Impact of restless legs syndrome and iron deficiency on attention-deficit/hyperactivity disorder in children

Jul 24, 2007Sleep medicine

How restless legs syndrome and low iron relate to ADHD in children

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Abstract

Mean serum ferritin levels were significantly lower in children with ADHD compared to controls (p<0.0005).

ADHD symptom severity was higher in children with ADHD and restless legs syndrome (ADHD+RLS) compared to those with ADHD alone, although the difference was not statistically significant.
Lower ferritin levels were observed in ADHD+RLS subjects compared to those with only ADHD.
A positive family history of restless legs syndrome was associated with more severe ADHD symptoms.
Previous iron supplementation in infancy was linked to increased severity of ADHD scores.

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OBJECTIVE: Increasing evidence suggests a significant comorbidity between attention-deficit/hyperactivity disorder (ADHD) and restless legs syndrome (RLS). Iron deficiency may underlie common pathophysiological mechanisms in subjects with ADHD plus RLS (ADHD+RLS). To date, the impact of iron deficiency, RLS and familial history of RLS on ADHD severity has been scarcely examined in children. These issues are addressed in the present study.

METHODS: Serum ferritin levels, familial history of RLS (diagnosed using National Institutes of Health (NIH) criteria) and previous iron supplementation in infancy were assessed in 12 ADHD+RLS children, 10 ADHD children and 10 controls. RLS was diagnosed using NIH-specific pediatric criteria, and ADHD severity was assessed using the Conners' Parent Rating scale.

RESULTS: ADHD symptom severity was higher, although not significantly, in children with ADHD+RLS compared to ADHD. The mean serum ferritin levels were significantly lower in children with ADHD than in the control group (p<0.0005). There was a trend for lower ferritin levels in ADHD+RLS subjects versus ADHD. Both a positive family history of RLS and previous iron supplementation in infancy were associated with more severe ADHD scores.

CONCLUSIONS: Children with ADHD and a positive family history of RLS appear to represent a subgroup particularly at risk for severe ADHD symptoms. Iron deficiency may contribute to the severity of symptoms. We suggest that clinicians consider assessing children with ADHD for RLS, a family history of RLS, and iron deficiency.

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Impact of restless legs syndrome and iron deficiency on attention-deficit/hyperactivity disorder in children

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