Fourteen consecutive children who were newly diagnosed with attention‐deficit hyperactivity disorder (ADHD) and who had never been exposed to stimulants and 10 control children without ADHD underwent polysomnographic studies to quantify Periodic Limb Movements in Sleep (PLMS) and arousals. Parents commonly gave both false‐negative and false‐positive reports of PLMS in their children, and a sleep study was necessary to confirm their presence or absence. The prevalence of PLMS on polysomnography was higher in the children with ADHD than in the control subjects. Nine of 14 (64%) children with ADHD had PLMS at a rate of >5 per hour of sleep compared with none of the control children (p <0.0015). Three of 14 children with ADHD (21%) had PLMS at a rate of >20 per hour of sleep. Many of the PLMS in the children with ADHD were associated with arousals. Historical sleep times were less for children with ADHD. The children with ADHD who had PLMS chronically got 43 minutes less sleep at home than the control subjects (p = 0.0091). All nine children with ADHD who had a PLMS index of >5 per hour of sleep had a long‐standing clinical history of sleep onset problems (>30 minutes) and/or maintenance problems (more than two full awakenings nightly) thus meeting the criteria for Periodic Limb Movement Disorder (PLMD). None of the control children had a clinical history of sleep onset or maintenance problems. The parents of the children with ADHD were more likely to have restless legs syndrome (RLS) than the parents of the control children. Twenty‐five of 28 biologic parents of the children with ADHD and all of the biologic parents of the control children were reached for interview. Eight of twenty‐five parents of the children with ADHD (32%) had symptoms of RLS as opposed to none of the control parents (p = 0.011). PLMS may directly lead to symptoms of ADHD through the mechanism of sleep disruption. Alternative explanations for the association between ADHD and RLS/PLMS are that they are genetically linked, they share a common dopaminergic deficit, or both.

Objective-To examine objective and subjective sleep problems in early-onset anxiety and depression.Method-Children and adolescents (46% female, ages 7 to 17 years) with anxiety disorders (n = 24), major depressive disorder (MDD) without comorbid anxiety disorders (n = 128), or no history of psychiatric disorder (n = 101) spent two consecutive nights in a sleep laboratory and completed self-reports of sleep quality.Results-On objective measures, the anxiety group exhibited more awakenings than the MDD group, less slow-wave sleep than the control or MDD group, and greater night 2 sleep latency than the MDD or control group. The anxiety group exhibited no decrease in rapid eye movement latency from the first night to the second. The MDD group exhibited less time awake than the control group and less stage 1 sleep than the anxiety or control group. On subjective measures, young people with anxiety reported greater sleep latency on the second night and no decrease in sleep latency. Age was covaried in analyses.Conclusions-Findings provide objective and subjective evidence of sleep disturbance in children and adolescents with anxiety disorders and replicate findings of limited objective sleep disturbance in those with MDD. Sleep problems are an important consideration when treating young people with anxiety. Keywordsanxiety; depression; objective sleep; sleep problems; early onset Sleep problems and affective disorders are common and often co-occurring difficulties experienced by children and adolescents. 1-3 The co-occurrence of sleep problems with affective disorders is worthy of attention because the combination of difficulties can result in a more pernicious course and greater impairment of functioning than these problems in isolation. 4 In addition, the relation between sleep problems and affective functioning in young people appears to be bidirectional. 5 For instance, depressive symptoms predict insomnia in adolescents, 6 and sleep problems predict later anxiety and depression. 7Correspondence to Erika E. Forbes, University of Pittsburgh, 3811 O'Hara Street, WPIC Loeffler 319, Pittsburgh, PA 15213; e-mail: Email: forbese@upmc.edu. Disclosure: Dr. Birmaher has participated in forums sponsored by Solvay Pharmaceuticals and Abcomm and has also presented on bipolar disorders in children at a meeting sponsored by Solvay. The payment for this conference was given to the WPIC Residency Training Program. He also has received royalties for publications from Random House. The other authors report no conflicts of interest. Sleep problems and anxiety disorders have been linked at many points in the life span. 8 However, investigations of sleep problems in children and adolescents with a specific focus on anxiety have generally been conducted only at the level of subjective reports. For instance, a recent study with clinician and parent reports indicated that most young people with anxiety disorders experience at least three sleep-related problems. 9 Furthermore, studies have typically included population-based samp...