Melatonin For Kids With ADHD
ADHD is sometimes accompanied by difficulty sleeping, emotional dysregulation, depression and anxiety. (In psychiatry, these accompanying issues are called “comorbidities.”) For example, a child with ADHD might develop social anxiety because they have chronic difficulty paying attention. Being unable to pay attention during conversations with peers makes it harder to interact and results in anxiety.
Parents of children with ADHD may wonder about how to best manage their child’s sleep problems. Usually, children with ADHD have no trouble staying asleep, but have chronic difficulty with sleep initiation. There are a number of medications and behavioral techniques that can help with sleep initiation. Melatonin is among the most popular options for a number of reasons.
- What Causes ADHD-Associated Seep Difficulties?
- Effect of ADHD Medications On Sleep
- Melatonin and ADHD
- Melatonin and the FDA
- Using Melatonin Correctly
What Causes ADHD-Associated Seep Difficulties?
This phenomenon may be related to the hyperactivity observed in patients with ADHD. Hyperactivity may make it difficult to “wind down” in the evening and quiet one’s mind just before bed.
Effect of ADHD Medications On Sleep
Psychostimulants like Adderall are the gold standard for the treatment for ADHD. It has been classically observed that children with ADHD are calmed down by psychostimulants whereas healthy controls are overstimulated. (In psychiatry, this is sometimes referred to as the ADHD-stimulant paradox).
Adequately treating a child’s ADHD with medication will in some cases resolve related sleep issues. Since the stimulant has a calming effect and tends to reduce symptoms of hyperactivity, children may find it easier to fall asleep while they are being treated with psychostimulants. However, at night, medication taken during the day may have worn off by bedtime, and so ADHD medication may also have no effect.
Melatonin and ADHD
According to a number of studies, patients with both ADHD and sleep issues tend to benefit from melatonin. Melatonin 2-3 hours before bed hastens sleep onset and affects circadian rhythm. Circadian rhythm refers to how your body’s clock is entrained to the environment (especially light and temperature cues).
Children with ADHD may have an irregular phase (e.g., the phase of their circadian rhythm may be delayed), which can be corrected by melatonin administration 2-3 hours before bedtime. Melatonin taken early in the evening tends to advance the phase (of the circadian rhythm), whereas melatonin taken late at night has the opposite effect.
Melatonin is an attractive option to manage ADHD-related sleep issues for a number of reasons:
- It is naturally present in your body (“endogenous”)
- It has no serious side effects (though it is associated with some mild side effects)
- It is relatively safe in overdose (it won’t kill you)
Melatonin and the FDA
While melatonin is anecdotally considered safe and modestly effective, melatonin is classified as a dietary supplement in the US. Therefore it has not been investigated or approved by the FDA. This does not mean that melatonin is unsafe, just that it has not been subjected to the same level of scrutiny as other drugs that make it through FDA approval. Millions of people take melatonin every day, and no ill health effects have come to light. But keep in mind that it is still a remote, theoretical possibility that melatonin ingestion will have some negative effect on health that just hasn’t been unrecognized yet.
Using Melatonin Correctly
- Give melatonin 2-3 hours before bedtime, not right at bedtime (timing is everything!)
- Don’t use melatonin as an excuse to avoid implementing good sleep hygiene (medication should be a last resort after behavioral changes have been tried!)
- Inform and consult your pediatrician (communicate!)
- Start at lower doses first (0.5-1mg) before moving to higher doses like 3mg (less is more!)