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Lindholm A, Jarbin H, Aili K, Nygren JM, Svedberg P, Larsson I. Sex Differences in Children with Uncomplicated Attention Deficit/Hyperactivity Disorder and Sleep Problems. CHILDREN (BASEL, SWITZERLAND) 2024; 11:636. [PMID: 38929216 PMCID: PMC11201524 DOI: 10.3390/children11060636] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/08/2024] [Revised: 05/15/2024] [Accepted: 05/23/2024] [Indexed: 06/28/2024]
Abstract
BACKGROUND Approximately 7.6% of children are diagnosed with attention deficit/hyperactivity disorder (ADHD), and sleep impairments affect 25-85%. There is a noticeable lack of research on girls and sex differences. The aim of this study was to examine sex differences in children with uncomplicated ADHD and sleep problems. METHODS Cross-sectional baseline data were retrieved from a randomized controlled trial with weighted blankets (55 boys and 41 girls, 6-14 years) on a cohort recently diagnosed with uncomplicated ADHD and sleep problems. Differences between boys and girls in ADHD symptoms, objectively and subjectively measured sleep, anxiety, and functioning were examined via parent- or self-reported validated instruments. RESULTS Girls reported significantly lower (worse) satisfaction with well-being, life overall, and school, but not for family. Parents reported more sleep anxiety and night-time wakings among boys, but no sex differences in other measures and also not in self-reported measures or objective sleep measures. Children who reported worry, sadness, or unhappiness had more sleep problems. CONCLUSIONS Boys with ADHD and sleep problems may need support with sleep-related anxiety and night-time wakings, while girls may require support with overall functioning. Additionally, children who express feelings of worry, sadness, or unhappiness alongside their ADHD symptoms should have attention given to their sleep.
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Affiliation(s)
- Annelie Lindholm
- Department of Health and Care, School of Health and Welfare, Halmstad University, SE-30118 Halmstad, Sweden; (A.L.); (J.M.N.); (P.S.)
| | - Håkan Jarbin
- Child and Adolescent Psychiatry, Department of Clinical Sciences Lund, Lund University, SE-22184 Lund, Sweden;
- Child and Adolescent Psychiatry, Region Halland, SE-30185 Halmstad, Sweden
| | - Katarina Aili
- Department of Health and Sport, School of Health and Welfare, Halmstad University, SE-30118 Halmstad, Sweden;
| | - Jens M. Nygren
- Department of Health and Care, School of Health and Welfare, Halmstad University, SE-30118 Halmstad, Sweden; (A.L.); (J.M.N.); (P.S.)
| | - Petra Svedberg
- Department of Health and Care, School of Health and Welfare, Halmstad University, SE-30118 Halmstad, Sweden; (A.L.); (J.M.N.); (P.S.)
| | - Ingrid Larsson
- Department of Health and Care, School of Health and Welfare, Halmstad University, SE-30118 Halmstad, Sweden; (A.L.); (J.M.N.); (P.S.)
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Dimakos J, Gauthier-Gagné G, Lin L, Scholes S, Gruber R. The Associations Between Sleep and Externalizing and Internalizing Problems in Children and Adolescents with Attention-Deficit/Hyperactivity Disorder: Empirical Findings, Clinical Implications, and Future Research Directions. Psychiatr Clin North Am 2024; 47:179-197. [PMID: 38302206 DOI: 10.1016/j.psc.2023.06.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2024]
Abstract
Sleep problems are common in youth with attention-deficit/hyperactivity disorder (ADHD). Externalizing and internalizing problems contribute to dysfunction in youth with ADHD and are amplified by disrupted sleep. This objective of this article is to synthesize empirical studies that examined the associations between sleep and internalizing or externalizing problems in individuals with ADHD. The main findings are that sleep problems precede, predict, and significantly contribute to the manifestation of internalizing and externalizing behavior problems among children and adolescents with ADHD. Clinicians should assess sleep and integrate sleep interventions into the management of youth with ADHD.
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Affiliation(s)
- Jenny Dimakos
- Faculty of Medicine, McGill University, Montreal, Quebec, Canada
| | - Gabrielle Gauthier-Gagné
- Attention Behavior and Sleep Lab, Douglas Mental Health University Institute, Montréal, Quebec H4H 1R3, Canada
| | - Lanyi Lin
- Attention Behavior and Sleep Lab, Douglas Mental Health University Institute, Montréal, Quebec H4H 1R3, Canada
| | - Samantha Scholes
- Attention Behavior and Sleep Lab, Douglas Mental Health University Institute, Montréal, Quebec H4H 1R3, Canada; Department of Educational and Counselling Psychology, McGill University, Montréal, Quebec, Canada
| | - Reut Gruber
- Attention Behavior and Sleep Lab, Douglas Mental Health University Institute, Montréal, Quebec H4H 1R3, Canada; Department of Psychiatry, Faculty of Medicine, McGill University, Montréal, Quebec, Canada.
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3
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Pagán AF, Ricker BT, Cooley JL, Cummings C, Sanchez CR. ADHD Symptoms and Sleep Problems During Middle Childhood: The Indirect Effect of Peer Victimization. Child Psychiatry Hum Dev 2024:10.1007/s10578-024-01666-6. [PMID: 38376574 DOI: 10.1007/s10578-024-01666-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/07/2024] [Indexed: 02/21/2024]
Abstract
The present cross-sectional study evaluated whether traditional and/or cyber peer victimization served as mechanisms linking ADHD symptoms to sleep disturbance and sleep impairment in a sample of 284 third- through fifth-grade students (51.9% boys; 50.4% Hispanic/Latine) from two elementary schools in the United States. ADHD symptoms were assessed using teacher ratings. Children provided reports of their traditional and cyber victimization as well as their sleep disturbance and impairment. Results from path analysis models revealed significant indirect effects of traditional victimization on the links from ADHD symptoms to sleep disturbance and impairment. There was also a significant indirect effect of cyber victimization on the link from ADHD symptoms to sleep impairment. These findings suggest that experiences of traditional and cyber peer victimization may need to be addressed among children exhibiting ADHD symptoms in order to mitigate their risk for sleep problems and downstream effects on other domains of psychosocial functioning.
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Affiliation(s)
- Antonio F Pagán
- Department of Psychiatry and Behavioral Sciences, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Brianna T Ricker
- Department of Psychological Sciences, Texas Tech University, Lubbock, TX, USA
| | - John L Cooley
- Department of Psychological Sciences, Texas Tech University, Lubbock, TX, USA.
| | - Caroline Cummings
- Department of Psychological Sciences, Texas Tech University, Lubbock, TX, USA
| | - Carlos R Sanchez
- Department of Psychological Sciences, Texas Tech University, Lubbock, TX, USA
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Özbudak P, Özaslan A, Temel EÜ, Güney E, Serdaroğlu A, Arhan E. New Electrographic Marker? Evaluation of Sleep Spindles in Children with Attention Deficit Hyperactivity Disorder. Clin EEG Neurosci 2024; 55:4-10. [PMID: 36259661 DOI: 10.1177/15500594221134025] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Introduction: Attention deficit and hyperactivity disorder (ADHD) is one of the most common developmental disorders in childhood which lasts lifelong. Sleep structure and sleep spindle features are disorganized in ADHD. In this study, we aimed to look for a new, simple, inexpensive, and an easily detectable electrographic marker in the diagnosis of ADHD by using electroencephalography (EEG). Method: We included treatment free 35 patients with ADHD and 32 healthy children (HC) who were examined by polysomnography (PSG) and EEG for sleep disorders. The ADHD group were separated into three groups according to predominant presentations of ADHD. We determined the sleep staging and slow and fast sleep spindles, calculated each spindle's amplitude, frequency, activity, duration and density at non rapid eye movement (REM) sleep stage 2. Results: Slow sleep spindle's amplitude, duration, density and activity are significantly higher in ADHD group (most significant in ADHD-I) than the HC group (p < 0,05). Sleep spindle's features are not statistically significant between in ADHD subgroups. Conclusions: In children with ADHD, slow sleep spindles showed higher amplitude, activity, density and duration in the frontal regions. These results indicate that slow sleep spindles in children with ADHD may reflect executive dysfunction and slow frontal spindles may be useful as a new electrographic marker in children with ADHD. This is the first study of its kind evaluating all aspects of sleep spindles in ADHD patients.
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Affiliation(s)
- Pınar Özbudak
- Department of Child Neurology, Gazi University Faculty of Medicine, Ankara, Turkey
| | - Ahmet Özaslan
- Department of Child and Adolescent Psychiatry, Gazi University Faculty of Medicine, Ankara, Turkey
| | - Esra Ülgen Temel
- Department of Child Neurology, Gazi University Faculty of Medicine, Ankara, Turkey
| | - Esra Güney
- Department of Child and Adolescent Psychiatry, Gazi University Faculty of Medicine, Ankara, Turkey
| | - Ayşe Serdaroğlu
- Department of Child Neurology, Gazi University Faculty of Medicine, Ankara, Turkey
| | - Ebru Arhan
- Department of Child Neurology, Gazi University Faculty of Medicine, Ankara, Turkey
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González-Safont L, Rebagliato M, Arregi A, Carrasco P, Guxens M, Vegas O, Julvez J, Estarlich M. Sleep problems at ages 8-9 and ADHD symptoms at ages 10-11: evidence in three cohorts from INMA study. Eur J Pediatr 2023; 182:5211-5222. [PMID: 37721582 PMCID: PMC10640481 DOI: 10.1007/s00431-023-05145-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Revised: 07/18/2023] [Accepted: 07/30/2023] [Indexed: 09/19/2023]
Abstract
Sleep problems and attention deficit hyperactivity disorder (ADHD) are interrelated during childhood and preadolescence. The objective of this work is assessing if sleep problems at ages 8-9 represent an alarm sign for presenting ADHD problems at ages 10-11 in three cohorts from INMA Study. Participants were 1244 children from Gipuzkoa, Sabadell, and Valencia cohorts. Sleep problems were assessed (ages 8-9) with the sleep items of the Child's Behaviour Checklist (CBCL), and ADHD problems were collected through the Conner's Parent Rating Scales-Revised: Short Form (CPRS-R:S) (age 10-11). Minimally and fully adjusted negative binomial models were fitted for each CPRS-R:S scale. Linearity of the relationship was assessed with generalized additive models (cubic smoothing splines with 2, 3, and 4 knots). For sensitivity analyses, children with previous symptoms, those born preterm and small for gestational age, and cases with extreme values, were excluded. Sleep problems presented IRR (95% CI) of 1.14 (1.10-1.19), 1.20 (1.14-1.26), 1.18 (1.11-1.25), and 1.18 (1.13-1.23) for opposition, inattention, hyperactivity, and ADHD scales, respectively. Fully adjusted models slightly decreased the IRR, but the association remained similar and significant. Sensitivity analyses showed similar results to fully adjusted models with only hyperactivity shown a slight decrease on significance (p = 0.051) when ADHD cases at age 9 were excluded. Conclusion: Sleep problems are an alarm sign for later neurodevelopment problems such as ADHD. Healthcare systems could take advantage implementing policies to pay special attention on the sleep habits and sleep hygiene. This could contribute to add evidence to public health programmes such as the Healthy Child Programme.
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Affiliation(s)
- Llúcia González-Safont
- Nursing and Chiropody Faculty of Valencia University, Nineteenth of Menéndez Pelayo St., 46010, Valencia, Spain
- CIBER de Epidemiología y Salud Pública (CIBERESP), Fifth of Monforte Lemos St., 28029, Madrid, Spain
- JRU in Epidemiology, Environment and Health FISABIO-UJI-UV, Valencia, Spain
| | - Marisa Rebagliato
- CIBER de Epidemiología y Salud Pública (CIBERESP), Fifth of Monforte Lemos St., 28029, Madrid, Spain
- JRU in Epidemiology, Environment and Health FISABIO-UJI-UV, Valencia, Spain
- Predepartamental Unit of Medicine of Universitat Jaume I, Faculty of Health Sciences of Jaume I University, Sos Baynat Av, 12071, Castelló, Spain
| | - Ane Arregi
- University of the Basque Country, UPV/EHU, 48940, Leioa, Spain
- Biodonostia Health Research Institute, Dr. Beguiristain Av, 20014, San Sebastian, Spain
| | - Paula Carrasco
- JRU in Epidemiology, Environment and Health FISABIO-UJI-UV, Valencia, Spain.
- Predepartamental Unit of Medicine of Universitat Jaume I, Faculty of Health Sciences of Jaume I University, Sos Baynat Av, 12071, Castelló, Spain.
| | - Mònica Guxens
- CIBER de Epidemiología y Salud Pública (CIBERESP), Fifth of Monforte Lemos St., 28029, Madrid, Spain
- ISGlobal, Barcelona, Biomedical Research Park (PRBB), Eighty-Eighth Doctor Aiguader Av, 08003, Barcelona, Spain
- Universitat Pompeu Fabra, Barcelona, Spain
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus MC, University Medical Centre, Rotterdam, The Netherlands
| | - Oscar Vegas
- University of the Basque Country, UPV/EHU, 48940, Leioa, Spain
- Biodonostia Health Research Institute, Dr. Beguiristain Av, 20014, San Sebastian, Spain
| | - Jordi Julvez
- CIBER de Epidemiología y Salud Pública (CIBERESP), Fifth of Monforte Lemos St., 28029, Madrid, Spain
- ISGlobal, Barcelona, Biomedical Research Park (PRBB), Eighty-Eighth Doctor Aiguader Av, 08003, Barcelona, Spain
| | - Marisa Estarlich
- Nursing and Chiropody Faculty of Valencia University, Nineteenth of Menéndez Pelayo St., 46010, Valencia, Spain
- CIBER de Epidemiología y Salud Pública (CIBERESP), Fifth of Monforte Lemos St., 28029, Madrid, Spain
- JRU in Epidemiology, Environment and Health FISABIO-UJI-UV, Valencia, Spain
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Bolic Baric V, Skuthälla S, Pettersson M, Gustafsson PA, Kjellberg A. The effectiveness of weighted blankets on sleep and everyday activities - A retrospective follow-up study of children and adults with attention deficit hyperactivity disorder and/or autism spectrum disorder. Scand J Occup Ther 2023; 30:1357-1367. [PMID: 34184958 DOI: 10.1080/11038128.2021.1939414] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Accepted: 06/02/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Attention deficit hyperactivity disorder (ADHD) and Autism Spectrum Disorder (ASD) are often accompanied by sleep problems influencing social, emotional and cognitive functioning in everyday activities. AIM The aim of this study was to investigate whether the use of a weighted blanket has a positive impact on sleep and everyday activities in individuals with ADHD and/or ASD. MATERIAL AND METHODS The study included 85 individuals diagnosed with ADHD and/or ASD, 48 children aged ≤17 (57%) and 37 adults ≥18 years (44%), who were prescribed with a weighted blanket. The participants responded via a telephone interview. RESULTS Findings demonstrated that a weighted blanket improved abilities related to falling asleep, sleeping the whole night, and relaxing during the day. Using a weighted blanket improved morning/evening daily routine, including preparing/going to sleep and waking up in the morning. CONCLUSIONS Weighted blankets showed positive impact on falling asleep, sleeping the whole night, and relaxing during the day, and they were used frequently by children and adults with ADHD and/or ASD. Findings indicate that a weighted blanket improved morning/evening routine, however this research area needs further investigation using both subjective and objective parameters.
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Affiliation(s)
- Vedrana Bolic Baric
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | | | | | - Per A Gustafsson
- Child and Adolescent Psychiatry, Center for Social and Affective Neuroscience, Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Anette Kjellberg
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
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Richter Y, Gordon C, Vainstein G, Bublil-Mor C, Geisinger D, Meital-Kfir N, Elyoseph Z. A novel intervention for treating adults with ADHD using peripheral visual stimulation. Front Psychiatry 2023; 14:1280440. [PMID: 37928920 PMCID: PMC10623343 DOI: 10.3389/fpsyt.2023.1280440] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2023] [Accepted: 10/03/2023] [Indexed: 11/07/2023] Open
Abstract
Objective Stimulation of the peripheral visual field has been previously reported as beneficial for cognitive performance in ADHD. This study assesses the safety and efficacy of a novel intervention involving peripheral visual stimuli in managing attention deficit hyperactivity disorder (ADHD). Methods One hundred and eight adults, 18-40 years old, with ADHD, were enrolled in a two-month open-label study. The intervention (i.e., Neuro-glasses) consisted of standard eyeglasses with personalized peripheral visual stimuli embedded on the lenses. Participants were assessed at baseline and at the end of the study with self-report measures of ADHD symptoms (the Adult ADHD Self-Report Scale; ASRS), and executive functions (The Behavior Rating Inventory of Executive Function Adult Version; BRIEF-A). A computerized test of continuous performance (The Conners' Continuous Performance Test-3; CPT-3) was tested at baseline with standard eyeglasses and at the end of study using Neuro-glasses. The Clinical Global Impression-Improvement scale (CGI-I) was assessed at the intervention endpoint. Safety was monitored by documentation of adverse events. Results The efficacy analysis included 97 participants. Significant improvements were demonstrated in self-reported measures of inattentive symptoms (ASRS inattentive index; p = 0.037) and metacognitive functions concerning self-management and performance monitoring (BRIEF-A; p = 0.029). A continuous-performance test (CPT-3) indicated significant improvement in detectability (d'; p = 0.027) and reduced commission errors (p = 0.004), suggesting that the Neuro-glasses have positive effects on response inhibition. Sixty-two percent of the participants met the response criteria assessed by a clinician (CGI-I). No major adverse events were reported. Conclusion Neuro-glasses may offer a safe and effective approach to managing adult ADHD. Results encourage future controlled efficacy studies to confirm current findings in adults and possibly children with ADHD.Clinical trial registration: https://www.clinicaltrials.gov/, Identifier NCT05777785.
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Affiliation(s)
| | | | - Gabriel Vainstein
- Kahan-Sagol-Maccabi Research and Innovation Institute, Tel Aviv, Israel
| | | | | | | | - Zohar Elyoseph
- The Department of Educational Psychology and Educational Counseling, Max Stern Yezreel Valley College, Emek Yezreel, Israel
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Denis I, Turcotte S, Morin CM, Belleville G, Foldes-Busque G. A preliminary validation of the pediatric adaptation of the Insomnia Severity Index. L'ENCEPHALE 2023; 49:474-480. [PMID: 36244838 DOI: 10.1016/j.encep.2022.05.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Revised: 05/03/2022] [Accepted: 05/12/2022] [Indexed: 06/16/2023]
Abstract
INTRODUCTION The prevalence of insomnia in children aged 5 to 12 years old is 20% to 31%. Currently, there is no well-validated questionnaire assessing all the components of insomnia in school-aged children. The present study aims to introduce an adaptation of the Insomnia Severity Index for this purpose. METHOD Fifty-nine children aged 8- to 12-years-old with at least one anxiety disorder were recruited from youth mental health care settings. Their parents completed the pediatric adaptation of the Insomnia Severity Index which includes two scales used to report insomnia symptoms in children and their impact on the child (ISI-Child) and parents (ISI-Parent), My Child's Sleep Habits questionnaire, and the Child Behavior Checklist. RESULTS Both the ISI-Child and the ISI-Parent scales presented adequate factorial structure (RMSEA ≤ 0.05) and internal consistency (ISI-Child: α=0.87; ISI-Parent: α=0.88). Furthermore, the results of the two scales were strongly correlated (r=0.91, P<0.001). The convergent validity was assessed using the Waking During the Night scale of the My Child's Sleep Habits questionnaire and was adequate for the ISI-Child (r=0.52, P<0.001) and the ISI-Parent (r=0.53, P<0.001). Finally, the Rule-Breaking Behavior (r ≤ 0.26, P ≥ 0.05) and Aggressive Behavior (r ≤ 0.19, P ≥ 0.19) scales of the Child Behavior Checklist showed small correlations with both subscales, indicating good divergent validity. CONCLUSION The pediatric adaptation of the Insomnia Severity Index is a potentially reliable and valid measure for screening and assessing insomnia in children.
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Affiliation(s)
- I Denis
- School of Psychology, Université Laval, G1V 0A6 Québec City, Canada; Research Centre, Centre intégré de santé et de services sociaux de Chaudière-Appalaches, G6V 3Z1 Lévis, Canada; Centre de recherche universitaire sur les jeunes familles, G1C 3S2 Québec City, Canada.
| | - S Turcotte
- Research Centre, Centre intégré de santé et de services sociaux de Chaudière-Appalaches, G6V 3Z1 Lévis, Canada
| | - C M Morin
- Research Centre, Centre intégré de santé et de services sociaux de Chaudière-Appalaches, G6V 3Z1 Lévis, Canada; Centre d'étude des troubles du sommeil, centre de recherche, institut universitaire en santé mentale, G1J 2G3 Québec City, Canada
| | - G Belleville
- Research Centre, Centre intégré de santé et de services sociaux de Chaudière-Appalaches, G6V 3Z1 Lévis, Canada
| | - G Foldes-Busque
- School of Psychology, Université Laval, G1V 0A6 Québec City, Canada; Research Centre, Centre intégré de santé et de services sociaux de Chaudière-Appalaches, G6V 3Z1 Lévis, Canada; Research Centre, Quebec Heart and Lung Institute, G1V 4G5 Québec City, Canada
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Gruber R, Gauthier-Gagné G, Little C, Fu Z. The Associations between the Homeostatic and Circadian Sleep Processes and the Neurobehavioral Functioning (NBF) of Individuals with ADHD-A Systematic Review. Brain Sci 2023; 13:1134. [PMID: 37626491 PMCID: PMC10452539 DOI: 10.3390/brainsci13081134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Revised: 07/21/2023] [Accepted: 07/22/2023] [Indexed: 08/27/2023] Open
Abstract
The objective of the present review was to systematically examine associations between perturbations of the homeostatic or circadian sleep processes and the neurobehavioral functioning (NBF) of individuals with ADHD. Electronic databases were searched for articles published between December 2013 and March 2023. Studies were included if they used objective measures of NBF, used objective or subjective measures of sleep, and focused on individuals with ADHD. Ten studies met these inclusion criteria. Of these, eight studies found perturbations in the interplay between NBF and Process S or Process C, and three studies did not. The quality of the studies was degraded because they failed to address key factors that affect the sleep processes and by the presence of methodological weaknesses. Our review suggests that homeostatic and circadian sleep processes are associated with NBF in individuals with ADHD. However, to confirm the validity of this conclusion, future studies should examine or control for confounders and utilize experimental designs that allow causality to be inferred.
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Affiliation(s)
- Reut Gruber
- Attention, Behaviour and Sleep Laboratory, Douglas Mental Health University Institute, Montréal, QC H4H 1R3, Canada
- Department of Psychiatry, McGill University, Montréal, QC H3A 0GA, Canada
| | - Gabrielle Gauthier-Gagné
- Attention, Behaviour and Sleep Laboratory, Douglas Mental Health University Institute, Montréal, QC H4H 1R3, Canada
- Integrated Program in Neuroscience, Faculty of Medicine, McGill University, Montréal, QC H3A 0G4, Canada
| | - Charlotte Little
- Attention, Behaviour and Sleep Laboratory, Douglas Mental Health University Institute, Montréal, QC H4H 1R3, Canada
| | - Ziqi Fu
- Attention, Behaviour and Sleep Laboratory, Douglas Mental Health University Institute, Montréal, QC H4H 1R3, Canada
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Stott J, Coleman E, Hamilton A, Blackwell J, Ball HL. Exploring the Longitudinal Relationship Between Short Sleep Duration, Temperament and Attention Deficit Hyperactivity Disorder Symptoms in a Biethnic Population of Children Aged Between 6 and 61 Months: A Born in Bradford Study. J Atten Disord 2023:10870547231168433. [PMID: 37154203 DOI: 10.1177/10870547231168433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
OBJECTIVE Examine the association between sleep duration, temperament and symptoms of Attention Deficit Hyperactivity Disorder (ADHD) in a biethnic child-population from The Born in Bradford cohort. METHOD Parent-report sleep duration categorized children as: early short, late short, consistently short or consistently normal sleepers between 6 and 36 months. Temperament was measured using the Infant Characteristics Questionnaire at 6 months. The Strengths and Difficulties Questionnaire assessed symptoms of ADHD at 37, 54, and 61 months. RESULTS Normal sleepers before 18 months had significantly fewer ADHD symptoms at 37 months compared with consistently short sleepers. Fussiness at 6 months was significantly positively associated with ADHD symptoms at 37 and 54 months; but does not appear to mediate the relationship between sleep duration and ADHD symptoms. CONCLUSION Awareness of the relationship between short sleep duration and fussiness in infancy and later ADHD symptomatology may support earlier identification of arising difficulties in children.
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Affiliation(s)
- Jonathan Stott
- Leeds and York Partnership NHS Foundation Trust, UK
- Tees, Esk and Wear Valleys NHS Foundation Trust, UK
- Hull York Medical School, UK
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11
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Ricketts EJ, Wolicki SB, Holbrook JR, Rozenman M, McGuire JF, Charania SN, Piacentini J, Mink JW, Walkup JT, Woods DW, Claussen AH. Clinical Characteristics of Children With Tourette Syndrome With and Without Sleep Disorder. Pediatr Neurol 2023; 141:18-24. [PMID: 36736236 PMCID: PMC10590926 DOI: 10.1016/j.pediatrneurol.2022.12.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Revised: 11/22/2022] [Accepted: 12/22/2022] [Indexed: 12/25/2022]
Abstract
BACKGROUND Sleep problems are common in children with Tourette Syndrome (TS). However, research regarding their demographic and clinical profile is limited. METHODS We examined characteristics of 114 children aged five to 17 years with a lifetime diagnosis of TS and compared children with sleep disorder (n = 32) and without sleep disorder (n = 82). Parent report from the 2014 National Survey of the Diagnosis and Treatment of ADHD and Tourette Syndrome provided demographics and clinical information, other diagnosed disorders, medication use, TS severity, and impairment. RESULTS More children with TS with sleep disorder were from households with lower parental education (P < 0.01) and poverty (P = 0.04); had other diagnoses (P = 0.03), including obsessive-compulsive disorder (P < 0.01), oppositional defiant disorder or conduct disorder (P < 0.01), attention-deficit/hyperactivity disorder (ADHD) (P = 0.02), and autism (P = 0.03); and had ever used TS medication (P = 0.01) than children with TS without sleep disorder. More children with TS with sleep disorder had severe TS symptoms (P <0.01), tic-related impairment (P<0.01), and severe ADHD symptoms (P < 0.01) compared with children with TS without sleep disorder. CONCLUSIONS Findings suggest greater parent-reported impact and tic-related interference in children with TS with sleep disorder compared with TS without sleep disorder. Results underscore the importance of monitoring and intervention for TS exacerbations, other diagnosed disorders, and medication use, and consideration of socioeconomic context in sleep disorder management and prevention in children with TS.
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Affiliation(s)
- Emily J Ricketts
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, California.
| | - Sara Beth Wolicki
- Division of Human Development and Disability, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Joseph R Holbrook
- Division of Human Development and Disability, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | - Joseph F McGuire
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Sana N Charania
- Division of Human Development and Disability, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - John Piacentini
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, California
| | - Jonathan W Mink
- Department of Neurology, University of Rochester Medical Center, Rochester, New York
| | - John T Walkup
- Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois; Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Douglas W Woods
- Department of Psychology, Marquette University, Milwaukee, Wisconsin
| | - Angelika H Claussen
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland
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12
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Gomes R, Sousa B, Gonzaga D, Prior C, Rios M, Vaz Matos I. Association between attention-deficit/hyperactivity symptoms and sleep in preschoolers. An Pediatr (Barc) 2023; 98:283-290. [PMID: 36932019 DOI: 10.1016/j.anpede.2023.01.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Revised: 06/22/2022] [Accepted: 07/02/2022] [Indexed: 03/17/2023] Open
Abstract
INTRODUCTION Sleep problems are frequent in children with attention-deficit/hyperactivity disorder (ADHD). Some authors have tried to characterize paediatric sleep habits in Portugal, but none has focused on preschool-age children nor attempted to establish their association with ADHD. We aimed to assess the prevalence of ADHD symptoms in preschool-age children and to study their association with sleep habits. MATERIAL AND METHODS We conducted a cross-sectional study. We distributed questionnaires to a random sample of caregivers of children enrolled in early childhood education centres in Porto. We collected data on sociodemographic characteristics, television watching and outdoor activities. We assessed ADHD symptoms and sleep habits with the Portuguese versions of the Conners' Parents Rating Scale, Revised and the Children's Sleep Habits Questionnaire (CSHQ-PT), respectively. RESULTS The study included 381 preschoolers (50.90% male). We found high scores for ADHD symptoms in 13.10%, with a higher prevalence in girls (14.40% vs. 11.85%; P = 0.276). In the CSHQ-PT, 45.70% of participants had a mean total score greater than 48, which is the cut-off point applied in the screening of sleep disturbances in the Portuguese population. There was a significant association between high scores for ADHD symptoms and a lower maternal education level (P < 0.001), a shorter sleep duration (P = 0.049), and higher scores on parasomnias (P = 0.019) and sleep disordered breathing (P = 0.002) in CSHQ-PT subscales. CONCLUSIONS ADHD and sleep disorders are common in preschoolers, in Porto, and this study suggests some clinical correlations between them. Since these interactions are complex and far from being elucidated, further studies are paramount to provide guidance for prevention and managing strategies in younger children at risk for ADHD.
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Affiliation(s)
- Rita Gomes
- Servicio de Pediatría, Centro Materno-Infantil do Norte Albino Aroso, Centro Hospitalar Universitário do Porto (CHUPorto), Porto, Portugal.
| | - Bebiana Sousa
- Servicio de Pediatría, Centro Materno-Infantil do Norte Albino Aroso, Centro Hospitalar Universitário do Porto (CHUPorto), Porto, Portugal
| | - Diana Gonzaga
- Unidad de Neurodesarrollo, Servicio de Pediatría, Centro Materno-Infantil do Norte Albino Aroso, Centro Hospitalar Universitário do Porto (CHUPorto), Porto, Portugal
| | - Catarina Prior
- Unidad de Neurodesarrollo, Servicio de Pediatría, Centro Materno-Infantil do Norte Albino Aroso, Centro Hospitalar Universitário do Porto (CHUPorto), Porto, Portugal
| | - Marta Rios
- Unidad de Neumonología, Servicio de Pediatría, Centro Materno-Infantil do Norte Albino Aroso, Centro Hospitalar Universitário do Porto (CHUPorto), Porto, Portugal
| | - Inês Vaz Matos
- Unidad de Neurodesarrollo, Servicio de Pediatría, Centro Materno-Infantil do Norte Albino Aroso, Centro Hospitalar Universitário do Porto (CHUPorto), Porto, Portugal
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13
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Sleep interventions for children with attention deficit hyperactivity disorder (ADHD): A systematic literature review. Sleep Med 2023; 102:64-75. [PMID: 36603513 DOI: 10.1016/j.sleep.2022.12.021] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Revised: 12/21/2022] [Accepted: 12/24/2022] [Indexed: 12/27/2022]
Abstract
OBJECTIVE/BACKGROUND Healthy sleep is particularly important for children with attention deficit hyperactivity disorder (ADHD), as sleep disturbances might aggravate disease symptoms. This review aims to synthesize and report evidence on the effectiveness of sleep interventions in increasing sleep, quality of life (QoL), and ADHD symptoms among children with ADHD. PATIENTS/METHODS The systematic literature review follows the Cochrane Collaboration methodology recommendations for literature reviews. Four databases were used based on the population, intervention, control and outcome (PICO) framework. Controlled trials with minimum 20 children in each group, aged 6-18, and published from 2005 and onwards were included. Results from the studies were reported in forest plots and three of the seven review outcomes were synthesized in meta-analyses. RESULTS The search identified 7710 records; of which 4808 abstracts were screened. After fulltext-screening of 99 papers, eight papers from five studies were included. The studies included behavioral sleep interventions and pharmacological interventions using melatonin and eszopiclone. For six of the seven outcomes, the effect sizes were small to moderate and the certainty of the evidence was low. For one outcome, sleep disturbances, the effect size was a moderate -0.49 standardized mean differences (95% confidence interval -0.65;-0.33), with a moderate certainty of evidence for the behavioral interventions for children aged 5-13 years with ADHD. CONCLUSIONS This review identified few and heterogeneous studies. A moderate certainty of evidence for a moderate effect size was only obtained for sleep disturbances from the behavioral interventions. A low certainty of the evidence for a moderate effect size was found for the total sleep time from the pharmacological intervention using melatonin and one behavioral intervention, which indicates that these sleep interventions impact sleep quantity and quality among children with ADHD.
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14
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Links between excessive daytime sleepiness and EEG power and activation in two subtypes of ADHD. Biol Psychol 2023; 177:108504. [PMID: 36681294 DOI: 10.1016/j.biopsycho.2023.108504] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Revised: 12/20/2022] [Accepted: 01/14/2023] [Indexed: 01/20/2023]
Abstract
OBJECTIVES This study aimed to replicate previously reported EEG characteristics between typically developing (TD) children and two subtypes of Attention Deficit Hyperactivity Disorder (ADHD) using a frontal, single-channel, dry-sensor portable EEG device, and explore whether differences are moderated by excessive daytime sleepiness (EDS). METHODS Children with ADHD Inattentive (ADHD-I) and ADHD Combined presentation (ADHD-C) and typically-developing (TD) children (N = 34 in each group) had frontal EEG recorded during eyes-closed resting, eyes-open resting, and focus tasks. Participants also completed the Children's Self-Report Sleep Patterns - Sleepiness Scale as a measure of EDS. RESULTS Consistent with previous literature, there were increases in frontal delta and theta power in the ADHD-C compared to ADHD-I and TD groups, in all conditions. Novel power and activation effects in ADHD subtypes, as well as significant group and EDS interactions for alpha and beta power were also found. CONCLUSIONS These findings highlight the importance of considering ADHD subtypes and EDS when exploring EEG characteristics, and have important implications for the diagnosis and treatment of children with ADHD.
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15
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Suzuki T, Wada K, Nakazato M, Ohtani T, Yamazaki M, Ikeda S. Associations Between Adult Attention-Deficit/Hyperactivity Disorder (ADHD) Traits and Sociodemographic Characteristics in Japanese Workers. Neuropsychiatr Dis Treat 2023; 19:759-773. [PMID: 37041858 PMCID: PMC10083016 DOI: 10.2147/ndt.s398478] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Accepted: 02/23/2023] [Indexed: 04/13/2023] Open
Abstract
Purpose Most previous studies that described associations between adult attention-deficit/hyperactivity disorder (ADHD) and sociodemographic characteristics were focused on individuals diagnosed with ADHD, and few studies investigated ADHD traits in the general population. Additionally, some workers, who experienced no problems while at university and successfully graduated from university, developed ADHD traits after finding employment. This study described associations between ADHD traits and sociodemographic characteristics among Japanese workers who were university graduates. Patients and Methods Participants were randomly selected workers (n=1240) from across Japan who completed a self-administered online survey. ADHD traits were measured using an adult ADHD Self-report Scale, with scoring rules applied to reflect the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition criteria. Information was collected on sociodemographic characteristics including sex, age, socioeconomic status, working time, and health-related behaviors. We performed partial correlation analysis to estimate trend associations and used analysis of covariance to compare adjusted averages. This model was adjusted for all variables. Results Males had higher levels of ADHD traits than females (p = 0.001), and younger age was associated with higher levels of ADHD traits (p < 0.001). Workers with low incomes had higher levels of ADHD traits than workers with high incomes (p = 0.009). More frequent consumption of midnight meals was associated with higher levels of ADHD traits (p < 0.001), although there were no differences for breakfast, lunch, and dinner. Those who did not get enough rest from sleep had higher levels of ADHD traits (p = 0.007). Conclusion Results for high levels of ADHD traits among workers were consistent with previous studies for adults diagnosed with ADHD, even though all participants had successfully graduated from university. Assessment of these ADHD traits may support prevention of health deterioration related to these ADHD traits.
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Affiliation(s)
- Tomoko Suzuki
- Department of Public Health, School of Medicine, International University of Health and Welfare, Narita, Japan
- Correspondence: Tomoko Suzuki, Department of Public Health, School of Medicine, International University of Health and Welfare, 4-3 Kozunomori, Narita, Chiba, 286-8686, Japan, Tel +81-476-20-7701, Fax +81-476- 28-1188, Email ;
| | - Koji Wada
- Department of Public Health, School of Medicine, International University of Health and Welfare, Narita, Japan
- Department of Social Medical Sciences, Graduate School of Medicine, International University of Health and Welfare, Tokyo, Japan
| | - Michiko Nakazato
- Department of Psychiatry, School of Medicine, International University of Health and Welfare, Narita, Japan
| | | | - Michiko Yamazaki
- Department of Social Medical Sciences, Graduate School of Medicine, International University of Health and Welfare, Tokyo, Japan
| | - Shunya Ikeda
- Department of Public Health, School of Medicine, International University of Health and Welfare, Narita, Japan
- Department of Social Medical Sciences, Graduate School of Medicine, International University of Health and Welfare, Tokyo, Japan
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16
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Gomes R, Sousa B, Gonzaga D, Prior C, Rios M, Matos IV. Relación entre los síntomas de déficit de atención/hiperactividad y el sueño en preescolares. An Pediatr (Barc) 2022. [DOI: 10.1016/j.anpedi.2022.07.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
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17
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A Cross-Sectional Comparative Study of Sleep Disturbances in Children with ADHD and Matched Controls. Brain Sci 2022; 12:brainsci12091158. [PMID: 36138894 PMCID: PMC9496794 DOI: 10.3390/brainsci12091158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Revised: 08/21/2022] [Accepted: 08/24/2022] [Indexed: 11/16/2022] Open
Abstract
Background: Systematic reviews conducted on sleep disturbances in attention deficit hyperactivity disorder (ADHD) have found inconsistent results due to the presence of several moderating variables which were not controlled for in previous studies. The aim of this study was to examine sleep disturbances in children with ADHD compared to their typically developing peers after controlling for moderating variables (age, sex, medication status, body mass index, and psychiatric and medical comorbidities). Methods: ADHD was diagnosed using DSM-IV-TR criteria (Diagnostic and Statistical Manual of Mental Disorders) and Conners’ Parent Rating Scales. Children recruited (aged 6−12 years) for the ADHD group (n = 40) met the following criteria: IQ > 80, unmedicated, and no psychiatric or medical comorbidities. The control group consisted of age- and sex-matched typically developing peers (n = 40). Sleep was assessed subjectively (through parent reported questionnaires and sleep logs) and objectively (using video polysomnography). Results: 65% of children with ADHD had a sleep disorder, as compared to 17% of controls. The ADHD group reported more sleep disturbances and disorders, both on subjective measures and objective measures. Conclusions: Sleep disturbances and primary sleep disorders in children with ADHD exist independent of moderating variables and differences in sleep assessment methods, thereby bolstering support for previously documented literature on the ADHD and sleep connection.
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18
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Hammerness P, Berger A, Angelini MC, Wilens TE. Cardiovascular Considerations for Stimulant Class Medications. Child Adolesc Psychiatr Clin N Am 2022; 31:437-448. [PMID: 35697394 DOI: 10.1016/j.chc.2022.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
The cardiovascular (CV) impact of stimulants has been examined for decades, with investigations ranging from small sample targeted studies of heart rate (HR) and blood pressure (BP), to large scale epidemiologic investigations. The preponderance of evidence is reassuring, albeit generally based on healthy samples using variable methodology, excluding those at theoretic high risk (eg, comorbid cardiac illness). Screening for theoretically vulnerable patients are recommended, as well as monitoring for CV symptoms and BP/HR, with shared inquiry/further evaluation if concerned. Future investigations to support the identification of risk are needed, while attention to stimulant-associated CV risk is an opportunity for clinicians to engage in general CV risk identification and intervention.
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Affiliation(s)
- Paul Hammerness
- Psychiatry Services, Southcoast Health, 101 Page Street, New Bedford, MA, USA.
| | - Amy Berger
- Child and Adolescent Psychiatry, Massachusetts General Hospital, 55 Fruit Street, Boston, MA, USA
| | - Michael C Angelini
- Massachusetts College of Pharmacy and Health Sciences University, Boston, MA, USA
| | - Timothy E Wilens
- Child and Adolescent Psychiatry, Massachusetts General Hospital, 55 Fruit Street, Boston, MA, USA
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19
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Valsecchi P, Nibbio G, Rosa J, Vita A. Adult ADHD and sleep disorders: Prevalence, severity and predictors of sleep disorders in a sample of Italian psychiatric outpatients. Psychiatry Res 2022; 310:114447. [PMID: 35192987 DOI: 10.1016/j.psychres.2022.114447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Revised: 02/03/2022] [Accepted: 02/12/2022] [Indexed: 10/19/2022]
Abstract
OBJECTIVE Sleep disorders are frequent in adult subjects diagnosed with ADHD. The aims of the present study were to assess the prevalence and the severity of sleep disorders in a sample of Italian psychiatric outpatients, to compare the prevalence and severity of sleep disorders in patients with and without diagnosis of adult ADHD, and to evaluate the role of ADHD as an individual predictor of sleep disturbances severity. METHOD 634 outpatients accessing psychiatric services were assessed with the Mini-International Neuropsychiatric Interview (MINI) Plus V. 5.0.0 interview and the Adult ADHD self-report Scale Symptoms Checklist (ASRS)-V 1.1 Short Form. Patients positive to the ASRS-V 1.1 were assessed with the Diagnostic Interview for ADHD in Adults (DIVA) 2.0. Sleep disorders and sleep disturbances' severity were assessed with the PROMIS Adult Sleep Disturbance Scale. RESULTS Sleep disorders were more frequent (p < 0.001) and sleep disturbances were more severe (d = 1.26, p < 0.001) in subjects diagnosed with adult ADHD compared to other outpatients. Among the 44 subjects diagnosed with ADHD, 15 (34.1%) reported no or slight sleep disturbances, 9 (20.5%) a mild sleep disorder, 17 (38.6%) a moderate sleep disorder and 3 (6.8%) a severe sleep disorder. ADHD diagnosis, multiple psychiatric comorbidity and history of suicide attempts emerged as individual predictors of worse sleep disturbances. CONCLUSION Sleep disorders are more frequent and severe in subjects diagnosed with ADHD compared to other adult outpatients. Sleep disturbances might represent an intrinsic feature in adult ADHD subjects, presenting important clinical repercussions, and should be routinely evaluated and monitored in this population.
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Affiliation(s)
- Paolo Valsecchi
- Department of Clinical and Experimental Sciences, University of Brescia, Piazzale Spedali Civili 1, Brescia 25123, Italy; Department of Mental Health and Addiction Services, Spedali Civili Hospital, Brescia, Italy.
| | - Gabriele Nibbio
- Department of Clinical and Experimental Sciences, University of Brescia, Piazzale Spedali Civili 1, Brescia 25123, Italy; Department of Mental Health and Addiction Services, Spedali Civili Hospital, Brescia, Italy
| | - Jennifer Rosa
- Department of Clinical and Experimental Sciences, University of Brescia, Piazzale Spedali Civili 1, Brescia 25123, Italy; Department of Mental Health and Addiction Services, Spedali Civili Hospital, Brescia, Italy
| | - Antonio Vita
- Department of Clinical and Experimental Sciences, University of Brescia, Piazzale Spedali Civili 1, Brescia 25123, Italy; Department of Mental Health and Addiction Services, Spedali Civili Hospital, Brescia, Italy
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20
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Lewis KJS, Martin J, Gregory AM, Anney R, Thapar A, Langley K. Sleep disturbances in ADHD: investigating the contribution of polygenic liability for ADHD and sleep-related phenotypes. Eur Child Adolesc Psychiatry 2022:10.1007/s00787-021-01931-2. [PMID: 34994865 DOI: 10.1007/s00787-021-01931-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Accepted: 12/17/2021] [Indexed: 11/24/2022]
Abstract
Sleep disturbances are common in attention deficit hyperactivity disorder (ADHD) and associated with poor outcomes. We tested whether, in children with ADHD, (1) polygenic liability for sleep phenotypes is over- or under-transmitted from parents, (2) this liability is linked to comorbid sleep disturbances, and (3) ADHD genetic risk is associated with comorbid sleep disturbances. We derived polygenic scores (PGS) for insomnia, chronotype, sleep duration, and ADHD, in 758 children (5-18 years old) diagnosed with ADHD and their parents. We conducted polygenic transmission disequilibrium tests for each sleep PGS in complete parent-offspring ADHD trios (N = 328) and an independent replication sample of ADHD trios (N = 844). Next, we tested whether insomnia, sleep duration, and ADHD PGS were associated with co-occurring sleep phenotypes (hypersomnia, insomnia, restless sleep, poor sleep quality, and nightmares) in children with ADHD. Children's insomnia and chronotype PGS did not differ from mid-parent average PGS but long sleep duration PGS were significantly over-transmitted to children with ADHD. This was supported by a combined analysis using the replication sample. Insomnia, sleep duration, and ADHD PGS were not associated with comorbid sleep disturbances. There is weak evidence that children with ADHD over-inherit polygenic liability for longer sleep duration and do not differentially inherit polygenic liability for insomnia or chronotype. There was insufficient evidence that childhood sleep disturbances were driven by polygenic liability for ADHD or sleep traits, suggesting that sleep disturbances in ADHD may be aetiologically different to general population sleep phenotypes and do not index greater ADHD genetic risk burden.
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Affiliation(s)
- Katie J S Lewis
- MRC Centre for Neuropsychiatric Genetics and Genomics, Cardiff University, Cardiff, UK
| | - Joanna Martin
- MRC Centre for Neuropsychiatric Genetics and Genomics, Cardiff University, Cardiff, UK
| | - Alice M Gregory
- Department of Psychology, Goldsmiths, University of London, London, UK
| | - Richard Anney
- MRC Centre for Neuropsychiatric Genetics and Genomics, Cardiff University, Cardiff, UK
| | - Anita Thapar
- MRC Centre for Neuropsychiatric Genetics and Genomics, Cardiff University, Cardiff, UK
| | - Kate Langley
- MRC Centre for Neuropsychiatric Genetics and Genomics, Cardiff University, Cardiff, UK. .,School of Psychology, Cardiff University, Cardiff, UK.
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21
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Yin H, Yang D, Yang L, Wu G. Relationship between sleep disorders and attention-deficit-hyperactivity disorder in children. Front Pediatr 2022; 10:919572. [PMID: 35935380 PMCID: PMC9354977 DOI: 10.3389/fped.2022.919572] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Accepted: 07/04/2022] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE To explore the correlation between sleep disorders and attention-deficit-hyperactivity disorder (ADHD) in children. METHODS We studied 100 Chinese children (70 boys and 30 girls; mean age, 8.77 ± 2.39 years). Parents completed the Children's Sleep Disturbance Scale (SDSC) and the Swanson Nolan and Pelham Version IV Scale (SNAP-IV) questionnaires. SNAP-IV and SDSC scores were compared in children with and without sleep disorders and ADHD. RESULTS There were significant differences in SDSC scores, Arousal Disorder (AD) scores, and Sleep Breathing Disorder (SBD) scores between children with and without ADHD (P < 0.05). The sleep disorder group had higher SNAP-IV scores than the non-sleep disorder group (P < 0.05). Children with sleep disorders showed higher ADHD symptom values (inattention, hyperactivity/impulsivity, and oppositional defiance) than children without sleep disorders (P < 0.01). There was a moderate correlation between SDSC scores and SNAP-IV scores (r = 0.486, P < 0.05). Using SNAP-IV scores as the dependent variable, multiple linear regression analysis was applied, and a statistically significant effect of AD and Sleep-Wake Transition Disorder (SWTD) scores on SNAP-IV scores was found (P < 0.05). The area under the curve (95% CI) of the SDSC score for predicting sleep disorders with ADHD was 0.714 (0.606, 0.821; P = 0.0005). CONCLUSION Children with ADHD are prone to sleep disorders. The higher the ADHD symptom score, the more sleeping problems. Sleep disorders can also cause or exacerbate ADHD symptoms, and the ADHD symptom score correlates with sleep disorder severity. We can reduce the severity of attention-deficit-hyperactivity in children with ADHD by improving their sleep with behavioral sleep interventions.
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Affiliation(s)
- Huimei Yin
- The Affiliated Hospital of Hangzhou Normal University, Hangzhou, China
| | - Dong Yang
- The Affiliated Hospital of Hangzhou Normal University, Hangzhou, China
| | - Lin Yang
- The Affiliated Hospital of Hangzhou Normal University, Hangzhou, China
| | - Guangsheng Wu
- The Affiliated Hospital of Hangzhou Normal University, Hangzhou, China
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22
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Kwon SJ, Kim Y, Kwak Y. Influence of smartphone addiction and poor sleep quality on attention-deficit hyperactivity disorder symptoms in university students: a cross-sectional study. JOURNAL OF AMERICAN COLLEGE HEALTH : J OF ACH 2022; 70:209-215. [PMID: 32240033 DOI: 10.1080/07448481.2020.1740228] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/14/2018] [Revised: 01/20/2020] [Accepted: 02/29/2020] [Indexed: 06/11/2023]
Abstract
Objective: This study examined the relationship between attention-deficit hyperactivity disorder ((ADHD)) symptoms, smartphone addiction, and poor sleep quality in university students, and identified factors affecting ADHD symptoms. Participants: Data were collected from 197 students from March to June 2017. Methods: We adopted a descriptive cross-sectional study design. Results: ADHD symptoms were positively correlated with smartphone addiction (r = .424, p < .01) and poor sleep quality (r = .313, p < .01). The regression analysis showed that academic achievement (ß =.128, p = .038), smartphone addiction (ß =.327, p < .001), sleep disturbance (ß = .197, p = .003), and daytime dysfunction (ß = .269, p < .001) were identified as factors significantly influencing ADHD symptoms, accounting for 31.1% of their variance. Conclusions: Interventions for university students with ADHD symptoms should involve the evaluation of these four factors as a multifaceted approach to reducing ADHD symptoms.
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Affiliation(s)
- Soo Jin Kwon
- Industry Academic Cooperation Foundation, Chung-Ang University, Seoul, Republic of Korea
| | - Yoonjung Kim
- Red Cross College of Nursing, Chung-Ang University, Seoul, Republic of Korea
| | - Yeunhee Kwak
- Red Cross College of Nursing, Chung-Ang University, Seoul, Republic of Korea
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23
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Davidson F, Rigney G, Brine S, Speth T, Miller L, Rusak B, Chambers C, Rajda M, Begum EA, Corkum P. Even a Mild Sleep Restriction Can Impact Daytime Functioning in Children with ADHD and Their Typically Developing Peers. Behav Sleep Med 2022; 20:21-36. [PMID: 33455462 DOI: 10.1080/15402002.2021.1873785] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
OBJECTIVES/BACKGROUND Correlational studies show that short sleep is associated with negative daytime outcomes in school-aged children, but there are few experimental sleep manipulation studies to assess whether this is a causal relation. The aim of this study was to determine the impact of mild, cumulative sleep restriction on daytime functioning of typically developing (TD) children and children with attention-deficit/hyperactivity disorder (ADHD). PARTICIPANTS A total of 36 school-aged children (n = 18 TD; n = 18 ADHD), aged 6-11 years participated. METHODS Children participated in two sleep conditions (order counter-balanced). The Restricted condition required a 1 h reduction of time in bed for one week, and the Controlled Typical condition was based on participant's average baseline sleep. At the end of each condition, participants attended the sleep lab for overnight polysomnography and daytime functioning assessments. RESULTS Children successfully reduced time in bed by ~1 h. Due to compensatory changes, total sleep time (TST) was reduced by only ~20 min, as children fell asleep faster and spent less time awake after sleep onset during the Restricted compared to Controlled Typical condition. Many daytime functions were not affected by this very mild sleep restriction, however, both groups showed significant changes in performance on an objective attention task and on a parent-rated emotional lability measure after six nights of minimal reductions in TST. There were no significant differences between groups. CONCLUSIONS Results suggest that a very mild sleep restriction can affect children's attention and emotional regulation, even with evidence of compensatory sleep mechanisms.
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Affiliation(s)
- Fiona Davidson
- Department of Psychology and Neuroscience, Dalhousie University, Halifax, Canada
| | - Gabrielle Rigney
- Department of Psychology and Neuroscience, Dalhousie University, Halifax, Canada.,School of Health, Medical and Applied Sciences, Central Queensland University, Queensland, Australia
| | - Sarah Brine
- Department of Psychology and Neuroscience, Dalhousie University, Halifax, Canada
| | - Tamara Speth
- Department of Psychology and Neuroscience, Dalhousie University, Halifax, Canada
| | - Laura Miller
- Department of Psychology and Neuroscience, Dalhousie University, Halifax, Canada
| | - Benjamin Rusak
- Department of Psychology and Neuroscience, Dalhousie University, Halifax, Canada
| | - Christine Chambers
- Department of Psychology and Neuroscience, Dalhousie University, Halifax, Canada
| | | | - Esmot Ara Begum
- Department of Psychology and Neuroscience, Dalhousie University, Halifax, Canada
| | - Penny Corkum
- Department of Psychology and Neuroscience, Dalhousie University, Halifax, Canada
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24
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Hsueh ML, Jong D. Self-Awareness of Sleep Apnea Symptoms Among Middle-Aged and Elderly People in Taiwan. Front Psychiatry 2022; 13:936097. [PMID: 35935424 PMCID: PMC9352881 DOI: 10.3389/fpsyt.2022.936097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Accepted: 06/20/2022] [Indexed: 12/01/2022] Open
Abstract
In recent years, the proportion of middle-aged and elderly people in Taiwan has gradually increased and has already surpassed that of advanced countries such as Europe, the United States and Japan, therefore, the health of middle-aged and elderly people is a topic that needs attention. This is because physical deterioration or illness can lead to a decline in quality of life and create a medical burden on the individual and society. This study investigated the common symptoms of sleep apnea in middle-aged and elderly people (over 40 years old), and developed a self-test subjective perception model, using "daytime sleepiness" and "sleep quality" as influencing factors, and "attention" as mediating variables to verify the effect with sleep apnea symptoms. An online electronic questionnaire was conducted and distributed through social media and groups of friends in Taiwan. A total of 541 valid questionnaires were collected and analyzed in three stages: Descriptive Analysis, Measurement Model Validation, and Structural Equation Model. The research processes of the study showed that the sample fitted the normal distribution and the measurement model conformed with convergent reliability and discriminant validity. The research results were found that "sleep quality" had a significant negative effect on sleep apnea symptoms. "Daytime sleepiness" had a positive effect on sleep apnea symptoms. "Daytime sleepiness" had a negative effect on sleep apnea symptoms through the "attention" mediator. Finally, through the questionnaire, we hope to make the middle-aged people aware of themselves, so that they can seek early medical treatment if there are signs and symptoms of sleep apnea symptoms.
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Affiliation(s)
- Meng-Lun Hsueh
- Graduate Institute of Intelligent Robotics, Hwa Hsia University of Technology, New Taipei City, Taiwan
| | - Din Jong
- Digital Design and Information Management, Chung Hwa University of Medical Technology, Tainan City, Taiwan
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25
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Larsson I, Aili K, Nygren JM, Jarbin H, Svedberg P. Parents' Experiences of Weighted Blankets' Impact on Children with Attention-Deficit/Hyperactivity Disorder (ADHD) and Sleep Problems-A Qualitative Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:12959. [PMID: 34948571 PMCID: PMC8700927 DOI: 10.3390/ijerph182412959] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Revised: 12/03/2021] [Accepted: 12/06/2021] [Indexed: 01/10/2023]
Abstract
Sleep disturbances are common among children with attention-deficit/hyperactivity disorder (ADHD). While pharmacological treatment has increased dramatically, parents often prefer non-pharmacological interventions. Research on experiences of weighted blankets and their effect in sleep improvement is scarce. The aim of this study was to explore parents' experiences of weighted blankets for children with ADHD and sleep problems, and the impact on their children's sleep. The explorative design was based on qualitative content analysis. Interviews were conducted with a purposeful sample of 24 parents of children with ADHD and sleep problems, after completing a sleep intervention with weighted blankets for 16 weeks. Parents reported that children sleeping with weighted blankets: (1) achieved satisfactory sleep, including improved sleep onset latency, sleep continuity, and sleep routines; (2) achieved overall well-being, including improved relaxation and reduced anxiety; and (3) mastered everyday life, including improved balance in life, family function, and participation in school and leisure activities. This study brings forward novel aspects of the effects of improved sleep among children with ADHD. The findings contribute to the understanding of potential positive effects of an intervention with weighted blankets critical for clinical practice to improve sleep, well-being, and everyday life of children with ADHD and their families.
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Affiliation(s)
- Ingrid Larsson
- Department of Health and Care, School of Health and Welfare, Halmstad University, SE-30118 Halmstad, Sweden; (J.M.N.); (P.S.)
| | - Katarina Aili
- Department of Health and Sport, School of Health and Welfare, Halmstad University, SE-30118 Halmstad, Sweden;
| | - Jens M. Nygren
- Department of Health and Care, School of Health and Welfare, Halmstad University, SE-30118 Halmstad, Sweden; (J.M.N.); (P.S.)
| | - Håkan Jarbin
- Child and Adolescent Psychiatry, Department of Clinical Sciences Lund, Lund University, SE-22184 Lund, Sweden;
- Child and Adolescent Psychiatry, Region Halland, SE-30185 Halmstad, Sweden
| | - Petra Svedberg
- Department of Health and Care, School of Health and Welfare, Halmstad University, SE-30118 Halmstad, Sweden; (J.M.N.); (P.S.)
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26
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Carpena MX, Bonilla C, Matijasevich A, Martins-Silva T, Genro JP, Hutz MH, Rohde LA, Tovo-Rodrigues L. Sleep-related traits and attention-deficit/hyperactivity disorder comorbidity: Shared genetic risk factors, molecular mechanisms, and causal effects. World J Biol Psychiatry 2021; 22:778-791. [PMID: 33821771 DOI: 10.1080/15622975.2021.1907719] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVES To evaluate the shared genetic components, common pathways and causal relationship between ADHD and sleep-related phenotypes. METHODS We used the largest genome-wide association summary statistics available for attention-deficit/hyperactivity disorder (ADHD) and various sleep-related phenotypes (insomnia, napping, daytime dozing, snoring, ease getting up, daytime sleepiness, sleep duration and chronotype). We estimated the genomic correlation using cross-trait linkage disequilibrium score regression (LDSR) and investigated the potential common mechanisms using gene-based cross-trait metanalyses and functional enrichment analyses. The causal effect was estimated using two-sample Mendelian randomisation (TSMR), using the inverse variance weighted method as the main estimator. RESULTS A positive genomic correlation between insomnia, daytime napping, daytime dozing, snoring, daytime sleepiness, short and long sleep duration, and ADHD was observed. Insomnia, daytime sleepiness, and snoring shared genes with ADHD, that are involved in neurobiological functions and regulatory signalling pathways. The TSMR supported a causal effect of insomnia, daytime napping, and short sleep duration on ADHD, and of ADHD on long sleep duration and chronotype. CONCLUSION Comorbidity between sleep phenotypes and ADHD may be mediated by common genetic factors that play an important role in neuronal signalling pathways. A causal effect of sleep disturbances and short sleep duration on ADHD reinforced their role as predictors of ADHD.
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Affiliation(s)
- Marina Xavier Carpena
- Post-Graduate Program in Epidemiology, Federal University of Pelotas, Pelotas, Brazil
| | - Carolina Bonilla
- Departamento de Medicina Preventiva, Faculdade de Medicina FMUSP, Universidade de São Paulo, SP, Brasil.,Population Health Sciences, University of Bristol, Bristol, UK
| | - Alicia Matijasevich
- Post-Graduate Program in Epidemiology, Federal University of Pelotas, Pelotas, Brazil.,Departamento de Medicina Preventiva, Faculdade de Medicina FMUSP, Universidade de São Paulo, SP, Brasil
| | - Thais Martins-Silva
- Post-Graduate Program in Epidemiology, Federal University of Pelotas, Pelotas, Brazil
| | - Julia P Genro
- Graduate Program in Biosciences, Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre, Brazil
| | - Mara Helena Hutz
- Department of Genetics, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Luis Augusto Rohde
- Federal University of Rio Grande do Sul, Department of Psychiatry, Child & Adolescent Psychiatry Unit, Hospital de Clinicas de Porto Alegre, Porto Alegre, Brazil
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27
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Zerón-Rugerio MF, Carpio-Arias TV, Ferreira-García E, Díez-Noguera A, Cambras T, Alda JÁ, Izquierdo-Pulido M. ADHD subtypes are associated differently with circadian rhythms of motor activity, sleep disturbances, and body mass index in children and adolescents: a case-control study. Eur Child Adolesc Psychiatry 2021; 30:1917-1927. [PMID: 33063173 DOI: 10.1007/s00787-020-01659-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2020] [Accepted: 10/05/2020] [Indexed: 11/30/2022]
Abstract
To date, few studies have examined the circadian pattern of motor activity in children and adolescents newly diagnosed with attention-deficit/hyperactivity disorder (ADHD). The objective was to study the circadian pattern of motor activity in subjects with ADHD (medication naïve) and to investigate the relationships between alterations in circadian patterns, the ADHD subtype (combined or inattentive), sleep disturbances and body mass index (BMI). One-hundred twenty children and adolescents (60 medication naïve ADHD and 60 controls) were included in a gender- and age-matched case-control study. ADHD was diagnosed according to the DSM-IV-TR, the Schedule for Affective Disorders and Schizophrenia-Present and Lifetime Version, and the Conner's Parents Rating Scale-Revised. Circadian rhythms of motor activity and sleep parameters were measured using actigraphy and the Sleep Disturbance Scale for Children. BMI and dietary intake were also evaluated. ADHD patients showed a trend towards eveningness and greater sleep disturbances than controls. Additionally, patients with ADHD-combined had significantly higher mean values of motor activity and showed a significant delay in bedtime. Furthermore, among ADHD-C patients hyperactivity symptoms were significantly associated with the least 5 h of activity. Regarding patients with ADHD-inattentive, increased fragmentation of the circadian pattern was associated with inattention symptoms, and they also showed a significant increase in BMI of 2.52 kg/m2 [95% CI 0.31, 4.73] in comparison with controls. Our findings highlight the potential use of actigraphy as a clinical tool to aid in the diagnosis of ADHD. It should be noted that evaluating motor activity variables could also allow the differentiation between ADHD subtypes.
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Affiliation(s)
- María Fernanda Zerón-Rugerio
- Department of Nutrition, Food Science, and Gastronomy, University of Barcelona, Av. Prat de la Riba 171. Recinte Torribera. Edifici Verdaguer, Santa Coloma de Gramenet, 08921, Barcelona, Spain.,Institut de Recerca en Nutrició i Seguretat Alimentaria (INSA-UB), University of Barcelona, Barcelona, Spain
| | | | | | - Antoni Díez-Noguera
- Department of Biochemistry and Physiology, Faculty of Pharmacy and Food Science, University of Barcelona, Barcelona, Spain
| | - Trinitat Cambras
- Department of Biochemistry and Physiology, Faculty of Pharmacy and Food Science, University of Barcelona, Barcelona, Spain
| | - Jose Ángel Alda
- Children and Adolescent Mental Health Research Group, Institut de Recerca Sant Joan de Déu, Barcelona, Spain.,Child and Adolescent Psychiatry and Psychology Department, Hospital Sant Joan de Deu Barcelona, Barcelona, Spain
| | - Maria Izquierdo-Pulido
- Department of Nutrition, Food Science, and Gastronomy, University of Barcelona, Av. Prat de la Riba 171. Recinte Torribera. Edifici Verdaguer, Santa Coloma de Gramenet, 08921, Barcelona, Spain. .,Institut de Recerca en Nutrició i Seguretat Alimentaria (INSA-UB), University of Barcelona, Barcelona, Spain.
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28
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Yıldız Miniksar D, Özdemir M. Sleep quality in children and adolescents with attention-deficit and hyperactivity disorder. Arch Pediatr 2021; 28:668-676. [PMID: 34688509 DOI: 10.1016/j.arcped.2021.09.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2020] [Revised: 08/02/2021] [Accepted: 09/26/2021] [Indexed: 10/20/2022]
Abstract
Sleep disturbances are associated with an increased risk of attention-deficit and hyperactivity disorder (ADHD), which can also lead to sleep problems. In this study we aimed to determine the variables that affect the relationship between ADHD and sleep quality. Moreover, we aimed to compare these variables in children and adolescents with ADHD and healthy controls. This cross-sectional study was conducted using a random sample of 122 ADHD patients and 100 healthy children in Turkey. A self-administered questionnaire was distributed to assess sleep quality using the Pittsburgh Sleep Quality Index (PSQI). The risk of impairment in sleep quality was associated with the presence of ADHD (OR: 13.3; 95% CI: 6.1-29.1), the presence of somatic disease (OR: 4.9; 95% CI: 1.9-12.2), and a family history of the psychiatric disorder (OR: 4.2; 95% CI: 1.3-13.1). The PSQI total score was higher in children with parental separation compared to those without parental separation (p=0.006). As the economic level of the participants decreased, the PSQI total score increased significantly (p=0.006). It was determined that combined-type ADHD was associated with impairment in sleep quality more than the other subtypes (p<0.001 and p=0.031, respectively). Our findings show that children with ADHD have significantly more sleep problems than healthy controls and that sociodemographic variables and familial characteristics affect sleep quality in healthy children and children with ADHD.
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Affiliation(s)
| | - Mikail Özdemir
- Tuberculosis Dispensary, Osmaniye Community Health Center, Osmaniye, Turkey
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29
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Lanca M, Abrams DN, Crittenden P, Jones KM. Cognitive Stabilization Intervention during the Era of COVID-19. Dev Neuropsychol 2021; 46:298-313. [PMID: 34225510 DOI: 10.1080/87565641.2021.1943398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
As COVID-19 halted traditional neuropsychological assessment due to infection risk, neuropsychologists considered alternative practice models. Cognitive stabilization intervention (CSI) via telehealth, was developed to stabilize cognition in advance of neuropsychological assessment. It incorporates elements of evidence-based treatments, including cognitive training, sleep training, and medication adherence training within a motivational interview framework. Two case vignettes are described. One vignette describes an elder man who received CSI to manage sleep difficulties, forgetfulness, and mood symptoms. Another vignette describes a woman who completed CSI following an autoimmune disorder episode to improve sleep, organization, and attention. The benefits and limitations of CSI are discussed.
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Affiliation(s)
- Margaret Lanca
- Department of Psychiatry, Harvard Medical School/Cambridge Health Alliance, Cambridge, USA
| | - Danielle N Abrams
- Department of Psychiatry, Harvard Medical School/Cambridge Health Alliance, Cambridge, USA
| | - Persephone Crittenden
- Department of Psychiatry, Harvard Medical School/Cambridge Health Alliance, Cambridge, USA
| | - Kelly M Jones
- Private Practice, Boston & Woburn, Massachusetts, USA
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30
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McQuillan ME, Bates JE, Staples AD, Hoyniak CP, Rudasill KM, Molfese VJ. Sustained attention across toddlerhood: The roles of language and sleep. Dev Psychol 2021; 57:1042-1057. [PMID: 34435821 PMCID: PMC8406408 DOI: 10.1037/dev0001197] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The present study examined individual differences in the development of sustained attention across toddlerhood, as well as how these individual differences related to the development of language and sleep. Toddlers (N = 314; 54% male) were assessed at 30, 36, and 42 months using multiple measures of attention, a standardized language assessment, and actigraphic measures of sleep. Toddlers were 80% White. Family socioeconomic status (SES) was calculated using the Hollingshead Four Factor Index and ranged from 13 to 66 (M = 47.59, SD = 14.13). Aims were (a) to examine associations between measures of attention across situations, informants, and time; (b) to consider the independent and interactive effects of language and sleep on attention; and (c) to test potential bidirectional associations between sleep and attention. Findings showed attention measures were stable across time but were only weakly linked with each other at 42 months. Attention was consistently linked with language. More variable sleep and longer naps were associated with less growth in sustained attention across time. Nighttime sleep duration interacted with language in that sleep duration was positively associated with attention scores among toddlers with less advanced language, even when SES was controlled. The findings describe an understudied aspect of how sustained attention develops, involving the main effect of consistent sleep schedules and the interaction effect of amount of sleep and child language development. These findings are relevant to understanding early childhood risk for developing attention problems and to exploring a potential prevention target in family sleep practices. (PsycInfo Database Record (c) 2021 APA, all rights reserved).
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31
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Ekholm B, Spulber S, Adler M. A randomized controlled study of weighted chain blankets for insomnia in psychiatric disorders. J Clin Sleep Med 2021; 16:1567-1577. [PMID: 32536366 DOI: 10.5664/jcsm.8636] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
STUDY OBJECTIVES This study aimed to evaluate the effect of weighted chain blankets on insomnia and sleep-related daytime symptoms for patients with major depressive disorder, bipolar disorder, generalized anxiety disorder, and attention deficit hyperactivity disorder. METHODS One hundred twenty patients were randomized (1:1) to either a weighted metal chain blanket or a light plastic chain blanket for 4 weeks. The outcome was evaluated using the Insomnia Severity Index as primary outcome measure and day and night diaries, Fatigue Symptom Inventory, and Hospital Anxiety and Depression Scale as secondary outcome measures. Sleep and daytime activity levels were evaluated by wrist actigraphy. RESULTS At 4 weeks, there was a significant advantage in Insomnia Severity Index ratings of the weighted blanket intervention over the light blanket (P < .001) with a large effect size (Cohen's d 1.90). The intervention by the weighted blanket resulted in a significantly better sleep-maintenance, a higher daytime activity level, and reduced daytime symptoms of fatigue, depression, and anxiety. No serious adverse events occurred. During a 12-month open follow-up phase of the study, participants continuing to use weighted blankets maintained the effect on sleep, while patients switching from a light to a weighted blanket experienced an effect on Insomnia Severity Index ratings similar to that of participants using the weighted blanket from the beginning. CONCLUSIONS Weighted chain blankets are an effective and safe intervention for insomnia in patients with major depressive disorder, bipolar disorder, generalized anxiety disorder, or attention deficit hyperactivity disorder, also improving daytime symptoms and levels of activity. CLINICAL TRIAL REGISTRATION Registry: ClinicalTrials.gov; Name: Controlled Study of Chain Blanket for Insomnia; URL: https://clinicaltrials.gov/ct2/show/NCT03546036; Identifier: NCT03546036.
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Affiliation(s)
- Bodil Ekholm
- The Affective Disorder Outpatient Clinic at Psychiatry Southwest, Karolinska University Hospital Huddinge, Stockholm, Sweden
| | - Stefan Spulber
- Department of Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Mats Adler
- The Affective Disorder Outpatient Clinic at Psychiatry Southwest, Karolinska University Hospital Huddinge, Stockholm, Sweden.,Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
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32
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Stickley A, Shirama A, Kitamura S, Kamio Y, Takahashi H, Saito A, Haraguchi H, Kumazaki H, Mishima K, Sumiyoshi T. Attention-deficit/hyperactivity disorder symptoms and sleep problems in preschool children: the role of autistic traits. Sleep Med 2021; 83:214-221. [PMID: 34049039 DOI: 10.1016/j.sleep.2021.04.037] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Revised: 04/26/2021] [Accepted: 04/26/2021] [Indexed: 12/01/2022]
Abstract
BACKGROUND Sleep problems are elevated in children with attention-deficit/hyperactivity disorder (ADHD). However, until now there has been comparatively little research on the role of autistic traits in this association. The current study examined the association between ADHD symptoms and sleep problems in Japanese preschool children and whether autistic traits might also be important for this relationship. METHODS Data were analyzed from 1053 children (average age 64.14 months, range 58-71; 50.3% male) that were drawn from the Tama Children's Survey (TCS). Parent-reported information was obtained on ADHD symptoms using the Strengths and Difficulties Questionnaire (SDQ) and autistic traits with the Social Responsiveness Scale Second Edition (SRS-2). Parents also provided information on three different categories of sleep problems experienced by their children - parasomnias, sleep disordered breathing and awakening/daytime problems. Ordinal logistic regression analysis was used to examine the associations. RESULTS In analyses adjusted for sociodemographic factors, the mother's mental health and child's emotional problems, compared to children with no ADHD symptoms or autistic traits, children with only ADHD symptoms had significantly increased odds for only one of 11 individual sleep problems - waking in a negative mood. In contrast, children with comorbid ADHD symptoms and autistic traits had elevated odds for five sleep problems with odds ratios ranging from 2.10 (takes time to become alert in the morning) to 3.46 (excessive body movement while sleeping). CONCLUSIONS Sleep problems may be especially elevated in children with comorbid ADHD symptoms and autistic traits.
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Affiliation(s)
- Andrew Stickley
- Department of Preventive Intervention for Psychiatric Disorders, National Institute of Mental Health, National Center of Neurology and Psychiatry, 4-1-1 Ogawahigashicho, Kodaira, Tokyo, 187-8553, Japan.
| | - Aya Shirama
- Department of Preventive Intervention for Psychiatric Disorders, National Institute of Mental Health, National Center of Neurology and Psychiatry, 4-1-1 Ogawahigashicho, Kodaira, Tokyo, 187-8553, Japan
| | - Shingo Kitamura
- Department of Sleep-Wake Disorders, National Institute of Mental Health, National Center of Neurology and Psychiatry (NCNP), 4-1-1 Ogawahigashicho, Kodaira, Tokyo, 187-8553, Japan
| | - Yoko Kamio
- Department of Preventive Intervention for Psychiatric Disorders, National Institute of Mental Health, National Center of Neurology and Psychiatry, 4-1-1 Ogawahigashicho, Kodaira, Tokyo, 187-8553, Japan; Institute of Education and Human Development, Ochanomizu University, 2-1-1 Otsuka, Bunkyo-ku, Tokyo, 112-8610, Japan
| | - Hidetoshi Takahashi
- Department of Preventive Intervention for Psychiatric Disorders, National Institute of Mental Health, National Center of Neurology and Psychiatry, 4-1-1 Ogawahigashicho, Kodaira, Tokyo, 187-8553, Japan; Kochi Medical School Department of Child and Adolescent Psychiatry, Kochi University, 185-1 Kohasu, Oko-cho, Nankoku-shi, Kochi, 783-8505, Japan
| | - Aya Saito
- Department of Preventive Intervention for Psychiatric Disorders, National Institute of Mental Health, National Center of Neurology and Psychiatry, 4-1-1 Ogawahigashicho, Kodaira, Tokyo, 187-8553, Japan; Human Science Division, Faculty of Core Research, Ochanomizu University, 2-1-1 Otsuka, Bunkyo-ku, Tokyo, 112-8610, Japan
| | - Hideyuki Haraguchi
- Department of Preventive Intervention for Psychiatric Disorders, National Institute of Mental Health, National Center of Neurology and Psychiatry, 4-1-1 Ogawahigashicho, Kodaira, Tokyo, 187-8553, Japan
| | - Hirokazu Kumazaki
- Department of Preventive Intervention for Psychiatric Disorders, National Institute of Mental Health, National Center of Neurology and Psychiatry, 4-1-1 Ogawahigashicho, Kodaira, Tokyo, 187-8553, Japan
| | - Kazuo Mishima
- Department of Sleep-Wake Disorders, National Institute of Mental Health, National Center of Neurology and Psychiatry (NCNP), 4-1-1 Ogawahigashicho, Kodaira, Tokyo, 187-8553, Japan
| | - Tomiki Sumiyoshi
- Department of Preventive Intervention for Psychiatric Disorders, National Institute of Mental Health, National Center of Neurology and Psychiatry, 4-1-1 Ogawahigashicho, Kodaira, Tokyo, 187-8553, Japan
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33
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Hammerness PG, Cassidy AR, Potts H, Richardson A, Fogler J, Daly KP, Augustyn M. Assessment and Treatment of a Young Adult with Congenital Heart Disease and ADHD. J Dev Behav Pediatr 2021; 42:340-342. [PMID: 33859122 DOI: 10.1097/dbp.0000000000000961] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Accepted: 02/23/2021] [Indexed: 11/26/2022]
Abstract
CASE Phillip is a young man born with hypoplastic left heart syndrome referred to your practice for a range of mental health concerns. He underwent palliation to an extracardiac Fontan in infancy and experienced multiple complications over the next decade including valvular regurgitation and arrhythmias necessitating a pacemaker. Phillip continued to have systolic heart failure with New York Heart Association class II symptoms, managed with 4 medications and anticoagulation.Despite this complex history, Phillip had intact cognitive abilities, achieved typical milestones, and performed well academically in secondary school. His first year of college proved to be more challenging, and Phillip presented to the outpatient psychiatry service with an acute depressive episode. His family history included depression, without known attention-deficit/hyperactivity disorder (ADHD). Treatment, including a selective serotonin reuptake inhibitor, cognitive behavioral therapy, and family support, led to near resolution of his symptoms of depression.In subsequent appointments, Phillip described a long history of inattention and disorganization with onset in childhood. This contributed to the decision to leave college, despite remission of symptoms of depression. Phillip was unable to study for any extended period without "perfect conditions," described as the absence of potential distractions except for background music. Despite attempts to maintain "perfect conditions," Phillip was often off task and "hyperfocusing" on irrelevant topics. Phillip struggled with planning and time management and would misplace items daily. Moreover, although the importance of self-care was well understood, Phillip often forgot to take his cardiac medication or to exercise, and he admitted to inconsistent sleep habits because of losing track of time.Based on a comprehensive psychiatric evaluation including retrospective report from a parent, Phillip was diagnosed with ADHD, coexisting with major depressive disorder, in remission. Significant ADHD symptoms were documented by interview, self-report, and administration of an abbreviated neuropsychological battery.Considering concerns regarding use of stimulants in a patient with congenital heart disease, including death, stroke, and myocardial infarction,1,2 how would you assess the risks-benefits of use of stimulants with Phillip? REFERENCES 1. Wilens TE, Prince JB, Spencer TJ, et al. Stimulants and sudden death: what is a physician to do? Pediatrics. 2006;118:1215-1219.2. Zito JM, Burcu M. Stimulants and pediatric cardiovascular risk. J Child Adolesc Psychopharmacol. 2017;27:538-545.
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Affiliation(s)
- Paul G Hammerness
- Department of Psychiatry, Boston Children's & Harvard Medical School, Boston, MA
| | - Adam R Cassidy
- Department of Psychiatry and Behavioral Sciences, Boston Children's Hospital, Harvard Medical School, Boston, MA
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN
| | - Heather Potts
- Outpatient Psychiatry Service, Boston Children's Hospital, Harvard Medical School, Boston, MA
| | | | - Jason Fogler
- ADHD Program, Division of Developmental Medicine, Boston Children's Hospital, Boston, MA
- Pediatrics & Psychology, Harvard Medical School, Boston, MA
| | - Kevin P Daly
- Department of Pediatrics, Harvard Medical School, Advanced Cardiac Therapies, Boston Children's Hospital, Boston, MA
| | - Marilyn Augustyn
- Division of Developmental-Behavioral Pediatrics, Boston Medical Center, Boston University School of Medicine, Boston, MA
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34
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Yuen T, Zhang H, Bonin RP. Pharmacists' knowledge, experiences and perceptions of treatments for attention-deficit/hyperactivity disorder. Can Pharm J (Ott) 2021; 154:110-119. [PMID: 33868522 DOI: 10.1177/1715163520981397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background Attention-deficit/hyperactivity disorder (ADHD) is a neurodevelopmental disorder that begins in childhood and often persists into adulthood. ADHD increases the risk of various negative impacts, and pharmacists are well positioned to address these issues in the community. Objectives This survey study aims to first identify pharmacists' ADHD knowledge gaps and experience with ADHD management and to second assess their preferences for continuing education and their experience with sleep-related issues in ADHD. Methods A survey was sent to Part A Ontario pharmacists with active licenses who opted in to receive research-related emails (n = 6022). Descriptive statistics were used to analyze survey data, while free-form answers were pooled and evaluated for common themes and trends. Results A total of 238 complete responses were received. The average self-reported ADHD knowledge was 5.8 ± 1.96 on a 10-point scale. There was no correlation between the number of years of practice as a pharmacist, the number of working hours per week or the location of practice on pharmacists' self-reported knowledge scores. There was a significant difference in self-reported knowledge of ADHD between pharmacists who were not aware of the Canadian ADHD Resource Alliance (CADDRA) guidelines (5.1 ± 2.1) and those who refer to it for standard of care (7.1 ± 1.5). Almost all pharmacists (95%) indicated they could benefit from additional ADHD education, with a strong preference for "online continuing education modules" (81%). The majority of responders considered psychostimulant ADHD medication as the major possible contributor to sleep disturbances (47%) in ADHD, highlighting a need for further education on the inconclusive link between ADHD medication effects on sleep. Conclusion The study results raise the concern that pharmacists may require additional ADHD education but also show the lack of awareness of available resources, such as the CADDRA guidelines. Can Pharm J (Ott) 2021;154:xx-xx.
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Affiliation(s)
- Terence Yuen
- Leslie Dan Faculty of Pharmacy (Yuen, Zhang, Bonin), University of Toronto, Toronto.,Purdue Pharma (Canada) (Yuen), Pickering.,University of Toronto Centre for the Study of Pain (Bonin), Toronto, Ontario
| | - Hantao Zhang
- Leslie Dan Faculty of Pharmacy (Yuen, Zhang, Bonin), University of Toronto, Toronto.,Purdue Pharma (Canada) (Yuen), Pickering.,University of Toronto Centre for the Study of Pain (Bonin), Toronto, Ontario
| | - Robert P Bonin
- Leslie Dan Faculty of Pharmacy (Yuen, Zhang, Bonin), University of Toronto, Toronto.,Purdue Pharma (Canada) (Yuen), Pickering.,University of Toronto Centre for the Study of Pain (Bonin), Toronto, Ontario
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35
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Fredriksen M, Golparian N, Beiske K, Stavem K. Impact of methylphenidate on sleep problems in adults with ADHD: a pilot polysomnography study. Nord J Psychiatry 2021; 75:234-238. [PMID: 33100096 DOI: 10.1080/08039488.2020.1833984] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND Attention-deficit hyperactivity disorder (ADHD) is associated with disrupted sleep and circadian rhythm. Medication for ADHD may have side effects aggravating sleep-disturbances, however beneficial effects on ADHD may contribute to improve sleep. AIMS This pilot study aims to examine outcomes of first time stimulant treatment on objective and subjective sleep characteristics, and psychiatric symptoms, in adult ADHD patients with pretreatment sleep problems, but without any primary sleep disorder. METHODS In total, 9 previously unmedicated adult ADHD subjects who reported pretreatment sleep problems, completed polysomnography (PSG) and questionnaires on subjective sleep disturbances and psychiatric symptoms. Data was collected before and after 6 weeks on first time medication with immediate-release methylphenidate (MPH-IR), mean daily dose 43 mg. RESULTS Subjects on-medication showed an increased percentage of Stage 2 sleep compared to their non-treated baseline (46.6% versus 55.2%, p = .011). Otherwise, there were no significant changes in PSG variables. There were no firm changes in daytime sleepiness or symptoms of sleep disturbances. CONCLUSIONS These findings should be interpreted cautiously given the open-label design and small sample size, and should be examined in larger studies with more rigorous study designs.
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Affiliation(s)
- Mats Fredriksen
- Division of Mental Health & Addiction, Vestfold Hospital Trust, Tønsberg, Norway
| | | | | | - Knut Stavem
- Division of Medicine and Laboratory Sciences, Akershus University Hospital, Lørenskog, Norway.,Faculty of Medicine, University of Oslo, Oslo, Norway
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Overlapping sleep disturbances in persistent tic disorders and attention-deficit hyperactivity disorder: A systematic review and meta-analysis of polysomnographic findings. Neurosci Biobehav Rev 2021; 126:194-212. [PMID: 33766675 DOI: 10.1016/j.neubiorev.2021.03.018] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Revised: 03/16/2021] [Accepted: 03/18/2021] [Indexed: 12/28/2022]
Abstract
INTRODUCTION Persistent tic disorders (PTDs) and attention-deficit hyperactivity disorder (ADHD) are common neurodevelopmental conditions which tend to co-occur. Both diagnoses are associated with sleep problems. This systematic review and meta-analysis investigates overlaps and distinctions in objective sleep parameters based on diagnosis (PTD-only, PTD + ADHD, and ADHD-only). METHODS Databases were searched to identify studies with objective sleep measures in each population. Meta-analyses were conducted using a random effects model. RESULTS Polysomnography was the only measure included in all three groups. Twenty studies met final inclusion criteria, combining PTD-only (N = 108), PTD + ADHD (N = 79), and ADHD-only (N = 316). Compared to controls (N = 336), PTD-only and PTD + ADHD groups had significantly lower sleep efficiency and higher sleep onset latency. PTD + ADHD also had significantly increased time in bed and total sleep time. No significant differences were observed between ADHD-only groups and controls. DISCUSSION Different sleep profiles appear to characterise each population. PTD + ADHD was associated with more pronounced differences. Further research is required to elucidate disorder-specific sleep problems, ensuring appropriate identification and monitoring of sleep in clinical settings.
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Zaccari V, Santonastaso O, Mandolesi L, De Crescenzo F, Foti F, Crescentini C, Fabbro F, Vicari S, Curcio G, Menghini D. Clinical application of mindfulness-oriented meditation in children with ADHD: a preliminary study on sleep and behavioral problems. Psychol Health 2021; 37:563-579. [PMID: 33678073 DOI: 10.1080/08870446.2021.1892110] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
OBJECTIVE High incidence of sleep problems in children and adolescents with Attention-Deficit/Hyperactivity Disorder (ADHD) has been described. Mindfulness meditation has emerged as a novel approach to sleep disturbances and insomnia remediation. This preliminary study tested the efficacy of Mindfulness-Oriented Meditation (MOM) training on sleep quality and behavioral problems in children with ADHD. DESIGN Twenty-five children with ADHD aged 7-11 years underwent two programs three times per week for eight-weeks: the MOM training (15 children) and an Active Control Condition (10 children). MAIN OUTCOME MEASURES Objective and subjective measures of sleep quality and behavioral measures were collected before and after the programs. RESULTS Positive effects on sleep and behavioral measures were found only in the MOM group. CONCLUSION Although they are preliminary, our results indicate that MOM training is a promising tool for ameliorating sleep quality and behavioral manifestations in ADHD.
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Affiliation(s)
- Vittoria Zaccari
- Child and Adolescent Neuropsychiatry Unit, Department of Neuroscience, Bambino Gesù Children's Hospital, IRCCS, Roma, Italy
| | - Ornella Santonastaso
- Child and Adolescent Neuropsychiatry Unit, Department of Neuroscience, Bambino Gesù Children's Hospital, IRCCS, Roma, Italy
| | - Laura Mandolesi
- Department of Humanities, University of Naples Federico II, Napoli, Italy
| | - Franco De Crescenzo
- Department of Psychiatry, University of Oxford, Oxford, UK.,Clinical Trial Unit, University Department of Paediatrics, Bambino Gesù Children's Hospital, IRCCS, Roma, Italy.,Department of Epidemiology, Lazio Regional Health Service, Rome, Italy
| | - Francesca Foti
- Department of Medical and Surgical Sciences, Magna Graecia University of Catanzaro, Catanzaro, Italy
| | - Cristiano Crescentini
- Department of Languages and Literatures, Communication, Education and Society, University of Udine, Udine, Italy
| | - Franco Fabbro
- Department of Languages and Literatures, Communication, Education and Society, University of Udine, Udine, Italy
| | - Stefano Vicari
- Child and Adolescent Neuropsychiatry Unit, Department of Neuroscience, Bambino Gesù Children's Hospital, IRCCS, Roma, Italy.,Department of Life Science and Public Health, Università Cattolica del Sacro Cuore, Roma, Italy
| | - Giuseppe Curcio
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - Deny Menghini
- Child and Adolescent Neuropsychiatry Unit, Department of Neuroscience, Bambino Gesù Children's Hospital, IRCCS, Roma, Italy
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38
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Helfer B, Steel C. Underrated concepts and key research priorities in adult ADHD: Improving explanatory power and fostering progress. J Psychiatr Res 2021; 134:78-80. [PMID: 33370665 DOI: 10.1016/j.jpsychires.2020.12.047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Revised: 11/21/2020] [Accepted: 12/17/2020] [Indexed: 11/18/2022]
Affiliation(s)
- Bartosz Helfer
- National Heart and Lung Institute, Faculty of Medicine, Imperial College London, United Kingdom; Institute of Psychology, University of Wroclaw, Poland.
| | - Charlotte Steel
- Division of Psychiatry, University College London, United Kingdom; Surrey and Borders Partnership NHS Foundation Trust, United Kingdom
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Effects of Sleep on the Academic Performance of Children with Attention Deficit and Hyperactivity Disorder. Brain Sci 2021; 11:brainsci11010097. [PMID: 33451030 PMCID: PMC7828506 DOI: 10.3390/brainsci11010097] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2020] [Revised: 01/06/2021] [Accepted: 01/11/2021] [Indexed: 12/02/2022] Open
Abstract
Attention deficit and hyperactivity disorder (ADHD) is commonly associated with disordered or disturbed sleep and the association of sleep problems with ADHD is complex and multidirectional. The purpose of this study was to analyze the relationship between sleep and academic performance, comparing children with ADHD and a control group without ADHD. Academic performance in Spanish, mathematics, and a foreign language (English) was evaluated. Different presentations of ADHD were considered as well as the potential difference between weekday and weekend sleep habits. The sample consisted of 75 children aged 6–12 in primary education. Accelerometry was used to study sleep, and school grades were used to gather information about academic performance. The results showed that ADHD influenced the amount of sleep during weekends, the time getting up at the weekends, weekday sleep efficiency, as well as academic performance. Given the effects that were seen in the variables linked to the weekend, it is necessary to consider a longitudinal design with which to determine if there is a cause and effect relationship.
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Holdø I, Bramness JG, Handal M, Hansen BH, Hjellvik V, Skurtveit S. Association Between Prescribed Hypnotics in Infants and Toddlers and Later ADHD: A Large Cohort Study from Norway. Child Psychiatry Hum Dev 2021; 52:533-543. [PMID: 32772207 PMCID: PMC8238762 DOI: 10.1007/s10578-020-01039-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
As previously indicated an association may exist between early sleep problems in infants and toddlers, and a diagnosis of attention deficit hyperactivity disorder (ADHD). The aim of this study was to study if this association could be replicated in a complete nationwide cohort of children. Prospective cohort study using national registries. All children born in Norway from January 2004 to December 2010 were included (N = 410,555). Information on hypnotic drugs dispensed to children 0-3 years of age outside of institutions was collected from the Norwegian Prescription Database and used as a proxy for sleep problems. The outcome ADHD (ICD-10), as diagnosed by specialists in the Child Mental Health Service, was obtained from the Norwegian Patient Registry. Data were analysed using weighted estimation in Cox regression. The unadjusted weighted hazard ratio (wHR) for a later diagnosis of ADHD in children dispensed two or more prescriptions for any hypnotic drug, compared to zero prescriptions, was 2.30 [95% confidence interval (CI) 1.63-3.23] for girls and 1.75 (95% CI 1.48-2.07) for boys. For the sedative antihistamine trimeprazine the corresponding wHR was 3.71 (95% CI 1.83-7.52) for girls and 2.78 (95% CI 2.04-3.80) for boys. After adjusting for parental ADHD and parental education the wHR for trimeprazine users was 2.81 (95% CI 1.34-5.88) for girls and 2.33 (95% CI 1.70-3.20) for boys. Infants and toddlers who were dispensed hypnotics had an increased risk of ADHD at school age. This association was most pronounced with the use of trimeprazine, a drug traditionally prescribed to toddlers for sleep problems in Norway. After adjusting for parental ADHD and educational level the risk for ADHD among the trimeprazine users was still more than twice the risk among controls.
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Affiliation(s)
- Ingvild Holdø
- Norwegian Centre of Addiction Research, University of Oslo, Oslo, Norway
| | - Jørgen G. Bramness
- Norwegian National Advisory Unit on Concurrent Substance Abuse and Mental Health Disorders, Innlandet Hospital Trust, Hamar, Norway ,Institute of Clinical Medicine, UiT – Norway’s Arctic University, Tromsö, Norway ,Norwegian Institute of Public Health, Skøyen, P.O. Box 222, 0213 Oslo, Norway
| | - Marte Handal
- Norwegian Institute of Public Health, Skøyen, P.O. Box 222, 0213 Oslo, Norway
| | - Berit Hjelde Hansen
- Norwegian Center on Expertise for Neurodevelopmental Disorders and Hypersomnias, Oslo, Norway
| | - Vidar Hjellvik
- Norwegian Institute of Public Health, Skøyen, P.O. Box 222, 0213 Oslo, Norway
| | - Svetlana Skurtveit
- Norwegian Centre of Addiction Research, University of Oslo, Oslo, Norway ,Norwegian Institute of Public Health, Skøyen, P.O. Box 222, 0213 Oslo, Norway
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Dimakos J, Gauthier-Gagné G, Lin L, Scholes S, Gruber R. The Associations Between Sleep and Externalizing and Internalizing Problems in Children and Adolescents with Attention-Deficit/Hyperactivity Disorder: Empirical Findings, Clinical Implications, and Future Research Directions. Child Adolesc Psychiatr Clin N Am 2021; 30:175-193. [PMID: 33223061 DOI: 10.1016/j.chc.2020.08.001] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Sleep problems are common in youth with attention-deficit/hyperactivity disorder (ADHD). Externalizing and internalizing problems contribute to dysfunction in youth with ADHD and are amplified by disrupted sleep. This objective of this article is to synthesize empirical studies that examined the associations between sleep and internalizing or externalizing problems in individuals with ADHD. The main findings are that sleep problems precede, predict, and significantly contribute to the manifestation of internalizing and externalizing behavior problems among children and adolescents with ADHD. Clinicians should assess sleep and integrate sleep interventions into the management of youth with ADHD.
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Affiliation(s)
- Jenny Dimakos
- Attention, Behaviour and Sleep Lab, Douglas Mental Health University Institute, Montréal, Quebec H4H 1R3, Canada; Faculty of Medicine, Integrated Program in Neuroscience, McGill University, Montréal, Quebec, Canada
| | - Gabrielle Gauthier-Gagné
- Attention, Behaviour and Sleep Lab, Douglas Mental Health University Institute, Montréal, Quebec H4H 1R3, Canada
| | - Lanyi Lin
- Attention, Behaviour and Sleep Lab, Douglas Mental Health University Institute, Montréal, Quebec H4H 1R3, Canada
| | - Samantha Scholes
- Attention, Behaviour and Sleep Lab, Douglas Mental Health University Institute, Montréal, Quebec H4H 1R3, Canada; Department of Educational and Counselling Psychology, McGill University, Montréal, Quebec, Canada
| | - Reut Gruber
- Attention, Behaviour and Sleep Lab, Douglas Mental Health University Institute, Montréal, Quebec H4H 1R3, Canada; Department of Psychiatry, Faculty of Medicine, McGill University, Montréal, Quebec, Canada.
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The Role of the Circadian System in Attention Deficit Hyperactivity Disorder. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2021; 1344:113-127. [PMID: 34773229 DOI: 10.1007/978-3-030-81147-1_7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
Attention deficit hyperactivity disorder (ADHD) is a common neurodevelopmental condition characterised by the core symptoms of inattention, impulsivity and hyperactivity. Similar to many other neuropsychiatric conditions, ADHD is associated with very high levels of sleep disturbance. However, it is not clear whether such sleep disturbances are precursors to, or symptoms of, ADHD. Neither is it clear through which mechanisms sleep and ADHD are linked. One possible link is via modulation of circadian rhythms. In this chapter we overview the evidence that ADHD is associated with alterations in circadian processes, manifesting as later chronotype and delayed sleep phase in ADHD, and examine some mechanisms that may lead to such changes. We also interrogate how the circadian clock may be a substrate for therapeutic intervention in ADHD (chronotherapy) and highlight important new questions to be addressed to move the field forward.
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Sleep Variables as Predictors of Treatment Effectiveness and Side Effects of Stimulant Medication in Newly Diagnosed Children with Attention-Deficit/Hyperactivity Disorder. J Dev Behav Pediatr 2021; 42:1-8. [PMID: 33086338 DOI: 10.1097/dbp.0000000000000866] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2019] [Accepted: 08/01/2020] [Indexed: 11/26/2022]
Abstract
OBJECTIVE There is a growing body of research on the impact of stimulant medication on sleep in children with attention-deficit/hyperactivity disorder (ADHD). Negative sleep side effects are a common reason for nonadherence or for discontinuing a course of treatment. However, there is no published evidence as to whether pretreatment sleep can predict responses to treatment and the emergence of side effects. METHOD In this study, baseline sleep variables were used to predict therapeutic effect (i.e., reduction of ADHD symptoms) and side effects (both sleep and global side effects) in a sample of newly diagnosed, medication-naive children (n = 50). RESULTS The results of hierarchical regression analysis showed that parent-reported shorter sleep duration before medication treatment significantly predicted better response to treatment, independent of pretreatment ADHD symptoms. Baseline sleep features did not significantly predict global (nonsleep) side effects but did predict increased sleep side effects during treatment. CONCLUSION These results indicate that baseline sleep variables may be helpful in predicting therapeutic response to medication and sleep disturbance as a side effect of stimulant medication.
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Shen C, Luo Q, Chamberlain SR, Morgan S, Romero-Garcia R, Du J, Zhao X, Touchette É, Montplaisir J, Vitaro F, Boivin M, Tremblay RE, Zhao XM, Robaey P, Feng J, Sahakian BJ. What Is the Link Between Attention-Deficit/Hyperactivity Disorder and Sleep Disturbance? A Multimodal Examination of Longitudinal Relationships and Brain Structure Using Large-Scale Population-Based Cohorts. Biol Psychiatry 2020; 88:459-469. [PMID: 32414481 PMCID: PMC7445427 DOI: 10.1016/j.biopsych.2020.03.010] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2019] [Revised: 03/17/2020] [Accepted: 03/17/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND Attention-deficit/hyperactivity disorder (ADHD) comorbid with sleep disturbances can produce profound disruption in daily life and negatively impact quality of life of both the child and the family. However, the temporal relationship between ADHD and sleep impairment is unclear, as are underlying common brain mechanisms. METHODS This study used data from the Quebec Longitudinal Study of Child Development (n = 1601, 52% female) and the Adolescent Brain Cognitive Development Study (n = 3515, 48% female). Longitudinal relationships between symptoms were examined using cross-lagged panel models. Gray matter volume neural correlates were identified using linear regression. The transcriptomic signature of the identified brain-ADHD-sleep relationship was characterized by gene enrichment analysis. Confounding factors, such as stimulant drugs for ADHD and socioeconomic status, were controlled for. RESULTS ADHD symptoms contributed to sleep disturbances at one or more subsequent time points in both cohorts. Lower gray matter volumes in the middle frontal gyrus and inferior frontal gyrus, amygdala, striatum, and insula were associated with both ADHD symptoms and sleep disturbances. ADHD symptoms significantly mediated the link between these structural brain abnormalities and sleep dysregulation, and genes were differentially expressed in the implicated brain regions, including those involved in neurotransmission and circadian entrainment. CONCLUSIONS This study indicates that ADHD symptoms and sleep disturbances have common neural correlates, including structural changes of the ventral attention system and frontostriatal circuitry. Leveraging data from large datasets, these results offer new mechanistic insights into this clinically important relationship between ADHD and sleep impairment, with potential implications for neurobiological models and future therapeutic directions.
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Affiliation(s)
- Chun Shen
- Institute of Science and Technology for Brain-Inspired Intelligence, MOE Key Laboratory of Computational Neuroscience and Brain-Inspired Intelligence, Fudan University, Shanghai, China; Shanghai Research Center for Brain Science and Brain-Inspired Intelligence, Institute of Brain-Intelligence Technology, Zhangjiang Laboratory, Shanghai, China
| | - Qiang Luo
- Institute of Science and Technology for Brain-Inspired Intelligence, MOE Key Laboratory of Computational Neuroscience and Brain-Inspired Intelligence, Fudan University, Shanghai, China; State Key Laboratory of Medical Neurobiology and MOE Frontiers Center for Brain Science, Institutes of Brain Science and Human Phenome Institute, Fudan University, Shanghai, China; Behavioural and Clinical Neuroscience Institute, Department of Psychology, University of Cambridge, Cambridge, United Kingdom; Shanghai Research Center for Brain Science and Brain-Inspired Intelligence, Institute of Brain-Intelligence Technology, Zhangjiang Laboratory, Shanghai, China.
| | | | - Sarah Morgan
- Department of Psychiatry, University of Cambridge, Cambridge, United Kingdom; Alan Turing Institute, London, United Kingdom
| | | | - Jingnan Du
- Institute of Science and Technology for Brain-Inspired Intelligence, MOE Key Laboratory of Computational Neuroscience and Brain-Inspired Intelligence, Fudan University, Shanghai, China
| | - Xingzhong Zhao
- Institute of Science and Technology for Brain-Inspired Intelligence, MOE Key Laboratory of Computational Neuroscience and Brain-Inspired Intelligence, Fudan University, Shanghai, China
| | - Évelyne Touchette
- Department of Psychoeducation, Université du Québec à Trois-Rivières, Trois-Rivières, Québec, Canada
| | - Jacques Montplaisir
- Department of Psychiatry, Université de Montréal, Montréal, Québec, Canada; Center for Advanced Research in Sleep Medicine, CIUSSS-NIM, Montréal, Québec, Canada
| | - Frank Vitaro
- School of Psychoeducation, Université de Montréal, Montréal, Québec, Canada
| | - Michel Boivin
- School of Psychology, Université Laval, Québec City, Québec, Canada
| | - Richard E Tremblay
- Department of Pediatrics and Psychology, Université de Montréal, Montréal, Québec, Canada; School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin, Ireland
| | - Xing-Ming Zhao
- Institute of Science and Technology for Brain-Inspired Intelligence, MOE Key Laboratory of Computational Neuroscience and Brain-Inspired Intelligence, Fudan University, Shanghai, China
| | - Philippe Robaey
- Department of Psychiatry, Université de Montréal, Montréal, Québec, Canada; Department of Psychiatry, University of Ottawa, Ottawa, Ontario, Canada; Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
| | - Jianfeng Feng
- Institute of Science and Technology for Brain-Inspired Intelligence, MOE Key Laboratory of Computational Neuroscience and Brain-Inspired Intelligence, Fudan University, Shanghai, China; Collaborative Innovation Center for Brain Science, Fudan University, Shanghai, China; School of Mathematical Sciences, Fudan University, Shanghai, China; Department of Computer Science, University of Warwick, Coventry, United Kingdom; Shanghai Research Center for Brain Science and Brain-Inspired Intelligence, Institute of Brain-Intelligence Technology, Zhangjiang Laboratory, Shanghai, China.
| | - Barbara J Sahakian
- Institute of Science and Technology for Brain-Inspired Intelligence, MOE Key Laboratory of Computational Neuroscience and Brain-Inspired Intelligence, Fudan University, Shanghai, China; Behavioural and Clinical Neuroscience Institute, Department of Psychology, University of Cambridge, Cambridge, United Kingdom; Department of Psychiatry, University of Cambridge, Cambridge, United Kingdom
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Lugo J, Fadeuilhe C, Gisbert L, Setien I, Delgado M, Corrales M, Richarte V, Ramos-Quiroga JA. Sleep in adults with autism spectrum disorder and attention deficit/hyperactivity disorder: A systematic review and meta-analysis. Eur Neuropsychopharmacol 2020; 38:1-24. [PMID: 32712061 DOI: 10.1016/j.euroneuro.2020.07.004] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Revised: 05/21/2020] [Accepted: 07/06/2020] [Indexed: 02/02/2023]
Abstract
Sleep-related problems have been frequently reported in neurodevelopmental disorders, with special emphasis in Autism Spectrum Disorder (ASD) and Attention Deficit/Hyperactivity Disorder (ADHD). The aim of the present study is to conduct a systematic review and meta-analysis on sleep disturbances in adults with ASD and/or ADHD (PROSPERO's CRD42019132916). PubMed and PsycINFO were searched for studies reporting data on sleep objective/subjective measures, as well as prevalence data of sleep disorders, in adults with ASD and/or ADHD. A manual search was conducted throughout reference lists of eligible studies. A total of 1126 studies and 66 references were identified by electronic and manual searches, respectively. Of these, 42 studies were included in the meta-analysis. Results showed that both disorders share a similar sleep-impaired profile with higher sleep onset latency, poorer sleep efficiency, greater number of awakenings during sleep, and a general lower self-perceived sleep quality compared with healthy controls. A higher proportion of N1 sleep was found in ASD participants, while a greater Periodic Limb Movements in Sleep is specific in ADHD adults. More studies are needed, especially those directly comparing ASD and ADHD participants. Controlling for medication, intellectual disability, and concurrent psychiatric disorders is mandatory.
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Affiliation(s)
- Jorge Lugo
- Department of Psychiatry, Hospital Universitari Vall d'Hebron, Barcelona, Catalonia, Spain.
| | - Christian Fadeuilhe
- Department of Psychiatry, Hospital Universitari Vall d'Hebron, Barcelona, Catalonia, Spain; Psychiatric Genetics Unit, Vall d'Hebron Research Institute (VHIR), Barcelona, Catalonia, Spain; Department of Psychiatry and Legal Medicine, Universitat Autònoma de Barcelona, Barcelona, Catalonia, Spain
| | - Laura Gisbert
- Department of Psychiatry, Hospital Universitari Vall d'Hebron, Barcelona, Catalonia, Spain; Department of Psychiatry and Legal Medicine, Universitat Autònoma de Barcelona, Barcelona, Catalonia, Spain; Biomedical Network Research Centre on Mental Health (CIBERSAM), Madrid, Spain
| | - Imanol Setien
- Department of Psychiatry, Hospital Universitari Vall d'Hebron, Barcelona, Catalonia, Spain; Psychiatric Genetics Unit, Vall d'Hebron Research Institute (VHIR), Barcelona, Catalonia, Spain
| | - Mercedes Delgado
- Department of Psychiatry, Hospital Universitari Vall d'Hebron, Barcelona, Catalonia, Spain
| | - Montserrat Corrales
- Department of Psychiatry, Hospital Universitari Vall d'Hebron, Barcelona, Catalonia, Spain; Psychiatric Genetics Unit, Vall d'Hebron Research Institute (VHIR), Barcelona, Catalonia, Spain; Department of Psychiatry and Legal Medicine, Universitat Autònoma de Barcelona, Barcelona, Catalonia, Spain; Biomedical Network Research Centre on Mental Health (CIBERSAM), Madrid, Spain
| | - Vanesa Richarte
- Department of Psychiatry, Hospital Universitari Vall d'Hebron, Barcelona, Catalonia, Spain; Psychiatric Genetics Unit, Vall d'Hebron Research Institute (VHIR), Barcelona, Catalonia, Spain; Department of Psychiatry and Legal Medicine, Universitat Autònoma de Barcelona, Barcelona, Catalonia, Spain; Biomedical Network Research Centre on Mental Health (CIBERSAM), Madrid, Spain
| | - Josep Antoni Ramos-Quiroga
- Department of Psychiatry, Hospital Universitari Vall d'Hebron, Barcelona, Catalonia, Spain; Psychiatric Genetics Unit, Vall d'Hebron Research Institute (VHIR), Barcelona, Catalonia, Spain; Department of Psychiatry and Legal Medicine, Universitat Autònoma de Barcelona, Barcelona, Catalonia, Spain; Biomedical Network Research Centre on Mental Health (CIBERSAM), Madrid, Spain.
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Gaur S, Pallanti S. Treatment Outcomes in an Adult Attention Deficit Hyperactivity Disorder Clinic With a Focus on Executive Functioning and Sluggish Cognitive Tempo. Cureus 2020; 12:e9814. [PMID: 32953325 PMCID: PMC7494416 DOI: 10.7759/cureus.9814] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Accepted: 08/17/2020] [Indexed: 12/18/2022] Open
Abstract
Aim Executive function (EF) is considered a core attention deficit hyperactivity disorder (cADHD) symptom in adults and, more recently, sluggish cognitive tempo (SCT). Despite considerable controversy around the role of SCT symptoms in the diagnosis of attention deficit hyperactivity disorder (ADHD), some scholars have suggested that SCT symptoms are a subset of the ADHD syndrome, whereas others have suggested that SCT is an entirely unique type of attention disorder. Therefore, we looked to characterize the impact of treatment as usual (TAU) with medication and psychoeducation on the functional impairments related to EF and SCT, and related functional impairments in adults with ADHD. We aim to clarify if the combination of TAU and modular ADHD therapy (TAUTx) further improves these symptoms. The goal is to assess the validity of self-reporting assessment of symptoms adopted in the present for the monitoring of treatment in this population. Methods We implemented the inclusion and exclusion criteria at the onset of the clinic. This prospective cohort case series study is designed to see the difference with self-reporting scales for EF, SCT, and cADHD symptoms in TAU and TAUTx. The STrengthening the Reporting of OBservational studies in Epidemiology (STROBE) checklist was used to provide transparency in reporting the data. Results Adults with ADHD showed a significant improvement with TAU in EF (p=0.001), cADHD (p=0.007), and SCT (p=0.002). Furthermore, TAUTx improved areas of EF (p=0.001), cADHD (p=0.004), and SCT (p=0.002). We saw a significant benefit from starting/optimizing medications in the treatment of ADHD along with psychoeducation. Self-reporting scales appeared to be reliable for monitoring the symptoms of ADHD and related dysfunction and were consistent with the Clinical Global Impressions Scale. Conclusions Adult ADHD patients reported significant benefit from TAU for aspects of impairment in EF and SCT. They require ongoing medication prescribing and "tailoring" through optimization. Psychoeducation is an effective form of therapy in these patients with or without the addition of adult ADHD modular therapy. Self-reporting is valid for monitoring and providing transparency in patient care.
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Affiliation(s)
- Sonia Gaur
- Psychiatry, Stanford University, Stanford, USA
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47
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Martella D, Aldunate N, Fuentes LJ, Sánchez-Pérez N. Arousal and Executive Alterations in Attention Deficit Hyperactivity Disorder (ADHD). Front Psychol 2020; 11:1991. [PMID: 32903419 PMCID: PMC7434859 DOI: 10.3389/fpsyg.2020.01991] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Accepted: 07/17/2020] [Indexed: 12/27/2022] Open
Abstract
Attention deficit hyperactivity disorder (ADHD) is the most common neurobehavioral disorder in childhood and can significantly affect a child's personal and social development and academic achievement. Taking into account the model of attentional networks proposed by Posner et al., the aim of the present study was to review the literature regarding two main explicative models of ADHD, i.e., the inhibition model and the cognitive-energetic model, by discussing behavioral and neurological evidence of both models and the limitations of each model. The review highlights evidence that favors the energetic model and points to an unstable arousal as a potential pathogenetic factor in ADHD.
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Affiliation(s)
- Diana Martella
- Facultad de Ciencias Sociales y Humanidades, Instituto de Estudios Sociales y Humanísticos, Universidad Autónoma de Chile, Santiago, Chile
| | - Nerea Aldunate
- Escuela de Psicología, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Luis J. Fuentes
- Departamento de Psicología Básica y Metodología, Facultad de Psicología, Universidad de Murcia, Murcia, Spain
| | - Noelia Sánchez-Pérez
- Departamento de Psicología y Sociología, Facultad de Ciencias Sociales y Humanas, Universidad de Zaragoza, Teruel, Spain
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Lundervold AJ, Jensen DA, Haavik J. Insomnia, Alcohol Consumption and ADHD Symptoms in Adults. Front Psychol 2020; 11:1150. [PMID: 32536897 PMCID: PMC7269111 DOI: 10.3389/fpsyg.2020.01150] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2020] [Accepted: 05/05/2020] [Indexed: 12/03/2022] Open
Abstract
Introduction Substance use disorders and insomnia are common in the general population, and particularly among adults with attention-deficit/hyperactivity disorder (ADHD). Here we investigated the relationship between insomnia, alcohol consumption and ADHD symptoms. Methods Adults with an ADHD diagnosis (n = 235, 41.3% males) and controls (n = 184, 38% males) completed a questionnaire assessing insomnia (Bergen Insomnia Scale), alcohol consumption (Alcohol Use Disorders Identification Test), and current ADHD symptoms (Adult ADHD Self-report Scale). The majority of the sample (95%) gave additional information about childhood ADHD symptoms (Wender Utah Rating Scale), and information about lifetime occurrence of an internalizing disorder was included as part of background information. Results Compared to controls, the ADHD group reported a higher frequency of insomnia, a higher quantity of consumed alcohol and a higher frequency of internalizing disorders. Current and childhood ADHD symptoms were more severe in those with than without insomnia. Scores on ADHD symptom scales were explained by the presence of insomnia and internalizing disorders, while the contribution from alcohol consumption was restricted to the control group. Discussion The high functional impact of insomnia, alcohol misuse and internalizing disorders is well known. The present study contributed by focusing on their relations to ADHD symptoms, and by showing that strong relations were not restricted to adults with a clinical ADHD diagnosis. By this, the results put a critical light on a categorical delineation between adults with an ADHD diagnosis and population selected controls, and call for further studies including dimensional metrics of ADHD symptoms and co-occurring problems.
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Affiliation(s)
- Astri J Lundervold
- Department of Biological and Medical Psychology, University of Bergen, Bergen, Norway
| | - Daniel A Jensen
- Department of Biological and Medical Psychology, University of Bergen, Bergen, Norway
| | - Jan Haavik
- Department of Biomedicine, University of Bergen, Bergen, Norway.,Division of Psychiatry, Haukeland University Hospital, Bergen, Norway
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Souto-Souza D, Mourão PS, Barroso HH, Douglas-de-Oliveira DW, Ramos-Jorge ML, Falci SGM, Galvão EL. Is there an association between attention deficit hyperactivity disorder in children and adolescents and the occurrence of bruxism? A systematic review and meta-analysis. Sleep Med Rev 2020; 53:101330. [PMID: 32554210 DOI: 10.1016/j.smrv.2020.101330] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2019] [Revised: 03/09/2020] [Accepted: 03/10/2020] [Indexed: 11/17/2022]
Abstract
Aim of the present systematic review was to evaluate whether children and adolescents with attention-deficit/hyperactivity disorder (ADHD) are at greater chance of developing bruxism compared to individuals without this disorder. Observational studies that evaluated the occurrence of bruxism in children and adolescents with ADHD were included. The quality of the evidence was evaluated using the Grading of Recommendations, Assessment, Development and Evaluation criteria. Thirty-two studies involving a total of 2629 children/adolescents with ADHD and 1739 with bruxism (1629 with sleep bruxism and 110 with awake bruxism) were included. The prevalence of bruxism, irrespective of type, in the children/adolescents was 31% (95% CI: 0.22-0.41, I2 = 93%). ADHD was associated with an increased chance of bruxism (OR: 2.94, 95% CI: 2.12-4.07, I2 = 61%), independently of the type [sleep bruxism (OR: 2.77, 95% CI: 1.90-4.03, I2 = 66%) or awake bruxism (OR: 10.64, 95% CI: 2.41-47.03, I2 = 65%)]. The presence of signs of ADHD without a diagnostic confirmation was not associated with an increased chance of bruxism (OR: 3.26, 95% CI: 0.76-14.04, I2 = 61%). Children and adolescents with a definitive diagnosis of ADHD are at greater chance of developing sleep and awake bruxism than those without this disorder.
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Affiliation(s)
- Debora Souto-Souza
- Post-Graduate Program in Dentistry, Universidade Federal dos Vales do Jequitinhonha e Mucuri, 39100-000, Diamantina, Minas Gerais, Brazil.
| | - Priscila S Mourão
- Post-Graduate Program in Dentistry, Universidade Federal dos Vales do Jequitinhonha e Mucuri, 39100-000, Diamantina, Minas Gerais, Brazil
| | - Heloisa H Barroso
- Post-Graduate Program in Dentistry, Universidade Federal dos Vales do Jequitinhonha e Mucuri, 39100-000, Diamantina, Minas Gerais, Brazil
| | - Dhelfeson W Douglas-de-Oliveira
- Department of Dentistry, Universidade Federal dos Vales do Jequitinhonha e Mucuri, 39100-000, Diamantina, Minas Gerais, Brazil
| | - Maria L Ramos-Jorge
- Department of Dentistry, Universidade Federal dos Vales do Jequitinhonha e Mucuri, 39100-000, Diamantina, Minas Gerais, Brazil
| | - Saulo G M Falci
- Department of Dentistry, Universidade Federal dos Vales do Jequitinhonha e Mucuri, 39100-000, Diamantina, Minas Gerais, Brazil
| | - Endi L Galvão
- Post-Graduate Program in Dentistry, Universidade Federal dos Vales do Jequitinhonha e Mucuri, 39100-000, Diamantina, Minas Gerais, Brazil
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Martins R, Scalco JC, Ferrari Junior GJ, Gerente JGDS, Costa MDL, Beltrame TS. Sleep disturbance in children with attention-deficit hyperactivity disorder: A systematic review. SLEEP SCIENCE (SAO PAULO, BRAZIL) 2020; 12:295-301. [PMID: 32318251 PMCID: PMC7159075 DOI: 10.5935/1984-0063.20190088] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/04/2022]
Abstract
The aim of the present systematic review was to compare sleep disorders in children, from 7 to 12 years old, with and without an attention-deficithyperactivity disorder (ADHD) diagnosis. Electronic literature search of PubMed, LILACS, Scopus, Web of Science and Cochrane Library databases was conducted in September 2017. We included cross-sectional observational studies comparing the sleep of children between 7 and 12 years old, with and without an ADHD diagnosis, reported according to the Diagnostic and Statistical Manual of Mental Disorders criteria. The studies with other research designs, those that included adolescents and/or adults in the sample and those who evaluated the sleep of children with ADHD and other associated comorbidities were excluded. A total of 1911 articles were identified. After analyzing, 8 articles were compatible with the theme and included in the review. For sleep evaluation, most of the studies used an objective measure together with another subjective measure. Three out of six studies that used objective measures did not observe any differences between children with and without ADHD diagnosis. Children with ADHD presented more sleep disturbances when compared to children without the diagnosis. These disorders were diverse, yet inconsistent among the surveys. More studies are needed to clarify and for robust results.
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Affiliation(s)
- Renata Martins
- MSc. In Physiotherapy at Santa Catarina State University, Florianópolis/SC/Brazil
| | | | | | | | - Matheus da Lapa Costa
- BSc. in Physical Education at Santa Catarina State University, Florianópolis/SC/Brazil
| | - Thaís Silva Beltrame
- Professor Dr. at Physical Education Department and Post-Graduation Program in Human Movement Science at Santa Catarina State University, Florianópolis /SC/ Brazil
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