Originated March, 1995; Last modofied 3/16/98.
Support Groups
Frequently Asked Questions
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Attention Deficit Disorders Association. (800) 487-2282
CHADD: Children & adults
with ADD. Local groups nationwide. (800) 233-4050 (Voice
Mail); (305) 587-3700 (Human)
CHADD is a parent-support group with many local chapters.
Write to me at lwasserman@alliancemedical.org. Questions of general interest will be addressed here.
I have heard that Cylert can cause insomnia. Is that true? What other side effects are possible with Cylert?
Some people notice some trouble going to sleep while using pemoline (Cylert), BUT, some others find that they are better able to organize themselves and calm down if they have a little stimulant on board. The doses used for ADD rarely cause excitation or insomnia, but it is reported as the most common side-effect of the drug. It's a very individual thing, and there's only one way to find out.
Common side-effects are loss of appetite and sometimes stomach ache, nausea, diarrhea, or headache. Rarely, it causes liver disease. Most doctors check blood tests at intervals during treatment to make sure there is no sign of liver disease.
If someone is prone to tics, any stimulant may make the tics more likely, but they have not been shown to cause tics per se. If your child has repetitive movements that are difficult to control while using stimulants, you should discuss this with your pediatrician. Examples of tics are sudden facial movements, twitching of hands or arms, grunting or throat-clearing, or other repetitive movements without purpose. The child may be able to control the movements for some time, but it takes effort.
What is the best method of assessing how allergies (and their medications) and behavior problems are interrelated?
Allergies and their treatment may be related to behavior problems in many ways, and they sometimes can be difficult to sort out. Specifically:
1. Allergic children are often bothered by their allergies. If you are sitting in class and your nose starts itching or you have a sneezing spell, you will be distracted from whatever you are doing. If this happens frequently, your teacher will wonder why you are not paying attention, and why you can't seem to finish your assignments. At home, you may be figety or "antsy," and you may have trouble finishing things such as chores, etc.. These are many of the symptoms we associate with attention deficit or "hyperactivity."
2. The medications used to treat allergies can cause a variety of behavioral symptoms. Different children react in very different ways to antihistamines, which are most often used to treat allergy symptoms. Some children become excitable, others depressed or drowsy. Some become irritable. Most have a shorter attention span, whether or not there are other symptoms. Oral decongestants can cause restlessness and irritability, as can asthma medicines. Most over-the-counter allergy and cold medicines have one or more of these in them.
3. Many allergic children have trouble with sleep, either because of their symptoms or their medications. Even if antihistamines make them drowsy, they disturb the normal sleep cycles, resulting in daytime drowsiness or irritability. ("antihistamine hangover") In some cases, allergic children may have enlarged adenoids or swolen membranes in the nose which causes obstruction to breathing at night. These children may have disturbed sleep, or may sleep longer than average. They are often irritable or drowsy during the day. We refer to this as "obstructive sleep apnea." Loud snoring is often a symptom of sleep apnea.
As far as assessment goes, this is obviously a complex problem, and assessment needs to be individual, based on the child's history, symptoms, and findings. A general approach in an individual patient who does not have signs of sleep apnea would be to try to eliminate the allergy symptoms by avoiding exposure and using medicines which do not cause behavior changes, and then assess the behavior compared to that before treatment. Also, if there are specific behavior patterns, they may need to be addressed separately.
Having said all that, a few caveats:
1. Most behavior problems we see have nothing to do with allergies.
2. You will notice that I have said nothing about food allergies. Although foods can trigger generalized allergy symptoms, the only "food" substance which has ever been shown to directly affect behavior is caffeine. Changing the diet (except in the case of a known food allergy) will NOT change the child's behavior. Sugar and sweets do NOT make kids hyperactive (though they DO cause tooth decay). In some children, there may be some irritability about 45-90 minutes after eating a load of sweets. This is actually a sign of low blood sugar. Additives and colorings have never been proven to affect kids' behavior.
3. If this is your child we are talking about, the best source of further information is your pediatrician or an allergist.
This page was created by Lewis Wasserman, M.D..
Lewis Wasserman / lwasserman@alliancemedical.org