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Periodic limb movement disorder and restless legs syndrome in children with attention-deficit hyperactivity disorder
D L Picchietti1, S J England, A S Walters
1Pediatric Neurology Department, Carle Clinic and University of Illinois at Urbana-Champaign, USA.
Insights
Children with ADHD may have higher rates of periodic limb movement disorder (PLMD) and restless legs syndrome (RLS). These sleep disorders could explain ADHD symptoms in some children.
Area of Science:
- Pediatric Neurology
- Sleep Medicine
- Neurodevelopmental Disorders
Background:
- Sleep disruption is linked to attention-deficit hyperactivity disorder (ADHD) symptoms in children.
- Periodic limb movement disorder (PLMD) and restless legs syndrome (RLS) are known causes of sleep disruption.
Purpose of the Study:
- To investigate the prevalence of PLMD and RLS in children diagnosed with ADHD.
- To explore a potential comorbidity between ADHD and these specific sleep disorders.
Main Methods:
- Surveyed parents of 69 children with ADHD regarding PLMD symptoms.
- Conducted overnight polysomnography on 27 children with suspected PLMD.
- Compared findings with a control group of 38 children without ADHD.
Main Results:
- 26% of children with ADHD met criteria for PLMD, significantly higher than the 5% in the control group (P=.017).
- 8 of 18 children with ADHD and PLMD also reported personal or parental history of RLS.
- RLS symptomatology was present in one control patient with PLMD.
Conclusions:
- This study establishes a potential comorbidity between ADHD and PLMD in children.
- Sleep disruption from PLMD/RLS and RLS-related motor restlessness may contribute to ADHD symptoms in a subset of patients.
- Highlights the importance of screening for sleep disorders in children with ADHD.
Abstract:
Sleep disruption can lead to symptoms of attention-deficit hyperactivity disorder (ADHD) in children. Since periodic limb movement disorder and/or restless legs syndrome can cause sleep disruption, we assessed whether these two specific sleep disorders are likely to occur in children with ADHD. We asked a series of 69 consecutive parents of children with ADHD questions about the symptoms of periodic limb movement disorder. Based on a positive response to these periodic limb movement disorder queries, 27 children underwent all-night polysomnography. Eighteen children (aged 2 to 15 years) of the 27 (26% of the 69 children with ADHD) had 5 or more periodic leg movements in sleep per hour of sleep and had complaints of sleep disruption, thus fulfilling the criteria for periodic limb movement disorder. A comparably age- and sex-matched group of children referred to a sleep laboratory for sleep complaints but without ADHD showed only a 5% prevalence (2 of 38 subjects) of periodic leg movements in sleep (P=.017). Eight of the 18 children with ADHD and periodic limb movement disorder and one of the two control patients with periodic limb movement disorder had both a personal and parental history of restless legs syndrome symptomatology. This study further documents the occurrence of periodic limb movement disorder and restless legs syndrome in children and is the first large-scale study establishing a possible comorbidity between ADHD and periodic limb movement disorder. We propose that the sleep disruption associated with periodic limb movement disorder and restless legs syndrome and the motor restlessness of restless legs syndrome while awake could contribute to the inattention and hyperactivity seen in a subgroup of ADHD-diagnosed children.