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By Jerry Morris, PsyD, MsPharm, MBA

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Efron D, Jarman F, Barker M. Side effects of methylphenidate and dexamphetamine in children with attention deficit hyperactivity disorder: a double-blind, crossover trial. Pediatrics. 1997 Oct;100(4):662-6. PubMed PMID:9310521.

The MTA Cooperative Group. Moderators and mediators of treatment response for children with attention-deficit/hyperactivity disorder: the Multimodal Treatment Study of children with Attention-deficit/hyperactivity disorder. Arch Gen Psychiatry. 1999 Dec;56(12):1088-96. PubMed PMID: 10591284.

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MB (Marc Braman, MD, MPH): This session, we're talking about ADD and sleep. Thank you for joining us again, Dr. Morris.

JM (Jerry Morris, PsyD, MSPharm , MBA): Glad to be here.

MB: So, we've touched on sleep in the past and there's a fair amount of science connecting sleep and ADD. But the question that immediately comes to my mind is, what's chicken and what's egg? Are the sleep problems creating the Attention Deficit Disorder or is the ADD creating the sleep problems? Because we know, just in day to day life, that we don't get a good night's sleep and we're grumpy and we can't concentrate, we're distracted easily. Pretty classic ADD symptoms. So, which is chicken and which is egg?

JM: That's really a great question for any of these diagnostic categories, and especially the ones such as Attention Deficit Disorder, the major depressive disorders and the bipolar disorders that have significant sleep problems associated with them. Now Marc, the trouble is that it's not a one size, fits all, and it's not a single entity etiology or cause. It's just like we've learned in genetics, you can't just find one gene that throws a switch and things happen, it takes lots and lots of switches thrown. And to develop a mental disorder, there's some good research that these are poly issue or multi-etiology vectors. Now, sleep's a big one.

JM: In my clinical experience over a number of years... 40 years... And in my reviews as a researcher over 40 years, which are pretty extensive, it can be 20% to 25% in ADHD or some of these mood disorders. There's good reasons for that. Sleep is a complex skill. It requires quieting of one of the alerting nervous systems and then activation of one of the more internally-focused and regulatory nervous systems... That's a big shift. It requires a lot of management of neurohormones, of muscle tone and tension. It requires hygiene or shutting out the world so that these switches and these changes in focus, internally and externally, occur. It requires a lot of things. So, sleep is a major contributor. It's a major contributor to recovery, in my opinion, in ADHD. If you're not assessing at least and focusing on the family and the individual's skill set and approach to sleep, you're gonna have a hard time with long term success in treatment.

MB: So, what I'm hearing you saying when you talk about many vectors or etiologies, meaning ADD has many forces creating it, there's many causes and those causes are potentially different makeups for different people. Now, you pulled out one concept that I really liked and I wanna touch a little bit more on that. Sleep as a skill. We don't typically think of sleep as a skill, and yet really you're saying that science teaches us that that is in fact the case. Now, obviously we have issues with stimulation, being alert, we take stimulants for ADD much of the time, and then we have trouble with sleep. So, we're having trouble with stimulation and rest or recovery, both. Could you explain that a little bit?

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