This document discusses the use of complimentary and alternative medicine (CAM), specifically homeopathy, to treat attention-deficit/hyperactivity disorder (ADHD) related sleep disturbances in children. It notes that sleep disturbances are common in 50-80% of children with ADHD. Current treatment modalities discussed include pharmacotherapy, behavioral therapy, and CAM such as homeopathy. Homeopathic remedies explored for treating ADHD sleep issues include melatonin, valerian, lemon balm, and German chamomile, though research support is strongest for melatonin and valerian. More research is still needed on the efficacy and safety of all CAM therapies for treating pediatric sleep disorders.

1. COMPLIMENTARY AND
ALTERNATIVE MEDICINE:
HOMEOPATHY
The Treatment of ADHD Related Sleep Disturbances
in Children
Kali Kouanchao, RN, BSN
Saint Louis University School of Nursing
NURS 5510 – Mental Health of the Family in Primary Care

2. CHANGING TRENDS
• The use of Complimentary and Alternative Medicine (CAM) has been common
among adults for some time, but is becoming more common among children and
adolescents in more recent years
• More commonly used in:
• Children of parents using alternative therapies themselves
• Children of parents with higher levels of education
• Children with chronic medical conditions
• Children with developmental and behavioral disorders (i.e. Autism Spectrum Disorders,
Attention-Deficit/Hyperactivity Disorder, Down Syndrome, Cerebral Palsy, and Spina
Bifida)
(Voigt, 2011, p. 450)

3. HOW TO EVALUATE CAM THERAPIES
QUESTIONS TO ASK
Theoretical Basis of
the Therapy
• Is treatment based on an overly
simplistic theory?
• Is treatment based on principles
that are inconsistent with
accumulated knowledge from
other scientific specialties?
• Has the treatment changed
insignificantly over a long period
of time?
Evidence Base of the
Therapy
• Is it possible to test the treatment
claim?
• Have well designed studies been
published for peer review?
• Do proponents of the treatment
“cherry pick” evidence and ignore
contrary evidence?
• Do proponents of the treatment
assume it is effective until sufficient
evidence shows otherwise?
• Do proponents claim the treatment
cannot be isolated and studied alone,
but only in combination with other
treatment modalities?
Tactics Used to
Promote the Therapy
• Is the treatment promoted as
having no adverse effects?
• Is the treatment promoted mainly
with anecdotes?
• Do proponents of the treatment
use scientific but nonsensical
terminology to describe the
treatment?
• Is the treatment promoted for a
wide range of physiologically
diverse conditions?
(Voigt, 2011, p. 451)

4. SLEEP DISTURBANCES IN
CHILDREN WITH
ATTENTION-
DEFICIT/HYPERACTIVITY
DISORDER (ADHD)
• Sleep disturbances are common among
children and typically develop in one-third
of the general pediatric population.
• 50-80% of children with ADHD struggle with
sleep disturbances though, placing them at
much higher risk for related complications.
• Children with ADHD tend to exhibit more
bedtime resistance, difficulties with sleep
onset, frequent night awakenings, and
difficulty with morning awakenings.
• Sleep disruption in school-aged children is
known to result in daytime sleepiness and
reduced alertness, which then results in
impaired cognitive skills, academic
performance, and behavioral issues.
• Consequently, appropriate and prompt
treatment is vital.
(Goodday, Corkum, & Smith, 2014, p. 55)

5. CURRENT TREATMENT MODALITIES FOR
TREATING SLEEP DISTURBANCES
• Pharmacotherapy
• Prescription Medications
• Over-the-Counter Medications
• Behavioral Therapy
• Interventional employment of strategies such
as using rewards and consequences,
graduated extinction, and bedtime routines.
• Complimentary and Alternative
Medicine (CAM)
• Homeopathy
• Mind-body interventions
• Self-hypnosis, guided imagery, relaxation,
music therapy
(Goodday, Corkum, & Smith, 2014, p. 56)

6. ACCEPTANCE OF THERAPY
• Typically, the parental belief in treatment is what predicts treatment choice.
• Their belief or disbelief in treatment has an immense impact on treatment adherence, as
well.
• Many parents of children with ADHD have sought treatment using Complimentary
or Alternative Medicine (CAM) for two main reasons:
• They are unsatisfied with the results of conventional treatments.
• They desire relief from the side effects, or perceived dependence on, pharmacological
treatments.
• Other known factors taken into account by parents in treatment choice include
naturalness of treatment, invasiveness of treatment, cost of treatment, and
recommendation from a friend or family member.
(Goodday, Corkum, & Smith, 2014, p. 56-57)

7. WHAT IS HOMEOPATHY?
• Homeopathy is a 200-year old tradition that is based on three principles:
• “Similia similibus curenter”, or treating like with like
• Individualization of treatment
• Minimum dose
• Homeopathy uses highly diluted natural substances to induce a healing response.
• Sources generally used for these remedies are botanical, mineral, or animal.
• Homeopathy has been regulated by the FDA as a drug therapy since the 1938 Food,
Drug, and Cosmetic Act (FDCA).
(Culbert & Olness, 2010, p. 234-
236)

8. HOMEOPATHIC TREATMENT
MODALITIES FOR ADHD RELATED
SLEEP DISTURBANCES
• The following homeopathic remedies have all been at the forefront of discussion
involving homeopathic possibilities for the treatment of ADHD related sleep
disturbances in children:
• Melatonin
• Valerian
• Lemon Balm
• German Chamomile
• The next few slides will discuss the above-mentioned homeopathic remedies in
regards to their known forms, benefit claims, related research, and any known
safety concerns.
(Culbert & Olness, 2010, p. 416)

9. MELATONIN
• Naturally occurring sleep hormone with relatively
benign side effects that is most commonly used in an
orally ingested pill form, but is also available in
sublingual and buccal tablets (Weiss & Salpekar,
2010, p. 824).
• No reliable proof that exogenous melatonin suppresses
the long-term release of endogenous melatonin (Weiss
& Salpekar, 2010, p. 825).
• Helps reduce sleep onset latency, increase total time
of sleep, and shows improvement in waking mood
and behavior (Weiss & Salpekar, 2010, p. 824).
• Safe for children at 1-5 mg/dose for short term use,
but no studies to support safety of long-term use
(Culbert & Olness, 2010, p. 417).

10. VALERIAN
• Valerian is a perennial plant found in Europe, Asia,
and North America that is transformed into
tinctures, teas, extracts, capsules, or tablets (NIH
Office of Dietary Supplements, 2013).
• In a small placebo controlled sleep study, valerian
showed to decrease sleep latency, increase total
sleep time, and increase total quality of sleep
(Culbert & Olness, 2010, p. 416)
• Shown in multiple studies to have no negative
behavioral effects during waking hours (Culbert &
Olness, 2010, p. 416)
• Disadvantages include that it usually takes 7- 28
days for full effect to occur and it has a notoriously
unpleasant smell and taste (Culbert & Olness,
2010, p. 416).

11. LEMON BALM
• Lemon Balm is a plant found in Southern Europe that is
typically used topically, orally, or by inhalation via
aromatherapy.
• Lemon balm extracts have shown to have a sedative effect
in mice, but human trials have not yet been performed .
• Aromatherapy has been tested in adults with Alzheimer's
and has proven to provide a noticeable calming effect, but
no pediatric trials have been performed, thus far.
• Multiple studies have shown great success in treating
insomnia and anxiety with a combination of valerian and
lemon balm.
• When taking orally for the sedative and calming effects,
the standard dose is 1.5-4.5g of dried herb daily or
according to the label instructions if using extracts.
• Oral lemon balm is on the FDA’s GRAS list (Generally
Recognized As Safe).
(Rocky Mountain Pediatric Neurology & Sleep Medicine, 2015).

12. GERMAN CHAMOMILE
• German chamomile is a plant that is used either
topically or orally, in the form of tea , and is said to
decrease mild tension and stress (Rocky Mountain
Pediatric Neurology & Sleep Medicine, 2015).
• It has been suggested in the treatment of pediatric
sleep disorders, but there are no studies to support
its use in the treatment of sleep insomnia in
children (Culbert & Olness, 2010, p. 416)
• Chamomile is listed on the FDA’s GRAS list
(Generally Recommended As Safe) (Rocky
Mountain Pediatric Neurology & Sleep Clinic,
2015).
• Safety in young children has not been verified, but
there have been no credible reports of toxicity (Rocky
Mountain Pediatric Neurology & Sleep Clinic, 2015).

13. CONCLUSION
• In reviewing available research, it is clear that Melatonin and Valerian are the two most
commonly trusted, studied, and used homeopathic treatment modalities for children
with ADHD related sleep disturbances.
• Little to no research, involving children specifically, has been done to prove the benefits
and safety of Lemon Balm and German Chamomile.
• What has been found regarding Lemon Balm and German Chamomile peaks general interest
and warrants the availability of thorough evidence-based research regarding their efficacy and
safety.
• With an ever-evolving society, that is actively educating themselves on various treatment
modalities, the interest in Complimentary and Alternative Medicine is at an all time
high.
• It is important as practitioners to have at least a general understanding of what
nontraditional therapies are available to patients in order to avoid patients trusting in
unreliable resources.
• We must respect a patient’s or family’s choice to seek alternative measures for therapy.

14. REFERENCES
• Culbert, T. & Olness, K. (2010). Integrative pediatrics. New York, NY: Oxford University Press,
Inc.
• Goodday, A., Corkum, P., & Smith, I. M. (2014). Parental acceptance of treatments for insomnia in
children with attention-deficit/hyperactivity disorder, autistic spectrum disorder, and their
typically developing peers. Children's Health Care, 43(1), 54-71.
• NIH Office of Dietary Supplements. (2013). Valerian: Fact sheet for professionals. US
Department of Health and Human Services. Retrieved from
https://ods.od.nih.gov/factsheets/Valerian-HealthProfessional/.
• Rocky Mountain Pediatric Neurology & Sleep Medicine. (2015). Lemon balm. Retrieved from
http://rockymountainkidsneuro.com/hl/?/21798/Lemon-Balm.
• Weiss, M. D., & Salpekar, J. (2010). Sleep problems in the child with attention-deficit
hyperactivity disorder: Defining aetiology and appropriate treatments. CNS Drugs,
24(10), 811-828.
• Voigt, R.G. (2011). Developmental and behavioral pediatrics. Elk Grove Village, IL: American
Academy of Pediatrics.