Introduction to Restless Legs Syndrome

Restless Legs Syndrome in Children

Children may exhibit restless legs syndrome symptoms differently than adults and may also describe it differently which leads to frequent missed diagnosis or misdiagnosis. It is often misdiagnosed as anxiety disorder, growing pains, or attention deficit and hyperactivity disorder (ADHD). Also, children often lack the descriptive language needed by the physician to understand the sensations they are feeling.

Diagnosing a child with restless legs syndrome is very difficult because many of them also exhibit signs of other disorders that occur more frequently in children with restless legs syndrome, and the overlap of these conditions can be confusing. These include:

• Learning problems
• Attention deficit hyperactivity disorder (ADHD) - there is a high degree of overlap between ADHD and restless legs syndrome. It is estimated that up to 90% of patients with idiopathic restless legs syndrome have a positive family history for ADHD. It is not clear if one causes the other but the common coexistence of both conditions is suggestive of a link.
• Behavioral problems
• Oppositional-defiance disorder (a pattern of negative, hostile, and defiant behavior)
• Problems falling and staying asleep
• Periodic limb movement disorder

Though restless legs syndrome and ADHD frequently appear together in children, the relationship is not well understood, for example, if restless legs syndrome actually causes ADHD or if there is another underlying basis for these comorbidities. This lack of understanding is a common source of misdiagnosis in children. Also, when a child complains of other problems, such as leg pains, they are often dismissed as "growing pains" and not evaluated further though the symptoms may be related to restless legs syndrome. Knowing of a family history of restless legs syndrome is very helpful in diagnosing childhood restless legs syndrome since it significantly increases the risk of a positive diagnosis.