment with stimulantia. We focus on treatment with melatonin and weigh up its efficacy and safety.

To consider the evidence supporting the use of melatonin in the treatment of children with ADHD and to assess the efficacy and safety of such treatment.

We studied the literature using databases Embase, PubMed, PsycINFO and the Cochrane Library and the search terms 'ADHD', ‘melatonin', ‘insomnia', ‘methylphenidate', ‘side-effects', ‘endocrinology'.

25-50% of children with ADHD reported disturbed sleep patterns particularly in the form of (chronic) sleep onset insomnia ((C)SOI). Currently available research results indicate that melatonin can be effective in the treatment of (C)SOI and, on the whole, is well tolerated. However, there is a lack of pharmaceutical preparations of melatonin that give details about their use for children and that give evidence-based guidelines about the dosage and timing of intake. Very little systematic research has been done into the possible impact of melatonin intake on puberty and the endocrine system. Therefore, treatment with melatonin in children with ADHD and (C)SOI is best reserved for children with persistent insomnia which is having a severe impact on daily functioning, particularly in cases where is an obvious phase-shift of the endogenous circadian rhythm.

If indications are particularly strong there may be good reason to use melatonin to treat sleep disorders in children with ADHD. However, further research into the safety of melatonin is needed.