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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): We want stimulation like exercise and light and food when we should be stimulated during the daytime, and we want to avoid things that are stimulants when it's time to go to sleep, be that foods, medications, the stimulants that they're already taking oftentimes would be a problem, and the family dynamics are hugely important around, is this child stressed? Does the family have a normal bedtime routines that help them get to sleep and relax, or the opposite? So all those things are forces regulating sleep that may then be causing ADD.

JM (Jerry Morris, PsyD, MSPharm , MBA): Well that's exactly right, and let me go to another metaphor. I'll go back to my learning to play violin in a war zone, Okay? What qualified violin teacher would sign up to come in at 3:00in the afternoon when you're in the foxhole in full uniform and could be attacked and try to give you a violin lesson? Well, but this is what we do in America in modern medicine. We come to the primary care center, and the primary care doc has about 8 to 12 minutes with you, doesn't have a full staff with psychologists and behavioral support that can work with him or her as a team. Their only arrow in their quiver is some stimulant that's gonna have side effects, one of which is interruption of sleep skill, and then we ask the doctor, "Will you take on the job of being the violin teacher in the war zone that maybe my family, in these circumstances, for my ADHD child?" The doctor ought to refuse the honor and say, [chuckle] "I only give lessons in the appropriate context."

MB: Good example. Excellent illustration. So final question: What we've just talked about, showing this very strong connection between sleep and ADD, and then the forces that are regulating sleep, can we use these lifestyle forces as a substantial part of solid, scientifically-based treatment for ADD?

JM: Yes. In a future conversation, I hope we will go into the actual electrophysiology and organicity of sleep and the five stages, and why each one is essential. You know, God didn't make any spare parts, and if we have five stages, they all do something. And understanding that, and how, if we don't have adequate sleep, which would be six to seven hours and going through at least three to four cycles of the five stages, then there is a disruption organically and neurohormonally of the brain. There is a disruption of the ability to regulate the skeletal muscles. There's a disruption of the ability to grow and maintain neurons in the brain, and therefore, based on that, the personality is disrupted and then the mind is disrupted, which is the personality interacting with others.

MB: Excellent. Thank you so much, Dr. Morris, for helping us understand the connection between ADD and sleep, and how we can use sleep as a fundamental part of treating the cause for ADD.

JM: Glad to work with you, Marc.

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