Sex differences and the interaction of age and sleep issues in neuropsychological testing performance across the lifespan in an ADD/ADHD sample from the years 1989 to 2009.

Chart review of population (9 to 80 years) neuropsychological test battery for ADHD diagnosis, questionnaires with multiple responders were evaluated in outpatient setting from 1989-2009. The focus was gender differences across age, diagnostic group (ADHD-Inattentive/ADHD plus), neuropsychological test performance, and reported sleep symptoms over the lifespan. Individuals were assigned to ADHD-I group or ADHD plus group (based upon secondary diagnosis of sleep, behavioral, emotional disturbance); ADHD not primary was excluded (brain insult, psychosis). Among these were 1,828 children (ages 9 to 14), adolescents (ages 15 to 17), and adults (ages 18 and above); 446 children (312 diagnosed ADHD-I), 218 adolescents (163 diagnosed ADHD-I), and 1,163 adults (877 ADHD-I). Sleep was problematic regardless of age, ADHD subtype, and gender. The type and number of sleep problems and fatigue were age dependent. ADHD subtype, gender, fatigue, age, and sleep (sleep onset, unrefreshing sleep, sleep maintenance) were significant variables affecting neuropsychological test performance (sequencing, cognitive flexibility, slow- and fast-paced input, divided attention, whole brain functioning). Findings suggest that ADHD involves numerous factors and symptoms beyond attention, such as sleep which interacts differently dependent upon age.

L-Dopa improves Restless Legs Syndrome and periodic limb movements in sleep but not Attention-Deficit-Hyperactivity Disorder in a double-blind trial in children.

BACKGROUND: In a previous open-label study, dopaminergic agents improved Restless Legs Syndrome (RLS) and Periodic Limb Movements in Sleep (PLMS), as well as Attention-Deficit-Hyperactivity Disorder (ADHD) in children with both disorders. We therefore conducted a double-blind placebo-controlled trial of L-DOPA in ADHD children with and without RLS/PLMS. METHODS: Two groups of patients (total n = 29), those with ADHD only or those with ADHD and RLS/PLMS, were randomized to L-DOPA or placebo therapy. At baseline and after therapy patients were assessed with Conners' parent and teacher rating scales; polysomnography; RLS rating scale; and neuropsychometric measures of memory, learning, attention, and vigilance. RESULTS: L-DOPA improved RLS/PLMS symptoms in all patients with those disorders compared with placebo (p = .007). When assessed by the Conners' Scales before therapy, ADHD was more severe in children without RLS/PLMS than in children with RLS/PLMS (p = 0.006). L-DOPA had no effect on Conners' scales, sleep, or neuropsychometric tests when all patients treated with the drug were compared to those on placebo or when patients with ADHD only were compared to those with ADHD and RLS/PLMS. CONCLUSIONS: In this first double-blind study of a dopaminergic therapy in children with RLS/PLMS, L-Dopa significantly improved RLS/PLMS but not ADHD. These results, however, should be interpreted carefully since they may have been influenced by the relatively small sample size and the baseline differences in severity of ADHD symptoms. Further work needs to be done to elucidate the relationship between dopamine, ADHD and RLS/PLMS.

Symptoms of attention-deficit/hyperactivity disorder in adults with restless legs syndrome.

OBJECTIVE: To determine the occurrence of symptoms of attention-deficit/hyperactivity disorder (ADHD) in adults with restless legs syndrome (RLS), normal controls, and controls with insomnia. SETTING: University-based hospital. METHODS: The occurrence and severity of current ADHD symptoms were determined in a prospective study of sequential adult patients with RLS (n = 62) or insomnia (n = 32) and adult controls (n = 77) using Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) ADHD criteria, the Brown Attention-Deficit Disorder (ADD) Scale for adults, and a structured psychological interview. RLS severity was assessed using the International RLS Study Group Rating Scale (IRLS). RESULTS: Only 1 experimental subject had previously been diagnosed with ADHD. More RLS patients (26%) than insomnia patients (6%) or controls (5%) had ADHD symptoms using age-adjusted total DSM-IV ADHD scores (P < .01). The mean Brown ADD score was greater in RLS patients (37 +/- 28) than in patients with insomnia (24 +/- 18) or controls (21 +/- 18) (P < .01). The RLS symptom severity (0-40 scale) was greater in RLS patients with ADD symptoms (26 +/- 9) than in those without ADD (21 +/- 10) (P < .04). Of the subjects with a Brown ADD score > 40, all reported ADD symptoms in 2 settings, and the majority had had ADHD symptoms since childhood. For subjects with a Brown ADD score > 40, there were no differences between the RLS, insomnia control, and normal control groups in quality of life or the level of anxiety or depression. CONCLUSIONS: ADHD symptoms are more common in RLS patients than in patients with insomnia or controls. RLS leg discomfort or poor quality of sleep may theoretically lead to hyperactivity and lack of concentration. Alternatively, RLS and ADHD may be part of a single symptom complex, and dopaminergic deficiency may play a role in both disorders.