A 6-year-old male with attention deficit hyperactivity disorder who responded poorly to methylphenidate (MPH) was benefited following treatment with the dopamine agonist ropinirole, in a report from the Hopital Robert Debre, Paris, France. Restless legs syndrome and sleep problems were comorbid disorders that were linked to iron deficiency (serum ferritin 10 mcg/L) and partially relieved by a 3-month course of ferrous sulfate. Symptoms of ADHD and oppositional behavior were also improved initially but later relapsed, despite a normal ferritin level (73 mcg/L) and an increased dose of MPH. Ropinirole (0.25 to 0.5 mg, 90 min before bedtime) resulted in improvements in sleeping habits, ADHD and ODD, control of restless leg movements, and a reduction in the dose of MPH. No adverse effects were observed. 
COMMENT. Having failed to diagnose restless legs syndrome in my patients with ADHD, despite polysomnograms in many, I was surprised to read the authors’ reference to an incidence of up to 40%. The potential benefit of a dopamine agonist in the treatment of ADHD unresponsive to MPH is of interest and warrants further study.