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Leman TY, Barden S, Swisher VS, Joyce DS, Kaplan KA, Zeitzer JM, Loo SK, Ricketts EJ. Sleep insufficiency and bedtime irregularity in children with ADHD: A population-based analysis. Sleep Med 2024; 121:117-126. [PMID: 38959718 DOI: 10.1016/j.sleep.2024.06.015] [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] [Received: 03/05/2024] [Revised: 06/09/2024] [Accepted: 06/14/2024] [Indexed: 07/05/2024]
Abstract
BACKGROUND Sleep is impaired in children with attention-deficit/hyperactivity disorder (ADHD). However, population-based examination of indicators of sleep insufficiency and bedtime irregularity is limited. This investigation examined associations between ADHD, weeknight sleep insufficiency, and bedtime irregularity in a nationally-representative child sample, and indicators of these sleep outcomes in ADHD. METHODS Parents of children aged 3-17 years with ADHD (n = 7671) were surveyed through the 2020-2021 National Survey of Children's Health. Inverse probability of treatment weighting generated a weighted matched control sample (n = 51,572). Weighted generalized linear models were performed without and with age-stratification to examine associations between ADHD and sleep, adjusting for sociodemographics in the full sample, and between nineteen sociodemographic and clinical variables and sleep in ADHD. RESULTS Having ADHD was associated with increased odds of sleep insufficiency and bedtime irregularity relative to controls, even after adjusting for sociodemographic variables. In ADHD, older age was associated with lower sleep insufficiency and greater bedtime irregularity. Black race, increased poverty, higher ADHD severity, depression, and increased screen time were associated with greater sleep insufficiency and bedtime irregularity. Adverse childhood experiences (ACEs) were associated with greater sleep insufficiency. Behavioral/conduct problems, female sex, and absence of both ADHD medication use and ASD diagnosis were associated with poorer bedtime irregularity. Age-stratified results are reported in text. CONCLUSIONS Children with ADHD face heightened risk for insufficient sleep and irregular bedtimes. Findings suggest intervention targets (e.g., Black race, poverty, depression, screen time) to improve both sleep insufficiency and bedtime irregularity. Results highlight ACEs and behavioral/conduct problems as targets to improve sleep insufficiency and bedtime regularity, respectively. Age-stratified findings are discussed.
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Affiliation(s)
- Talia Y Leman
- Department of Psychological and Brain Sciences, University of Iowa, USA
| | - Sophia Barden
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, USA
| | - Valerie S Swisher
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, USA
| | - Daniel S Joyce
- Centre for Health Research and School of Psychology and Wellbeing, University of Southern Queensland, Ipswich, Australia
| | - Katherine A Kaplan
- Department of Psychiatry and Behavioral Sciences, Stanford University, USA
| | - Jamie M Zeitzer
- Department of Psychiatry and Behavioral Sciences, Stanford University, USA
| | - Sandra K Loo
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, USA
| | - Emily J Ricketts
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, USA.
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Paulsrud C, Thorsen SU, Helms P, Weis MSF, Karacan MN, Lydolph SR, Ranjan AG, Leonthin H, Jennum PJ, Svensson J, Mol Debes N. Validation of the newly developed Sleep Screening Questionnaire Children and Adolescents (SSQ-CA) with objective sleep measures. Sleep Med 2023; 112:359-367. [PMID: 37979560 DOI: 10.1016/j.sleep.2023.10.010] [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] [Received: 06/27/2023] [Revised: 10/03/2023] [Accepted: 10/08/2023] [Indexed: 11/20/2023]
Abstract
OBJECTIVES Objectively validated pediatric sleep questionnaires covering a broader age range and different sleep disturbances are lacking, therefore we developed the Sleep Screening Questionnaire Children and Adolescents (SSQ-CA) and compared it with objective sleep parameters. METHODS This child-reported questionnaire was developed by a multidisciplinary panel and face validated. In a cross-sectional prospective design, participants aged 6-17, answered the questionnaire twice with 21-28 days in between, wore actigraphy (AG) and kept a sleep diary for seven nights and home-polysomnography (PSG) for one of these nights. Exploratory factor analyses (EFA), reliability and validity assessments were performed. RESULTS Of the 139 participants, 128 (F:47.7%, AG: n = 128, PSG: n = 59), were included in the analyses. Mean age: 11.3 years (SD: 2.9). EFA revealed 11 factors and 40 items loading above r = 0.4. Subscale internal consistency: 0.54-0.92. Subscale test-retest reliability: r = 0.71-0.87. Total sleep time (TST) from SSQ-CA on weekdays correlated with PSG (r = 0.48, p = 0.001) and with AG (r = 0.75, p < 0.001). The subscale total score for "Sleep duration and latency" correlated with TST from AG (r = -0.19, p = 0.03) and sleep latency (r = 0.31, p < 0.001), but not for PSG variables. The subscale "Awakenings" showed no correlation with objective measures whereas "Circadian rhythm" correlated to AG-derived mid-sleep time (r = 0.34, p < 0.001). CONCLUSIONS The SSQ-CA shows adequate reliability for the 6-17-year-olds and acceptable criterion validity for two subscales. It appears to be a useful tool for screening for sleep disturbances in combination with objective tools as the subjective and objective parameters seem to uncover different aspects of sleep.
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Affiliation(s)
- Cecilie Paulsrud
- Steno Diabetes Center Copenhagen, Denmark; Department of Pediatrics, Herlev and Gentofte University Hospital, Denmark.
| | | | - Pernille Helms
- Steno Diabetes Center Copenhagen, Denmark; Department of Pediatrics, Herlev and Gentofte University Hospital, Denmark
| | - Mia Sofie F Weis
- Steno Diabetes Center Copenhagen, Denmark; Department of Pediatrics, Herlev and Gentofte University Hospital, Denmark
| | - Munise N Karacan
- Department of Pediatrics, Herlev and Gentofte University Hospital, Denmark
| | - Siff R Lydolph
- Department of Pediatrics, Herlev and Gentofte University Hospital, Denmark
| | | | | | | | - Jannet Svensson
- Steno Diabetes Center Copenhagen, Denmark; Department of Pediatrics, Herlev and Gentofte University Hospital, Denmark
| | - Nanette Mol Debes
- Department of Pediatrics, Herlev and Gentofte University Hospital, Denmark; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
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Liang X, Qiu H, Li SX. Objectively measured sleep continuity in children and adolescents with ADHD: A systematic review and meta-analysis. Psychiatry Res 2023; 328:115447. [PMID: 37657199 DOI: 10.1016/j.psychres.2023.115447] [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] [Received: 03/30/2023] [Revised: 08/25/2023] [Accepted: 08/27/2023] [Indexed: 09/03/2023]
Abstract
Sleep disturbances are often linked to attention-deficit/hyperactivity disorder (ADHD). Consistent findings document that children and adolescents with ADHD report more sleep problems than their typically developing (TD) peers across subjective sleep domains. However, few differences between these groups were observed in objectively measured sleep parameters, such as polysomnography (PSG) and actigraphy. This study synthesized empirical studies to identify objectively measured sleep continuity differences between children and adolescents with ADHD and TD. We included observational research and baseline data from intervention studies between 5- to 18-year-old individuals with ADHD and their TD peers at five databases from inception and September 2022. This systematic review and meta-analysis of 45 articles, including 1622 children and adolescents with ADHD and 2013 TD, found that compared with TD, children and adolescents with ADHD have higher sleep latency and moderately decreased sleep efficiency measured by actigraphy. Polysomnography-measured differences between ADHD and TD were not significant. Medication status and comorbid psychiatric status significantly moderated the group differences in sleep efficiency between ADHD and TD. Also, the group differences in sleep latency between ADHD and TD were moderated by actigraphy recorded nights. These findings highlight the importance of reducing disparities in sleep parameters among children and adolescents with and without ADHD.
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Affiliation(s)
- Xiao Liang
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong SAR, China.
| | - Hui Qiu
- Department of Educational Administration and Policy, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Shirley Xin Li
- Department of Psychology, University of Hong Kong, Hong Kong SAR, China; State Key Laboratory of Brain and Cognitive Sciences, University of Hong Kong, Hong Kong SAR, China
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Sidol CA, Becker SP, Peugh JL, Lynch JD, Ciesielski HA, Zoromski AK, Epstein JN. Examining bidirectional associations between sleep and behavior among children with attention-deficit/hyperactivity disorder. JCPP ADVANCES 2023; 3:e12157. [PMID: 37753159 PMCID: PMC10519735 DOI: 10.1002/jcv2.12157] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Accepted: 02/13/2023] [Indexed: 09/28/2023] Open
Abstract
Background Children with attention-deficit/hyperactivity disorder (ADHD) have more sleep problems than their peers which contribute to behavioral and functional impairments. This study examines the bidirectional relationship between nightly sleep (i.e., total sleep time and sleep efficiency) and daily behavior of children with ADHD. Method Forty-three children (ages 6-13 [mean = 9.05, 54% male, 77% medicated]) participated in a 2-week study during an ADHD Summer Treatment Program (STP). Sleep was measured with actigraphy. Behavior was assessed using STP clinical data and daily parent and counselor ratings of ADHD symptoms, oppositional defiant disorder behaviors, and emotion regulation (e.g., difficulty regulating emotional disposition and controlling emotions). We hypothesized that healthier night's sleep measured by actigraphy (i.e., sleep efficiency and total sleep time [TST]) would relate to less ADHD symptoms, less emotional dysregulation, and better academic performance the next day. Additionally, we hypothesized that less ADHD symptoms, less emotional dysregulation, and greater academic performance would relate to healthier sleep that night. Results Higher nightly sleep efficiency was related to improved parent-ratings of ADHD the next day (R 2 = 0.04, p = 0.04) and improved parent-ratings of ADHD during the day lead to higher sleep efficiency that night (R 2 = 0.002, p = 0.02). Higher rates of daily assignment completion were related to higher sleep efficiency at night (R 2 = 0.035, p = 0.03). TST was not related to any behavioral outcomes. Conclusion Sleep efficiency may be more relevant than TST to behavioral performance the next day. Additionally, a bidirectional relationship exists between sleep efficiency and parent ratings of ADHD. Findings highlight the importance of assessing for manifestations of poor sleep efficiency, waking minutes, and wakings after sleep onset when diagnosing and treating ADHD.
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Affiliation(s)
- Craig A. Sidol
- Division of Behavioral Medicine and Clinical PsychologyCincinnati Children's Hospital Medical CenterCincinnatiOhioUSA
- Department of PsychologyUniversity of CincinnatiCincinnatiOhioUSA
| | - Stephen P. Becker
- Division of Behavioral Medicine and Clinical PsychologyCincinnati Children's Hospital Medical CenterCincinnatiOhioUSA
- Department of PediatricsUniversity of Cincinnati College of MedicineCincinnatiOhioUSA
| | - James L. Peugh
- Division of Behavioral Medicine and Clinical PsychologyCincinnati Children's Hospital Medical CenterCincinnatiOhioUSA
- Department of PediatricsUniversity of Cincinnati College of MedicineCincinnatiOhioUSA
| | - James D. Lynch
- Department of PsychologyUniversity of CincinnatiCincinnatiOhioUSA
| | - Heather A. Ciesielski
- Division of Behavioral Medicine and Clinical PsychologyCincinnati Children's Hospital Medical CenterCincinnatiOhioUSA
- Department of PediatricsUniversity of Cincinnati College of MedicineCincinnatiOhioUSA
| | - Allison K. Zoromski
- Division of Behavioral Medicine and Clinical PsychologyCincinnati Children's Hospital Medical CenterCincinnatiOhioUSA
- Department of PediatricsUniversity of Cincinnati College of MedicineCincinnatiOhioUSA
| | - Jeffery N. Epstein
- Division of Behavioral Medicine and Clinical PsychologyCincinnati Children's Hospital Medical CenterCincinnatiOhioUSA
- Department of PsychologyUniversity of CincinnatiCincinnatiOhioUSA
- Department of PediatricsUniversity of Cincinnati College of MedicineCincinnatiOhioUSA
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Arias-Mera C, Paillama-Raimán D, Lucero-González N, Leiva-Bianchi M, Avello-Sáez D. Relation between sleep disorders and attention deficit disorder with hyperactivity in children and adolescents: A systematic review. RESEARCH IN DEVELOPMENTAL DISABILITIES 2023; 137:104500. [PMID: 37075589 DOI: 10.1016/j.ridd.2023.104500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Accepted: 04/03/2023] [Indexed: 05/03/2023]
Abstract
BACKGROUND Sleep problems have a high recurrence in children and adolescents with attention deficit disorder with hyperactivity (ADHD) experience high rates of sleep problems. OBJECTIVE Understand the relationship between sleep disorders and ADHD symptoms. METHODS AND PROCEDURES A systematic review was performed using electronic databases, including PubMed, Cochrane Library, Scopus, Lilacs, and Psychology Database (ProQuest) systems. The quality of each article was assessed using a 5-criteria checklist, measuring relevant dimensions. OUTCOMES AND RESULTS The review analyzed fifteen articles, were included that raised the realizations among sleep problems in the population of children with ADHD, obtaining a total of 1645 children and adolescents with ADHD that were compared with typical development groups. The articles selected for this systematic review of observational design have a high quality. CONCLUSIONS AND IMPLICATIONS Children and adolescents with ADHD have sleep problems, which may exacerbate or be the cause of the ADHD clinic, affecting the quality of life of children and their families. Early inquiry and a timely approach can contribute to reducing the severity of ADHD symptoms.
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Affiliation(s)
| | - Daniel Paillama-Raimán
- Department of Sociology, Political Sciences and Public Administration, Social Sciences and Humanities Faculty, Universidad Católica de Temuco, Temuco, Chile
| | - Nayadet Lucero-González
- Occupational Therapy School, Department of Health Sciences, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | | | - Daniela Avello-Sáez
- Occupational Therapy School, Department of Health Sciences, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile.
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Jiang Y, Guo L, Lai W, Li Y, Sun X, Zhao H, Shi J, Zhang C, Huang X, Lu C, Zhu L. Association of emotional and behavioral problems with sleep disturbance among Chinese adolescents: The moderation effect of academic performance. J Affect Disord 2023; 330:94-100. [PMID: 36868389 DOI: 10.1016/j.jad.2023.02.136] [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: 05/05/2022] [Revised: 02/22/2023] [Accepted: 02/24/2023] [Indexed: 03/05/2023]
Abstract
BACKGROUND This study aimed to explore the association of emotional and behavioral problems with sleep disturbance among Chinese adolescents, and to test whether these associations vary with adolescents' academic performance. METHODS Data were from the 2021 School-based Chinese Adolescents Health Survey using a multistage, stratified-cluster, and random-sampling method to collect information from 22,684 middle school students in Guangdong Province, China. RESULTS Emotional problems (aOR = 1.34, 95 % CI = 1.32-1.36), conduct problems (aOR = 1.19, 95 % CI = 1.16-1.21), hyperactivity (aOR = 1.35, 95 % CI = 1.33-1.37), and peer problems (aOR = 1.06, 95 % CI = 1.04-1.09) were significantly associated with the increased risk of sleep disturbance among middle school students in Guangdong Province. The prevalence of sleep disturbance among adolescents was 29.4 %. There were significant interactions of emotional problems/conduct problems/peer problems/prosocial behavior with academic performance on sleep disturbance. Further stratification analyses by academic performance showed that adolescents with self-reported good academic performance had a higher risk of sleep disturbance than those students with self-reported average or poor academic performance. LIMITATIONS This study only included school students and used the cross-sectional design to preclude causality determination. CONCLUSIONS Our findings suggest that emotional and behavioral problems elevate the risk of sleep disturbance in adolescents. Adolescent academic performance plays a modulating role in these above-mentioned significant associations for sleep disturbance.
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Affiliation(s)
- Yunbin Jiang
- Department of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, China; Guangdong Provincial Key Laboratory of Food, Nutrition and Health, Sun Yat-sen University, Guangzhou, China
| | - Lan Guo
- Department of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, China; Guangdong Provincial Key Laboratory of Food, Nutrition and Health, Sun Yat-sen University, Guangzhou, China
| | - Wenjian Lai
- Department of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, China; Guangdong Provincial Key Laboratory of Food, Nutrition and Health, Sun Yat-sen University, Guangzhou, China
| | - Yanzhi Li
- Department of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, China; Guangdong Provincial Key Laboratory of Food, Nutrition and Health, Sun Yat-sen University, Guangzhou, China
| | - Xinchang Sun
- Department of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, China; Guangdong Provincial Key Laboratory of Food, Nutrition and Health, Sun Yat-sen University, Guangzhou, China
| | - Hao Zhao
- Department of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, China; Guangdong Provincial Key Laboratory of Food, Nutrition and Health, Sun Yat-sen University, Guangzhou, China
| | - Jingman Shi
- Department of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, China; Guangdong Provincial Key Laboratory of Food, Nutrition and Health, Sun Yat-sen University, Guangzhou, China
| | - Caiyun Zhang
- Department of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, China; Guangdong Provincial Key Laboratory of Food, Nutrition and Health, Sun Yat-sen University, Guangzhou, China
| | - Xinyu Huang
- Department of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, China; Guangdong Provincial Key Laboratory of Food, Nutrition and Health, Sun Yat-sen University, Guangzhou, China
| | - Ciyong Lu
- Department of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, China; Guangdong Provincial Key Laboratory of Food, Nutrition and Health, Sun Yat-sen University, Guangzhou, China.
| | - Liqing Zhu
- Shenzhen Nanshan District Chronic Disease Prevention and Control Hospital, Shenzhen, Guangdong, China.
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Schick A, Rauschenberg C, Ader L, Daemen M, Wieland LM, Paetzold I, Postma MR, Schulte-Strathaus JCC, Reininghaus U. Novel digital methods for gathering intensive time series data in mental health research: scoping review of a rapidly evolving field. Psychol Med 2023; 53:55-65. [PMID: 36377538 PMCID: PMC9874995 DOI: 10.1017/s0033291722003336] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Revised: 09/13/2022] [Accepted: 10/05/2022] [Indexed: 11/16/2022]
Abstract
Recent technological advances enable the collection of intensive longitudinal data. This scoping review aimed to provide an overview of methods for collecting intensive time series data in mental health research as well as basic principles, current applications, target constructs, and statistical methods for this type of data.In January 2021, the database MEDLINE was searched. Original articles were identified that (1) used active or passive data collection methods to gather intensive longitudinal data in daily life, (2) had a minimum sample size of N ⩾ 100 participants, and (3) included individuals with subclinical or clinical mental health problems.In total, 3799 original articles were identified, of which 174 met inclusion criteria. The most widely used methods were diary techniques (e.g. Experience Sampling Methodology), various types of sensors (e.g. accelerometer), and app usage data. Target constructs included affect, various symptom domains, cognitive processes, sleep, dysfunctional behaviour, physical activity, and social media use. There was strong evidence on feasibility of, and high compliance with, active and passive data collection methods in diverse clinical settings and groups. Study designs, sampling schedules, and measures varied considerably across studies, limiting the generalisability of findings.Gathering intensive longitudinal data has significant potential to advance mental health research. However, more methodological research is required to establish and meet critical quality standards in this rapidly evolving field. Advanced approaches such as digital phenotyping, ecological momentary interventions, and machine-learning methods will be required to efficiently use intensive longitudinal data and deliver personalised digital interventions and services for improving public mental health.
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Affiliation(s)
- Anita Schick
- Department of Public Mental Health, Medical Faculty Mannheim, Central Institute of Mental Health, Heidelberg University, Heidelberg, Germany
| | - Christian Rauschenberg
- Department of Public Mental Health, Medical Faculty Mannheim, Central Institute of Mental Health, Heidelberg University, Heidelberg, Germany
| | - Leonie Ader
- Department of Public Mental Health, Medical Faculty Mannheim, Central Institute of Mental Health, Heidelberg University, Heidelberg, Germany
| | - Maud Daemen
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University, Maastricht, The Netherlands
| | - Lena M. Wieland
- Department of Public Mental Health, Medical Faculty Mannheim, Central Institute of Mental Health, Heidelberg University, Heidelberg, Germany
| | - Isabell Paetzold
- Department of Public Mental Health, Medical Faculty Mannheim, Central Institute of Mental Health, Heidelberg University, Heidelberg, Germany
| | - Mary Rose Postma
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University, Maastricht, The Netherlands
| | - Julia C. C. Schulte-Strathaus
- Department of Public Mental Health, Medical Faculty Mannheim, Central Institute of Mental Health, Heidelberg University, Heidelberg, Germany
| | - Ulrich Reininghaus
- Department of Public Mental Health, Medical Faculty Mannheim, Central Institute of Mental Health, Heidelberg University, Heidelberg, Germany
- Centre for Epidemiology and Public Health, Health Service and Population Research Department, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
- ESRC Centre for Society and Mental Health, King's College London, London, UK
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Gruber R, Salamon L, Tauman R, Al-Yagon M. Sleep Disturbances in Adolescents with Attention-Deficit/Hyperactivity Disorder. Nat Sci Sleep 2023; 15:275-286. [PMID: 37113558 PMCID: PMC10126718 DOI: 10.2147/nss.s386435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Accepted: 01/23/2023] [Indexed: 04/29/2023] Open
Abstract
Introduction Delayed sleep phase syndrome (DSPS) and insomnia disorders are prevalent in adolescents and are comorbid with attention-deficit/hyperactivity disorder (ADHD), but only limited information is available regarding the prevalence of DSPS and insomnia in adolescents with ADHD. Moreover, previous studies comparing objective sleep parameters averaged the findings across all participants of each group (ADHD, control) regardless of each individual's level of reported sleep disturbance. This might have resulted in inconsistency between information obtained by objective and subjective sleep measures in adolescents with ADHD. The objectives of the present study were 1) to compare the prevalence of risk for DSPS and insomnia in adolescents with ADHD and control adolescents in our samples; 2) to compare objectively measured sleep characteristics of adolescents with ADHD and controls while taking into consideration their levels of risk for DSPS or their level of insomnia; and 3) to compare the ADHD symptom levels of adolescents with moderate/high and low risk for DSPS or insomnia. Methods Seventy-three adolescents (37 ADHD, 36 controls) aged 12-15 years participated in a cross-sectional study. Actigraphy was used to characterize objective sleep parameters and parents' or adolescents' reports were used to characterize subjective sleep parameters. Results Of the participants in the ADHD and control groups, 33.33% and 27%, respectively, had moderate/high levels of risk for DSPS. Adolescents in the high-risk group for DSPS had an objectively measured delayed sleep schedule and more variable sleep duration, time in bed, and sleep efficiency compared to adolescents in the low-risk group for DSPS, regardless of their ADHD diagnosis. Adolescents with higher levels of insomnia spent more time in bed and had more variable sleep efficiency compared to adolescents with no insomnia, regardless of their diagnosis. Conclusion The prevalence of moderate/high risk for DSPS was similarly high in adolescents with ADHD and controls. Participants' subjective reports of sleep disturbances were consistent with their objective sleep parameters when the type and level of subjectively defined sleep disturbance were considered. ADHD symptom levels were not different in adolescents with moderate/high or low risk for DSPS or insomnia.
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Affiliation(s)
- Reut Gruber
- Department of Psychiatry, McGill University, Montreal, QC, Canada
- Attention, Behaviour and Sleep Lab, Douglas Mental Health University Institute, Montreal, QC, Canada
- Correspondence: Reut Gruber, Department of Psychiatry, McGill University, Montreal, QC, Canada, Email
| | - Liron Salamon
- Department of School Counseling and Special Education, Tel-Aviv University, Tel-Aviv, Israel
| | - Riva Tauman
- Sleep Disorders Center, Tel Aviv Souraski Medical Center, Tel Aviv, Israel
| | - Michal Al-Yagon
- Department of School Counseling and Special Education, Tel-Aviv University, Tel-Aviv, Israel
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9
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Johnson EC, Atkinson P, Muggeridge A, Chan S, Helen Cross J, Reilly C. Perceived impact of epilepsy on sleep: Views of children with epilepsy, parents and school staff. Epilepsy Behav 2023; 138:109026. [PMID: 36512932 DOI: 10.1016/j.yebeh.2022.109026] [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: 10/03/2022] [Revised: 11/16/2022] [Accepted: 11/23/2022] [Indexed: 12/14/2022]
Abstract
OBJECTIVE To gain an understanding of the views of school-aged children with epilepsy, their parents, and school staff regarding the impact of epilepsy on sleep. METHODS As part of the What I Need in School (WINS) study, school-aged children (n = 18) with 'active epilepsy' (taking Anti-Seizure Medications, ASMs, for epilepsy), their parents (n = 68) and school staff (n = 56) were interviewed or completed bespoke questionnaires. Questions focussed on the potential impact of epilepsy on the child's sleep or tiredness in school and the potential impact of sleep/tiredness on learning and behavior. RESULTS Fifty-six percent of children believed that epilepsy affects their sleep while 65% of parents believed that their child had more difficulties with sleep than other children of their age. Seventy-eight percent of parents believed that their child's difficulties were due to epilepsy and 95% believed that their child's difficulties impacted their learning and behavior. Fifty-four percent of school staff believed that the child with epilepsy they supported was more tired/fatigued than their peers, and 86% of school staff believed that the child's increased tiredness affected their learning/behavior. Parents of children with intellectual disabilitiy were significantly more likely to indicate that they felt that their child had more sleep difficulties than other children (p = 0.016). Regarding the impact on their sleep, participating children felt that epilepsy contributed to difficulties in falling and staying asleep and daytime tiredness. Their parents reported a range of potential sleep difficulties and potential impacts on the child's learning and behavior. Parental reported difficulties included daytime tiredness, difficulty falling and staying asleep, and the impact of nocturnal seizures. In terms of impact, parents felt that sleep difficulties impacted negatively cognition and emotional-behavioral functioning. Additionally, parents reported that ASMs and medication for ADHD can contribute to sleep difficulties. School staff felt that many of the children appeared tired/fatigued during the day and this could lead to less engagement with classroom activities, impact attention and processing speed negatively, and contribute to behavioral and emotional difficulties. CONCLUSION The majority of children and parents who responded believed that epilepsy affects the child's sleep. Most parents and school staff also believed that the child's sleep difficulties/excess tiredness were due to the child's epilepsy and that the difficulties significantly impacted the child's learning and behavior. There is a need to better understand the role epilepsy plays in sleep difficulties and associated learning and behavioral impairments. There is also a need to develop interventions to reduce the subsequent impact on child learning and behavior.
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Affiliation(s)
- Emma C Johnson
- Research Department, Young Epilepsy, Lingfield, Surrey RH7 6PW, UK
| | - Patricia Atkinson
- Child Development Centre, Crawley Hospital, West Green Drive, Crawley RH11 7DH, West Sussex, UK
| | - Amy Muggeridge
- Research Department, Young Epilepsy, Lingfield, Surrey RH7 6PW, UK
| | - Samantha Chan
- Great Ormond Street Hospital for Children NHS Trust, Great Ormond Street, London WC1N 3JH, UK; UCL Great Ormond Street Institute of Child Health (ICH), 30 Guilford Street London WC1N 1EH, UK
| | - J Helen Cross
- Research Department, Young Epilepsy, Lingfield, Surrey RH7 6PW, UK; Great Ormond Street Hospital for Children NHS Trust, Great Ormond Street, London WC1N 3JH, UK; UCL Great Ormond Street Institute of Child Health (ICH), 30 Guilford Street London WC1N 1EH, UK
| | - Colin Reilly
- Research Department, Young Epilepsy, Lingfield, Surrey RH7 6PW, UK; UCL Great Ormond Street Institute of Child Health (ICH), 30 Guilford Street London WC1N 1EH, UK.
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10
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Gunuc S. Investigation of the relationships between ADHD risk and digital screen exposure in children aged 4–11: A large population study in Turkey. PSYCHOLOGY IN THE SCHOOLS 2022. [DOI: 10.1002/pits.22839] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Affiliation(s)
- Selim Gunuc
- Psychology Department Izmir Bakırçay University Izmir Turkey
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Kalaskar R, Bhaje P, Kalaskar A, Faye A. Sleep Difficulties and Symptoms of Attention-deficit Hyperactivity Disorder in Children with Mouth Breathing. Int J Clin Pediatr Dent 2021; 14:604-609. [PMID: 34934269 PMCID: PMC8645617 DOI: 10.5005/jp-journals-10005-1987] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Aims and objectives Persistent mouth breathing affects stomatognathic functions along with effects on the academics and social life of a child. Sleep-related problems and behavioral symptoms similar to that found in attention-deficit hyperactivity disorder (ADHD) can be present in mouth breathers. This study aims at assessing the sleep disturbances and pattern of symptoms of ADHD in children with mouth breathing. Materials and methods A cross-sectional study was carried out on 100 children of mouth breathing (consecutively selected) in 7–12 years of age using semi-structured proforma, children's sleep habit questionnaire (CSHQ), and diagnostic and statistical manual of mental disorders, version 5 (DSM 5). Statistical analysis was done using SPSS software version 21. Mean, standard deviation, Chi-square, and Pearson's correlation coefficient test were utilized during the analysis. p value of <0.05 was considered significant. Results Out of 100 children, 70 were males and 30 were females. On the CSHQ scale, the highest score was found on sleep-disordered breathing followed by sleep onset delay and daytime sleepiness. The commonest symptom of inattention was “failing to give close attention in school” (73%) whereas the commonest symptom of hyperactivity was “trouble waiting for his/her turn” (66%). Seven participants satisfied complete criteria for ADHD. Sleep duration and daytime sleepiness had a significant negative correlation with hyperactivity (p < 0.05). A positive correlation was observed between daytime sleepiness and inattention (p < 0.01). Conclusion Children with sleep disturbances or ADHD should be assessed for the presence of mouth breathing, as early identification and correction of mouth breathing may help to prevent unnecessary exposure to the medication. Clinical significance Children with ADHD or sleep disturbances should always be assessed for the presence of mouth breathing. Early identification and correction of mouth breathing may help in preventing unnecessary exposure to medication for treating ADHD. How to cite this article Kalaskar R, Bhaje P, Kalaskar A, et al. Sleep Difficulties and Symptoms of Attention-deficit Hyperactivity Disorder in Mouth Breathing. Int J Clin Pediatr Dent 2021;14(5):604–609.
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Affiliation(s)
- Ritesh Kalaskar
- Department of Pediatric and Preventive Dentistry, Government Dental College and Hospital, Nagpur, Maharashtra, India
| | - Priyanka Bhaje
- Department of Pediatric and Preventive Dentistry, Government Dental College and Hospital, Nagpur, Maharashtra, India
| | - Ashita Kalaskar
- Department of Oral Medicine and Radiology, Government Dental College, Nagpur, Maharashtra, India
| | - Abhijeet Faye
- Department of Psychiatry, NKP Salve Institute of Medical Sciences, Nagpur, Maharashtra, India
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Ziegler M, Kaiser A, Igel C, Geissler J, Mechler K, Holz NE, Becker K, Döpfner M, Romanos M, Brandeis D, Hohmann S, Millenet S, Banaschewski T. Actigraphy-Derived Sleep Profiles of Children with and without Attention-Deficit/Hyperactivity Disorder (ADHD) over Two Weeks-Comparison, Precursor Symptoms, and the Chronotype. Brain Sci 2021; 11:brainsci11121564. [PMID: 34942866 PMCID: PMC8699578 DOI: 10.3390/brainsci11121564] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Revised: 11/18/2021] [Accepted: 11/23/2021] [Indexed: 11/16/2022] Open
Abstract
Although sleep problems are common in children with ADHD, their extent, preceding risk factors, and the association between neurocognitive performance and neurobiological processes in sleep and ADHD, are still largely unknown. We examined sleep variables in school-aged children with ADHD, addressing their intra-individual variability (IIV) and considering potential precursor symptoms as well as the chronotype. Additionally, in a subgroup of our sample, we investigated associations with neurobehavioral functioning (n = 44). A total of 57 children (6-12 years) with (n = 24) and without ADHD (n = 33) were recruited in one center of the large ESCAlife study to wear actigraphs for two weeks. Actigraphy-derived dependent variables, including IIV, were analyzed using linear mixed models in order to find differences between the groups. A stepwise regression model was used to investigate neuropsychological function. Overall, children with ADHD showed longer sleep onset latency (SOL), higher IIV in SOL, more movements during sleep, lower sleep efficiency, and a slightly larger sleep deficit on school days compared with free days. No group differences were observed for chronotype or sleep onset time. Sleep problems in infancy predicted later SOL and the total number of movements during sleep in children with and without ADHD. No additional effect of sleep problems, beyond ADHD symptom severity, on neuropsychological functioning was found. This study highlights the importance of screening children with ADHD for current and early childhood sleep disturbances in order to prevent long-term sleep problems and offer individualized treatments. Future studies with larger sample sizes should examine possible biological markers to improve our understanding of the underlying mechanisms.
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Affiliation(s)
- Mirjam Ziegler
- Department of Child and Adolescent Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, 68159 Mannheim, Germany; (A.K.); (C.I.); (K.M.); (N.E.H.); (D.B.); (S.H.); (S.M.); (T.B.)
- Correspondence: ; Tel.: +49-(0)-621-1703-4911
| | - Anna Kaiser
- Department of Child and Adolescent Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, 68159 Mannheim, Germany; (A.K.); (C.I.); (K.M.); (N.E.H.); (D.B.); (S.H.); (S.M.); (T.B.)
| | - Christine Igel
- Department of Child and Adolescent Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, 68159 Mannheim, Germany; (A.K.); (C.I.); (K.M.); (N.E.H.); (D.B.); (S.H.); (S.M.); (T.B.)
| | - Julia Geissler
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Hospital of Würzburg, University of Würzburg, 97080 Würzburg, Germany; (J.G.); (M.R.)
| | - Konstantin Mechler
- Department of Child and Adolescent Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, 68159 Mannheim, Germany; (A.K.); (C.I.); (K.M.); (N.E.H.); (D.B.); (S.H.); (S.M.); (T.B.)
| | - Nathalie E. Holz
- Department of Child and Adolescent Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, 68159 Mannheim, Germany; (A.K.); (C.I.); (K.M.); (N.E.H.); (D.B.); (S.H.); (S.M.); (T.B.)
- Donders Center for Brain, Cognition and Behavior, Radboud University Nijmegen, 6525 EN Nijmegen, The Netherlands
- Department for Cognitive Neuroscience, Radboud University Medical Center Nijmegen, 6525 EN Nijmegen, The Netherlands
| | - Katja Becker
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Medical Faculty, Philipps-University Marburg and University Hospital Marburg, 35039 Marburg, Germany;
- Center for Mind, Brain and Behavior (CMBB), University of Marburg and Justus Liebig University Giessen, 35032 Marburg, Germany
| | - Manfred Döpfner
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Faculty of Medicine and University Hospital Cologne, University of Cologne, 50931 Cologne, Germany;
| | - Marcel Romanos
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Hospital of Würzburg, University of Würzburg, 97080 Würzburg, Germany; (J.G.); (M.R.)
| | - Daniel Brandeis
- Department of Child and Adolescent Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, 68159 Mannheim, Germany; (A.K.); (C.I.); (K.M.); (N.E.H.); (D.B.); (S.H.); (S.M.); (T.B.)
- Department of Child and Adolescent Psychiatry and Psychotherapy, University Hospital of Psychiatry, University of Zürich, 8032 Zürich, Switzerland
- Center for Integrative Human Physiology, University of Zürich, 8057 Zürich, Switzerland
- Neuroscience Center Zürich, Swiss Federal Institute of Technology, University of Zürich, 8057 Zürich, Switzerland
| | - Sarah Hohmann
- Department of Child and Adolescent Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, 68159 Mannheim, Germany; (A.K.); (C.I.); (K.M.); (N.E.H.); (D.B.); (S.H.); (S.M.); (T.B.)
| | - Sabina Millenet
- Department of Child and Adolescent Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, 68159 Mannheim, Germany; (A.K.); (C.I.); (K.M.); (N.E.H.); (D.B.); (S.H.); (S.M.); (T.B.)
| | - Tobias Banaschewski
- Department of Child and Adolescent Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, 68159 Mannheim, Germany; (A.K.); (C.I.); (K.M.); (N.E.H.); (D.B.); (S.H.); (S.M.); (T.B.)
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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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Luongo A, Lukowski A, Protho T, Van Vorce H, Pisani L, Edgin J. Sleep's role in memory consolidation: What can we learn from atypical development? ADVANCES IN CHILD DEVELOPMENT AND BEHAVIOR 2021; 60:229-260. [PMID: 33641795 DOI: 10.1016/bs.acdb.2020.08.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Research conducted over the last century has suggested a role for sleep in the processes guiding healthy cognition and development, including memory consolidation. Children with intellectual and developmental disabilities (IDDs) tend to have higher rates of sleep disturbances, which could relate to behavior issues, developmental delays, and learning difficulties. While several studies examine whether sleep exacerbates daytime difficulties and attention deficits in children with IDDs, this chapter focuses on the current state of knowledge regarding sleep and memory consolidation in typically developing (TD) groups and those at risk for learning difficulties. In particular, this chapter summarizes the current literature on sleep-dependent learning across developmental disabilities, including Down syndrome, Williams syndrome, Autism Spectrum Disorder, and Learning Disabilities (Attention-Deficit/Hyperactivity Disorder and Dyslexia). We also highlight the gaps in the current literature and identify challenges in studying sleep-dependent memory in children with different IDDs. This burgeoning new field highlights the importance of considering the role of sleep in memory retention across long delays when evaluating children's memory processes. Further, an understanding of typical and atypical development can mutually inform recent theories of sleep's role in memory.
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Affiliation(s)
- A Luongo
- Department of Psychology, University of Arizona, Tucson, AZ, Unites States
| | - A Lukowski
- Department of Psychological Sciences, University of California Irvine, Irvine, CA, United States
| | - T Protho
- Department of Psychology, University of Arizona, Tucson, AZ, Unites States
| | - H Van Vorce
- Department of Psychology, University of Arizona, Tucson, AZ, Unites States
| | - L Pisani
- Department of Psychology, University of Arizona, Tucson, AZ, Unites States
| | - J Edgin
- Department of Psychology, University of Arizona, Tucson, AZ, Unites States; University of Arizona Sonoran UCEDD, Tucson, AZ, United States.
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15
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Sanabra M, Gómez-Hinojosa T, Alcover C, Sans O, Alda JA. Effects of stimulant treatment on sleep in attention deficit hyperactivity disorder (ADHD). Sleep Biol Rhythms 2020. [DOI: 10.1007/s41105-020-00289-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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16
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Cohen A, Dan O, Asraf K, Haimov I. The Sleepiness Curve of Young Men With and Without Attention-Deficit Hyperactivity Disorder (ADHD). Behav Sleep Med 2020; 18:321-333. [PMID: 30806088 DOI: 10.1080/15402002.2019.1583564] [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] [Indexed: 01/19/2023]
Abstract
Objectives: The present study aimed at comparing the sleepiness curve of young men with attention-deficit hyperactivity disorder (ADHD) to that of young men without ADHD before, during, and after a night of sleep deprivation. Participants: Thirty young men (age 18-30) of whom 14 were diagnosed with ADHD combined type (ADHD-C) and 16 without ADHD. Methods: The participants' sleep was monitored for 5 days via actigraphy. Subsequently, the participants were kept continuously awake in a controlled environment for 25 hr (8:00 a.m.-9:00 a.m.). The sleepiness of the participants was assessed every hour by the Karolinska Sleepiness Scale (KSS) in order to obtain the sleepiness curve of both study groups. Results: Actigraphy data demonstrated that the two groups did not differ in their total sleep time, sleep onset latency, or sleep efficiency during the 5 nights preceding the experimental session. However, during the experimental session, the ADHD group demonstrated higher sleepiness scores, particularly following midnight and on the morning following the night of sleep deprivation. Moreover, on the morning following sleep deprivation the proportion of participants reporting extreme levels of sleepiness (KSS > 7) was significantly higher in the ADHD group than in the control group. Conclusions: Young men with ADHD suffer from sleepiness more than their counterparts from the general population, and are particularly vulnerable to the effects of sleep deprivation on sleepiness. As excessive daytime sleepiness negatively affects cognition and increases the risk for motor vehicle crash and other accidents, these findings may have important clinical implications.
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Affiliation(s)
- Ami Cohen
- Psychology Department, The Center for Psychobiological Research, The Max Stern Yezreel Valley College, Emek Yezreel, Israel
| | - Ori Dan
- Psychology Department, The Center for Psychobiological Research, The Max Stern Yezreel Valley College, Emek Yezreel, Israel
| | - Kfir Asraf
- Psychology Department, The Center for Psychobiological Research, The Max Stern Yezreel Valley College, Emek Yezreel, Israel
| | - Iris Haimov
- Psychology Department, The Center for Psychobiological Research, The Max Stern Yezreel Valley College, Emek Yezreel, Israel
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17
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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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18
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Thoma VK, Schulz-Zhecheva Y, Oser C, Fleischhaker C, Biscaldi M, Klein C. Media Use, Sleep Quality, and ADHD Symptoms in a Community Sample and a Sample of ADHD Patients Aged 8 to 18 Years. J Atten Disord 2020; 24:576-589. [PMID: 30296879 DOI: 10.1177/1087054718802014] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Objective: Relationships between sleep, screen-based media, and ADHD symptomatology were investigated using a case- and community-based approach. Method: N = 357 healthy and N = 61 children with ADHD (12.72 ± 2.83 years) completed a sleep and media questionnaire. To measure ADHD symptomatology, parents filled out the Strengths and Weaknesses of ADHD symptoms and Normal behavior (SWAN) scale. Two samples were formed: a matched (N = 61 patients and N = 61 controls) and a community sample (N = 357 healthy participants and N = 20 patients). Results: Compared with controls, participants with ADHD reported delayed sleep onset and more screen time on school days. Adolescent patients showed more behavior promoting delayed sleep phase. In the community sample, media time, sleep deviation, and circadian rhythm were correlated with ADHD symptomatology. Furthermore, media time, sleep-wake behavior, and sleep deviation were predictive of ADHD symptomatology (variance explained = 4%-15%). Conclusion: Longer media time and inadequate sleep-wake behavior increase the risk of ADHD-like symptoms. However, research using objective assessments is needed to disentangle this distinct association and to provide possible directions for intervention.
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Affiliation(s)
| | | | | | | | | | - Christoph Klein
- University of Freiburg, Germany.,University of Cologne, Germany
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Dan O, Haimov I, Asraf K, Nachum K, Cohen A. The Effect of Sleep Deprivation on Recognition of Ambiguous Emotional Facial Expressions in Individuals With ADHD. J Atten Disord 2020; 24:565-575. [PMID: 29973106 DOI: 10.1177/1087054718785473] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Objective: The present study sought to investigate whether young adults with ADHD have more difficulty recognizing emotional facial expressions compared with young adults without ADHD, and whether such a difference worsens following sleep deprivation. Method: Thirty-one young men (M = 25.6) with (n = 15) or without (n = 16) a diagnosis of ADHD were included in this study. The participants were instructed to sleep 7 hr or more each night for one week, and their sleep quality was monitored via actigraph. Subsequently, the participants were kept awake in a controlled environment for 30 hr. The participants completed a visual emotional morph task twice-at the beginning and at the end of this period. The task included presentation of interpolated face stimuli ranging from neutral facial expressions to fully emotional facial expressions of anger, sadness, or happiness, allowing for assessment of the intensity threshold for recognizing these facial emotional expressions. Results: Actigraphy data demonstrated that while the nightly sleep duration of the participants with ADHD was similar to that of participants without ADHD, their sleep efficiency was poorer. At the onset of the experiment, there were no differences in recognition thresholds between the participants with ADHD and those without ADHD. Following sleep deprivation, however, the ADHD group required clearer facial expressions to recognize the presence of angry, sad, and, to a lesser extent, happy faces. Conclusion: Among young adults with ADHD, sleep deprivation may hinder the processing of emotional facial stimuli.
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Affiliation(s)
- Orrie Dan
- The Max Stern Academic College of Emek Yezreel, Israel
| | - Iris Haimov
- The Max Stern Academic College of Emek Yezreel, Israel
| | - Kfir Asraf
- The Max Stern Academic College of Emek Yezreel, Israel
| | - Kesem Nachum
- The Max Stern Academic College of Emek Yezreel, Israel
| | - Ami Cohen
- The Max Stern Academic College of Emek Yezreel, Israel
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20
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Melegari MG, Vittori E, Mallia L, Devoto A, Lucidi F, Ferri R, Bruni O. Actigraphic Sleep Pattern of Preschoolers With ADHD. J Atten Disord 2020; 24:611-624. [PMID: 27708108 DOI: 10.1177/1087054716672336] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective: To assess the features of sleep in preschoolers with ADHD by means of questionnaire and actigraphy. Method: Twenty-five ADHD and 21 age-matched typically developing (TD) preschool children underwent the Child Behavior Checklist (CBCL) for ages 1½ to 5 and Pre-School-Age Psychiatric Assessment interview. Sleep was assessed by means of a modified Sleep Disturbance Scale for Children and wrist actigraphy for at least 5 days. Results: Children with ADHD, compared with TD, showed higher scores in CBCL Withdrawal (58.83 vs. 51.15, p < .0001), Attention Problems (69.88 vs. 51.54, p < .0001), and Aggressive Behavior (59.46 vs. 51.08, p < .0001) dimensions; they also showed increased actigraphic nocturnal activity (activity index 31.57 vs. 25.74, p < .05); and night-to-night variability for sleep minutes (56.44 vs. 32.79, p < .01), mean wake episodes (1.34 vs. 0.98, p < .05), mean activity (2.64 vs. 1.71, p < .05), and activity index (5.15 vs. 3.77, p < .05). Conclusion: This pilot study in preschoolers with ADHD showed increased motor activity during sleep and night-to-night variability for sleep duration and motor activity.
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Affiliation(s)
| | - Elena Vittori
- Centro Ricerca e Cura Balbuzie e disturbi della voce e del linguaggio, Rome, Italy
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21
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Melegari MG, Sette S, Vittori E, Mallia L, Devoto A, Lucidi F, Ferri R, Bruni O. Relations Between Sleep and Temperament in Preschool Children With ADHD. J Atten Disord 2020; 24:535-544. [PMID: 29468918 DOI: 10.1177/1087054718757645] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective: The objective of this study was to assess the links between temperament and sleep in a group of preschoolers with ADHD. Method: Twenty-five ADHD (M = 5.37 years, SD = 1.09) and 22 typically developing (TD; M = 5.10, SD = 1.18) preschoolers participated in the study. Sleep was assessed with the Sleep Disturbance Scale and wrist actigraphy. The Preschool Temperament and Character Inventory (PsTCI) was used to evaluate the child temperament. Results: ADHD children showed a temperamental profile characterized by higher novelty seeking, lower persistence, self-directness, and cooperativeness and marginally lower harm avoidance (HA) compared with controls. HA was associated negatively to wakefulness after sleep onset and sleep fragmentation and positively with sleep efficiency and sleep time. Reward dependence was negatively associated with wake episode length. Conclusion: Sleep and temperament are correlated in preschoolers with ADHD and temperament might represent an intermediate endophenotype underlying the relation between ADHD and sleep disorders.
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Affiliation(s)
| | | | - Elena Vittori
- Centro Ricerca e Cura Balbuzie e disturbi della voce e del linguaggio, Rome, Italy
| | | | | | | | - Raffaele Ferri
- Oasi Institute (Istituto di Ricovero e Cura a carattere scientifico), Troina, Italy
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22
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Langberg JM, Breaux RP, Cusick CN, Green CD, Smith ZR, Molitor SJ, Becker SP. Intraindividual variability of sleep/wake patterns in adolescents with and without attention-deficit/hyperactivity disorder. J Child Psychol Psychiatry 2019; 60:1219-1229. [PMID: 31231801 PMCID: PMC6800768 DOI: 10.1111/jcpp.13082] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/15/2019] [Indexed: 11/28/2022]
Abstract
BACKGROUND Prior studies examining the sleep of adolescents with and without attention-deficit/hyperactivity disorder (ADHD) have relied on mean values such as average sleep duration, which masks intraindividual variability (IIV). The objective was to investigate whether adolescents with ADHD have greater IIV of sleep/wake patterns than adolescents without ADHD using actigraphy and daily sleep diaries. METHOD Adolescents (ages 13.17 ± 0.40 years; 45% female) with (n = 162) and without (n = 140) ADHD were recruited from middle schools at two sites. Participants wore actigraphs and completed sleep diaries for an average of 2 weeks. RESULTS Multilevel models were conducted with sex, sleep medication use, ADHD medication use, number of days with data, and social jetlag controlled for in analyses. For actigraphy, adolescents with ADHD had greater variability for time in bed, sleep onset and offset, and wake after sleep onset than adolescents without ADHD. For sleep diary data, adolescents with ADHD had greater variability in bedtime, wake time, sleep duration, sleep onset latency, sleep quality, and night wakings than adolescents without ADHD. Social jetlag was a significant predictor of variability in sleep measures based on both actigraph and daily diaries; however, ADHD status was not associated with social jetlag. CONCLUSIONS This is the first study to show that adolescents with ADHD have more variable sleep/wake patterns than their peers using both objective and subjective sleep measures. IIV of sleep/wake patterns may be important for clinicians to assess and monitor as part of treatment. Research is needed to understand the mechanisms underlying increased IIV of sleep/wake patterns in adolescents with ADHD and potential consequences for daytime functioning.
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Affiliation(s)
- Joshua M Langberg
- Department of Psychology, Virginia Commonwealth University, Richmond, VA, USA
| | - Rosanna P Breaux
- Department of Psychology, Virginia Commonwealth University, Richmond, VA, USA
| | - Caroline N Cusick
- Department of Psychology, Virginia Commonwealth University, Richmond, VA, USA
| | - Cathrin D Green
- Department of Psychology, Virginia Commonwealth University, Richmond, VA, USA
| | - Zoe R Smith
- Department of Psychology, Virginia Commonwealth University, Richmond, VA, USA
| | - Stephen J Molitor
- Department of Psychology, Virginia Commonwealth University, Richmond, VA, USA
| | - Stephen P Becker
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
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Scarpelli S, Gorgoni M, D'Atri A, Reda F, De Gennaro L. Advances in Understanding the Relationship between Sleep and Attention Deficit-Hyperactivity Disorder (ADHD). J Clin Med 2019; 8:E1737. [PMID: 31635095 PMCID: PMC6832299 DOI: 10.3390/jcm8101737] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2019] [Revised: 10/09/2019] [Accepted: 10/17/2019] [Indexed: 02/05/2023] Open
Abstract
Starting from the consolidated relationship between sleep and cognition, we reviewed the available literature on the association between Attention Deficit-Hyperactivity Disorder (ADHD) and sleep. This review analyzes the macrostructural and microstructural sleep features, following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses criteria (PRISMA). We included the polysomnographic studies published in the last 15 years. The results of macrostructural parameters are mixed. Almost half of the 18 selected investigations did not find differences between sleep architecture of children with ADHD and controls. Five studies observed that children with ADHD show a longer Rapid Eye Movement (REM) sleep duration than controls. Eight studies included microstructural measures. Remarkable alterations in sleep microstructure of ADHD are related to slow wave activity (SWA) and theta oscillations, respectively, during Non-REM (NREM) and REM sleep. Specifically, some studies found higher SWA in the ADHD group than controls. Similarly, higher theta activity appears to be detrimental for memory performance and inhibitory control in ADHD. These patterns could be interpreted as a maturational delay in ADHD. Also, the increased amount of these activities would be consistent with the hypothesis that the poor sleep could imply a chronic sleep deprivation in children with ADHD, which in turn could affect their cognitive functioning.
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Affiliation(s)
- Serena Scarpelli
- Department of Psychology, University of Rome "Sapienza", Rome 00185, Italy.
| | - Maurizio Gorgoni
- Department of Psychology, University of Rome "Sapienza", Rome 00185, Italy.
| | - Aurora D'Atri
- Department of Psychology, University of Rome "Sapienza", Rome 00185, Italy.
| | - Flaminia Reda
- Department of Psychology, University of Rome "Sapienza", Rome 00185, Italy.
| | - Luigi De Gennaro
- Department of Psychology, University of Rome "Sapienza", Rome 00185, Italy.
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Sleep Difficulties in Infancy Are Associated with Symptoms of Inattention and Hyperactivity at the Age of 5 Years: A Longitudinal Study. J Dev Behav Pediatr 2019; 40:432-440. [PMID: 31166249 PMCID: PMC6738636 DOI: 10.1097/dbp.0000000000000684] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [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
OBJECTIVE Sleep difficulties are associated with cognitive and behavioral problems in childhood. However, it is still unclear whether early sleep difficulties are related to later development. We studied whether parent-reported sleep duration, night awakenings, and parent-reported sleep problems in early childhood are associated with symptoms of inattention and hyperactivity at the age of 5 years. METHOD Our study is based on the Child-Sleep birth cohort initially comprising 1673 families, of which 713 were retained at the age of 5 years. We used the Brief Infant Sleep Questionnaire and the Infant Sleep Questionnaire, which were filled out by the parents when their child was 3, 8, and 24 months and 5 years old. Symptoms of inattention and hyperactivity at the age of 5 years were assessed using the Strengths and Difficulties Questionnaire and the Five-to-Fifteen questionnaire. RESULTS Sleep duration at the age of 3, 8, and 24 months was associated with inattentiveness at 5 years of age. Moreover, parent-reported sleep problems at the age of 24 months were related to both inattentive and hyperactive symptoms at the age of 5 years. Finally, at the age of 5 years, parent-reported sleep problems and night awakenings were associated with concurrent symptoms of inattention and hyperactivity. CONCLUSION Our findings suggest that certain sleep characteristics related to sleep quality and quantity in early childhood are associated with inattentiveness and hyperactivity at the age of 5 years. Interestingly, sleep duration in early childhood is consistently related to inattention at the age of 5 years.
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Chin WC, Huang YS, Chou YH, Wang CH, Chen KT, Hsu JF, Hsu SC. Subjective and objective assessments of sleep problems in children with attention deficit/hyperactivity disorder and the effects of methylphenidate treatment. Biomed J 2018; 41:356-363. [PMID: 30709577 PMCID: PMC6362263 DOI: 10.1016/j.bj.2018.10.004] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2018] [Revised: 10/17/2018] [Accepted: 10/19/2018] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND to investigate the sleep problems in children with different ADHD presentations and effects of methylphenidate (MPH) on the sleep problems of children with ADHD by both subjective and objective measurements. METHODS 71 children with ADHD and 30 controls were included. 35 had ADHD with predominantly inattentive presentation (ADHD-I) and 36 with predominantly hyperactive/impulsive or combined presentation (ADHD-C). We used the pediatric sleep questionnaire (PSQ) and a nocturnal polysomnography (PSG) to assess the sleep problems in children with ADHD before and 6 months after being treated with methylphenidate (0.3-0.7 mg/kg/dose). RESULTS PSG showed significantly higher apnea-hypopnea index and hypopnea counts, and lower slow-wave sleep percentage in children with ADHD. The results of PSQ reported by parents showed significantly higher rates of delay initiation of sleep, sleep onset latency, sleep fragment, daytime sleepiness, enuresis, bruxism, nightmares, periodic limb movement disorder (PLMD), and snoring in children with ADHD compared to normal controls. Comparisons of ADHD presentations revealed no significant difference between ADHD-I and ADHD-C by either PSG or PSQ measurements. After 6-month MPH treatment, the PSG showed significantly increased total sleep time and reduced periodic limb movement index (PLMI). The PSQ indicated significant reduction in bruxism and snoring in ADHD-I, as well as nightmares in ADHD-C, and both subgroups showed significant reduction in PLMD. CONCLUSION subjective and objective approaches produced inconsistent findings regarding the sleep problems in children with ADHD. Besides, MPH didn't worsen the sleep problems in children with ADHD.
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Affiliation(s)
- Wei-Chih Chin
- Division of Pediatric Psychiatry, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan; College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Yu-Shu Huang
- Division of Pediatric Psychiatry, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan; Craniofacial Research Center and Sleep Center, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan; College of Medicine, Chang Gung University, Taoyuan, Taiwan.
| | - Ya-Hsin Chou
- Department of Psychiatry, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan; College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Chih-Huan Wang
- Department of Psychology, Zhejiang Normal University, Zhejiang, China
| | - Kuang-Tai Chen
- Department of Psychiatry, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan; College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Jen Fu Hsu
- Division of Pediatric Neonatology, Department of Pediatrics, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan; College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Shih-Chieh Hsu
- Department of Psychiatry, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan; College of Medicine, Chang Gung University, Taoyuan, Taiwan
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Prehn-Kristensen A, Göder R. [Sleep and cognition in children and adolescents]. ZEITSCHRIFT FUR KINDER-UND JUGENDPSYCHIATRIE UND PSYCHOTHERAPIE 2018; 46:405-422. [PMID: 30141742 DOI: 10.1024/1422-4917/a000614] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Sleep and cognition in children and adolescents Abstract. In this review, one of the most important functions of sleep was described: Its role in promoting cognitive processes in children and adolescents. Particularly, studies of older children and adolescents revealed that sleep interacts in a complex manner with cognitive performance. Moreover, it was shown that sleep supports long-term memory even in young children. This is true for many different long-term memory systems such as memory of factual information (declarative memory), language acquisition, and for reward-related learning, but less so for learning motor skills. Clinical implications arise from observing the consequences of sleep deficits in children and adolescents due to early school hours or due to clinical conditions like attention deficits hyperactive disorder (ADHD), sleep apnea syndrome or other sleep disturbances. Current research has only partially shown that the treatment of sleep problems also benefits cognitive and memory performance. Filling this gap remains an opportunity for further research.
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Affiliation(s)
- Alexander Prehn-Kristensen
- 1 Klinik für Kinder- und Jugendpsychiatrie und -psychotherapie, Zentrum für Integrative Psychiatrie, Universitätsklinikum Schleswig-Holstein, UKSH, Campus Kiel
| | - Robert Göder
- 2 Klinik für Psychiatrie und Psychotherapie, Zentrum für Integrative Psychiatrie, Universitätsklinikum Schleswig-Holstein, UKSH, Campus Kiel
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Poirier A, Corkum P. Night-to-Night Variability of Sleep in Children With ADHD and Typically Developing Controls. J Atten Disord 2018; 22:942-946. [PMID: 25788495 DOI: 10.1177/1087054715575065] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Research results on the nature of sleep problems in children with ADHD are highly inconsistent. It is frequently reported that children with ADHD show more night-to-night variability in sleep than their typically developing (TD) peers, but this finding is also inconsistent. Lack of methodological control may account for these inconsistent findings. The current study examined the night-to-night variability of sleep between TD children and children with ADHD who were rigorously diagnosed, medication naïve, and free from comorbid mental health disorders. METHOD Sleep parameters were analyzed for night-to-night variability across 4 weekday nights using actigraphy in 50 children with ADHD and 50 age- and sex-matched TD children. RESULTS There was a significant night-to-night variability for only sleep duration, but this was similar in both groups. CONCLUSION These findings suggest that sleep problems in children with ADHD are not due to greater variability in sleep parameters relative to their TD peers.
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Affiliation(s)
- Abbey Poirier
- 1 Dalhousie University, Halifax, Nova Scotia, Canada
| | - Penny Corkum
- 1 Dalhousie University, Halifax, Nova Scotia, Canada.,2 IWK Health Centre, Halifax, Nova Scotia, Canada.,3 Colchester East Hants Health Authority, Truro, Nova Scotia, Canada
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Mendoza J, van Diepen HC, Pereira RR, Meijer JH. Time-shifting effects of methylphenidate on daily rhythms in the diurnal rodent Arvicanthis ansorgei. Psychopharmacology (Berl) 2018; 235:2323-2333. [PMID: 29777288 DOI: 10.1007/s00213-018-4928-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2017] [Accepted: 05/10/2018] [Indexed: 12/23/2022]
Abstract
People suffering of attention-deficit/hyperactivity disorder (ADHD) and treated with the psychostimulant methylphenidate (MPH) show sleep-wake cycle and daily rhythm alterations despite the beneficial effects of MPH on behavioral symptoms (i.e., hyperactivity, attention). In nocturnal rodents (i.e., mice), chronic exposure to MPH alters the neural activity of the circadian clock in the suprachiasmatic nucleus (SCN), behavioral rhythms, and the sleep-wake cycle. Here, we studied the effects of MPH on daily rhythms of behavior and body temperature of the diurnal rodent Arvicanthis ansorgei. Under a light-dark cycle, chronic exposure to MPH in drinking water delayed the onset of both activity and body temperature rhythms. Interestingly, delays were larger when MPH access was restricted to the first 6 h of the light phase (i.e., activity phase) of the 24-h cycle. Since MPH effects are dependent on animal's fluid intake, in a last experiment, we controlled the time and dose of MPH delivery in Arvicanthis using an intraperitoneal perfusion method. Similarly to the experiment with MPH in drinking water, Arvicanthis showed a delay in the onset of general activity and body temperature when MPH infusions, but not vehicle, were during the first 6 h of the light phase. This study indicates that MPH alters daily rhythms in a time-dependent manner and proposes the use of a diurnal rodent for the study of the effects of MPH on the circadian clock. Knowing the circadian modulation on the effects of MPH in behavior could give new insights in the treatment of ADHD.
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Affiliation(s)
- Jorge Mendoza
- Institute of Cellular and Integrative Neurosciences, CNRS UPR-3212, University of Strasbourg, 5 rue Blaise Pascal, 67084, Strasbourg, France.
| | - Hester C van Diepen
- Department of Molecular Cell Biology, Leiden University Medical Centre, Leiden, The Netherlands
| | | | - Johanna H Meijer
- Department of Molecular Cell Biology, Leiden University Medical Centre, Leiden, The Netherlands
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Sleep Disturbances in Child and Adolescent Mental Health Disorders: A Review of the Variability of Objective Sleep Markers. Med Sci (Basel) 2018; 6:medsci6020046. [PMID: 29867064 PMCID: PMC6024884 DOI: 10.3390/medsci6020046] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2018] [Revised: 05/28/2018] [Accepted: 05/29/2018] [Indexed: 12/27/2022] Open
Abstract
Sleep disturbances are often observed in child and adolescent mental health disorders. Although previous research has identified consistent subjective reports of sleep disturbances, specific objective sleep markers have not yet been identified. We evaluated the current research on subjective and objective sleep markers in relation to attention deficit hyperactivity disorders, autism spectrum disorders, anxiety and depressive disorders. Subjective sleep markers are more consistent than objective markers of actigraphy, polysomnography, and circadian measures. We discuss the causes of variability in objective sleep findings and suggest future directions for research.
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30
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Bundgaard AKF, Asmussen J, Pedersen NS, Bilenberg N. Disturbed sleep and activity in toddlers with early signs of attention deficit hyperactivity disorder (ADHD). J Sleep Res 2018. [PMID: 29527757 DOI: 10.1111/jsr.12686] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
This study investigated whether early signs of attention deficit hyperactivity disorder (ADHD) in toddlers aged 2-3 years are associated with disturbed sleep and activity levels. Participants were recruited from the Odense Child Cohort, and children scoring above the 93rd percentile on the ADHD scale of the Child Behaviour Checklist 1½-5 were categorised as cases and compared with age- and gender-matched normal-scoring controls. Daytime and nocturnal activity for 24 children with ADHD traits (cases) and 25 healthy controls was assessed through 7 days of actigraphy, and parents completed the Children's Sleep Habits Questionnaire (CSHQ) and the ADHD Rating Scale IV Preschool Version (ADHD-RS). Cases differed significantly on actigraphic parameters by having fewer minutes of moderate-to-vigorous physical activity (MVPA), prolonged total sleep time, fewer sleep interruptions, and increased night-to-night variability. A significant association was found between fewer minutes of MVPA and higher parent-reported motor activity on the ADHD-RS. Furthermore, increased night-to-night variability was significantly associated with higher total scores on both CSHQ and ADHD-RS. The findings show that early signs of ADHD are associated with an irregular sleep pattern and lower daytime activity, as illustrated by actigraphy. Studies investigating early ADHD risk factors could lead to a preschool ADHD risk index to help guide future early intervention.
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Affiliation(s)
- Anne-Katrine F Bundgaard
- Research Unit of Child and Adolescent Psychiatry, University of Southern Denmark, Odense, Denmark
| | - Jette Asmussen
- Research Unit of Child and Adolescent Psychiatry, University of Southern Denmark, Odense, Denmark
| | - Nadia S Pedersen
- Research Unit of Child and Adolescent Psychiatry, University of Southern Denmark, Odense, Denmark
| | - Niels Bilenberg
- Research Unit of Child and Adolescent Psychiatry, University of Southern Denmark, Odense, Denmark
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Ulate-Campos A, Tsuboyama M, Loddenkemper T. Devices for Ambulatory Monitoring of Sleep-Associated Disorders in Children with Neurological Diseases. CHILDREN (BASEL, SWITZERLAND) 2017; 5:E3. [PMID: 29295578 PMCID: PMC5789285 DOI: 10.3390/children5010003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/18/2017] [Revised: 11/18/2017] [Accepted: 12/18/2017] [Indexed: 12/30/2022]
Abstract
Good sleep quality is essential for a child's wellbeing. Early sleep problems have been linked to the later development of emotional and behavioral disorders and can negatively impact the quality of life of the child and his or her family. Sleep-associated conditions are frequent in the pediatric population, and even more so in children with neurological problems. Monitoring devices can help to better characterize sleep efficiency and sleep quality. They can also be helpful to better characterize paroxysmal nocturnal events and differentiate between nocturnal seizures, parasomnias, and obstructive sleep apnea, each of which has a different management. Overnight ambulatory detection devices allow for a tolerable, low cost, objective assessment of sleep quality in the patient's natural environment. They can also be used as a notification system to allow for rapid recognition and prompt intervention of events like seizures. Optimal monitoring devices will be patient- and diagnosis-specific, but may include a combination of modalities such as ambulatory electroencephalograms, actigraphy, and pulse oximetry. We will summarize the current literature on ambulatory sleep devices for detecting sleep disorders in children with neurological diseases.
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Affiliation(s)
- Adriana Ulate-Campos
- Department of Neurology, National Children's Hospital Dr. Carlos Saenz Herrera, 10103 San José, Costa Rica.
| | - Melissa Tsuboyama
- Division of Epilepsy and Clinical Neurophysiology, Department of Neurology, Boston Children's Hospital, Harvard Medical School, Boston, MA 02115, USA.
| | - Tobias Loddenkemper
- Division of Epilepsy and Clinical Neurophysiology, Department of Neurology, Boston Children's Hospital, Harvard Medical School, Boston, MA 02115, USA.
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Grünwald J, Schlarb AA. Relationship between subtypes and symptoms of ADHD, insomnia, and nightmares in connection with quality of life in children. Neuropsychiatr Dis Treat 2017; 13:2341-2350. [PMID: 28919767 PMCID: PMC5592957 DOI: 10.2147/ndt.s118076] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
OBJECTIVES This study examined the links between sleep disorders and subtypes of attention deficit-hyperactivity disorder (ADHD-inattention, ADHD-combined, ADHD-hyperactive/impulsive) in childhood. We set up a hypothetical model linking different symptoms of both disorders to construct the underlying and shared pathways. By examining a sample of children with ADHD we firstly tested parts of the model. METHODS A total of 72 children with symptoms of ADHD (aged 6-13 years; 79.2% boys) were diagnosed according to the Diagnostic and Statistical Manual of Mental Disorders, fifth edition and the International Classification of Sleep Disorders, third edition in regards to ADHD and sleep disorders via standardized parent-rated questionnaires. Additionally, quality of life (QoL) was assessed. Overall, 46 children fulfilled the criteria of ADHD and were medication-naive. RESULTS On average, the whole sample had clinically elevated total scores of the Children's Sleep Habits Questionnaire in the validated German version (CSHQ-DE), indicating an increased prevalence of sleep disorders in children with ADHD. In accordance to our hypothetical model, children with primarily hyperactive-impulsive ADHD showed the highest CSHQ-DE scores. Moreover, we found a high impact for insomnia in this subgroup and a high comorbid load for the mutual occurrence of insomnia and nightmares. Furthermore, QoL was reduced in our whole sample, and again intensified in children with comorbid insomnia and nightmares. CONCLUSION We verified an elevated occurrence of sleep disorders in children with ADHD and were able to link them to specific subtypes of ADHD. These results were in line with our hypothetical model. Moreover, we found a clinically reduced QoL in mean for the whole sample, indicating the strong impact of ADHD in the lives of affected children, even intensified if children exhibited comorbid insomnia and nightmares. These results should be kept in mind regarding the treatment and therapy of this subgroup of children. Specific treatment strategies should be considered for these children.
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Affiliation(s)
- Julia Grünwald
- Department of Psychology, Faculty of Science, University of Tübingen, Tübingen
| | - Angelika Anita Schlarb
- Department of Clinical Psychology and Psychotherapy, Faculty of Psychology and Sports Science, University of Bielefeld, Bielefeld, Germany
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Waxmonsky JG, Mayes SD, Calhoun SL, Fernandez-Mendoza J, Waschbusch DA, Bendixsen BH, Bixler EO. The association between Disruptive Mood Dysregulation Disorder symptoms and sleep problems in children with and without ADHD. Sleep Med 2017; 37:180-186. [PMID: 28899532 DOI: 10.1016/j.sleep.2017.02.006] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2016] [Revised: 02/13/2017] [Accepted: 02/15/2017] [Indexed: 11/25/2022]
Abstract
BACKGROUND Many youth experience persistent irritability and recurrent temper outbursts, conceptualized by DSM-5 as Disruptive Mood Dysregulation Disorder (DMDD). Sleep deprivation impairs emotion regulation which could increase rates of DMDD symptoms, especially in those with preexisting regulatory impairments, as seen with ADHD. However, there has been little examination of the relationship between chronic sleep problems and DMDD symptoms. METHODS Associations between DMDD symptoms and sleep parameters in children were assessed using parent-report and objective measures of sleep in a general population sample (N = 665) and an ADHD sample (N = 784). Irritability, temper outbursts, sleep problems and other psychological problems were assessed with the Pediatric Behavior Scale. The general population study also completed overnight polysomnography (PSG). RESULTS DMDD symptoms were reported in 9.2% of the community sample and 31.4% of the ADHD sample. In both samples, children with DMDD symptoms had significantly higher parent-reported sleep problems than children without DMDD symptoms. Children with sleep problems had significantly higher DMDD scores than children without sleep problems. However, DMDD symptoms were most strongly associated with oppositional behavior. Sleep problems were not a significant contributor. Hyperactivity-impulsivity was most strongly associated with sleep problems, and DMDD was not a significant contributor. Children with and without DMDD symptoms did not differ significantly on any PSG parameter. CONCLUSIONS Associations between parent-reported sleep problems and DMDD symptoms were due to their shared relationship with other behavioral problems. Therefore, chronic sleep problems do not appear to be a primary source of DMDD symptoms in children with or without ADHD.
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Affiliation(s)
- James G Waxmonsky
- Department of Psychiatry, Penn State College of Medicine, Hershey, PA, USA.
| | - Susan D Mayes
- Department of Psychiatry, Penn State College of Medicine, Hershey, PA, USA
| | - Susan L Calhoun
- Department of Psychiatry, Penn State College of Medicine, Hershey, PA, USA
| | | | | | | | - Edward O Bixler
- Department of Psychiatry, Penn State College of Medicine, Hershey, PA, USA
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Khan S, Heussler H, McGuire T, Dakin C, Pache D, Cooper D, Norris R, Flenady V, Charles B. Melatonin for non-respiratory sleep disorders in children with neurodevelopmental disorders. Hippokratia 2017. [DOI: 10.1002/14651858.cd009140.pub2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Affiliation(s)
- Sohil Khan
- School of Pharmacy, Menzies Health Institute Queensland, Griffith University; Gold Coast Australia
| | - Helen Heussler
- Mater Children's Hospital; Department of Respiratory and Sleep Medicine; Stanley St., South Brisbane Queensland Australia 4101
- The University of Queensland; Discpline of Paediatrics and Child Health, School of Medicine; Brisbane Australia
| | - Treasure McGuire
- Bond University; Faculty of Health Sciences and Medicine; University Drive, Robina Gold Coast Queensland Australia 4229
- The University of Queensland; School of Pharmacy; Pharmacy Australia Centre of Excellence 20 Cornwall Street, Woolloongabba Brisbane Queensland Australia 4102
- Mater Health Services; Mater Pharmacy Services (Practice & Development); South Brisbane Australia 4101
| | - Carolyn Dakin
- Mater Children's Hospital; Department of Respiratory and Sleep Medicine; Stanley St., South Brisbane Queensland Australia 4101
| | - David Pache
- The University of Queensland; School of Pharmacy; Pharmacy Australia Centre of Excellence 20 Cornwall Street, Woolloongabba Brisbane Queensland Australia 4102
- Mater Health Services; Pharmacy (Practice & Development); South Brisbane Queensland Australia 4101
- Queensland University of Technology; School of Nursing and Midwifery; Brisbane Australia
| | - David Cooper
- Mater Children's Hospital; Department of Respiratory and Sleep Medicine; Stanley St., South Brisbane Queensland Australia 4101
- The University of Queensland; School of Medicine; Brisbane Australia
| | - Ross Norris
- The University of Queensland; School of Pharmacy; Pharmacy Australia Centre of Excellence 20 Cornwall Street, Woolloongabba Brisbane Queensland Australia 4102
- Mater Pharmacy Services; Australian Centre for Paediatric Pharmacokinetics and Therapeutic Advisory Service; Mater Hospital South Brisbane Queensland Australia 4101
- Griffith University; Gold Coast Australia
| | - Vicki Flenady
- Mater Research Institute - The University of Queensland (MRI-UQ); Stillbirth Research Team; Level 2 Aubigny Place Mater Health Services Brisbane Queensland Australia 4101
| | - Bruce Charles
- The University of Queensland; School of Pharmacy; Pharmacy Australia Centre of Excellence 20 Cornwall Street, Woolloongabba Brisbane Queensland Australia 4102
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Clemow DB, Bushe C, Mancini M, Ossipov MH, Upadhyaya H. A review of the efficacy of atomoxetine in the treatment of attention-deficit hyperactivity disorder in children and adult patients with common comorbidities. Neuropsychiatr Dis Treat 2017; 13:357-371. [PMID: 28223809 PMCID: PMC5304987 DOI: 10.2147/ndt.s115707] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Attention-deficit hyperactivity disorder (ADHD) is a common neuropsychiatric disorder that is often diagnosed during childhood, but has also increasingly been recognized to occur in adults. Importantly, up to 52% of children (including adolescents) and 87% of adults with ADHD also have a comorbid psychiatric disorder. The presence of a comorbid disorder has the potential to impact diagnosis and could affect treatment outcomes. Atomoxetine is a nonstimulant treatment for ADHD. Despite numerous published studies regarding efficacy of atomoxetine in the treatment of ADHD in patients with comorbid disorders, there is limited information about the impact of individual common comorbid disorders on the efficacy of atomoxetine for ADHD, especially with regard to adults. Moreover, a cumulative review and assessment of these studies has not been conducted. For this reason, we performed a literature review to find, identify, and cumulatively review clinical studies that examined the efficacy of atomoxetine in the treatment of patients with ADHD and comorbid psychiatric disorders. We found a total of 50 clinical studies (37 in children; 13 in adults) that examined the efficacy of atomoxetine in patients with ADHD and a comorbid disorder. The comorbidities that were studied in children or in adults included anxiety, depression, and substance use disorder. Overall, the presence of comorbidity did not adversely impact the efficacy of atomoxetine in treatment of ADHD symptoms in both patient populations. In the studies identified and assessed in this review, atomoxetine did not appear to exacerbate any of the comorbid conditions and could, therefore, be an important therapy choice for the treatment of ADHD in the presence of comorbid disorders.
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Memory consolidation of socially relevant stimuli during sleep in healthy children and children with attention-deficit/hyperactivity disorder and oppositional defiant disorder: What you can see in their eyes. Biol Psychol 2016; 123:196-204. [PMID: 28049026 DOI: 10.1016/j.biopsycho.2016.12.017] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2016] [Revised: 11/08/2016] [Accepted: 12/29/2016] [Indexed: 11/22/2022]
Abstract
Children with attention-deficit/hyperactivity disorder (ADHD) display deficits in sleep-dependent memory consolidation, and being comorbid with oppositional defiant disorder (ODD), results in deficits in face processing. The aim of the present study was to investigate the role of sleep in recognizing faces in children with ADHD+ODD. Sixteen healthy children and 16 children diagnosed with ADHD+ODD participated in a sleep and a wake condition. During encoding (sleep condition at 8p.m.; wake condition at 8a.m.) pictures of faces were rated according to their emotional content; the retrieval session (12h after encoding session) contained a recognition task including pupillometry. Pupillometry and behavioral data revealed that healthy children benefited from sleep compared to wake with respect to face picture recognition; in contrast recognition performance in patients with ADHD+ODD was not improved after sleep compared to wake. It is discussed whether in patients with ADHD+ODD social stimuli are preferentially consolidated during daytime.
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Vélez-Galarraga R, Guillén-Grima F, Crespo-Eguílaz N, Sánchez-Carpintero R. Prevalence of sleep disorders and their relationship with core symptoms of inattention and hyperactivity in children with attention-deficit/hyperactivity disorder. Eur J Paediatr Neurol 2016; 20:925-937. [PMID: 27461837 DOI: 10.1016/j.ejpn.2016.07.004] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2015] [Revised: 06/18/2016] [Accepted: 07/04/2016] [Indexed: 01/31/2023]
Abstract
OBJECTIVES To determine the prevalence of sleep disorders in children with attention-deficit/hyperactivity disorder (ADHD) and in a control population. To examine the relationship between sleep disorders and symptoms of inattention, hyperactivity/impulsiveness and executive dysfunction. MATERIALS AND METHODS We studied 126 children with ADHD and 1036 control children aged between 5 and 18 years old. Caregivers completed the Pediatric Sleep Questionnaire and the ADHD Rating Scale (ADHD-RS). Children with ADHD were subsequently assessed for executive function with the Conner's Continuous Performance Test (CPT) or with AULA Nesplora. RESULTS Children with ADHD slept less at night and were more likely to display sleep-related rhythmic movements. Children in the ADHD group who were under 12 years old and who had total ADHD-RS scores over the 90th percentile had more difficulty falling asleep than other children; there was also a relationship between total ADHD-RS scores over the 90th percentile and certain parasomnias in the control population. There was a correlation between shorter duration of night-time sleep and omission errors in children who were 12 or older and who were under pharmacological treatment for ADHD. Bedtime resistance and difficulty falling sleep were more frequent in children with ADHD whose symptoms were not treated pharmacologically, than in children receiving treatment. INTERPRETATION Symptoms of inattention and hyperactivity are correlated with impaired sleep duration and quality; specifically, there is an association between ADHD symptoms and problems falling asleep and parasomnias, however, the current study does not address the nature and direction of causality. Children with ADHD and receiving methylphenidate had fewer sleep disorders, suggesting that, at least in some children, stimulant treatment is associated with improvement of some aspects of sleep. Shorter sleep duration in adolescents under pharmacological treatment for ADHD tended to result in more errors of omission, suggesting that it is important to promote good sleep habits in this population.
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Affiliation(s)
| | - Francisco Guillén-Grima
- Department of Preventive Medicine, Clínica Universidad de Navarra, Pamplona, Spain; Navarra's Health Research Institute (IDISNA), Pamplona, Spain; Department of Health Sciences, Public University of Navarra, Pamplona, Spain
| | | | - Rocío Sánchez-Carpintero
- Pediatric Neurology Unit, Clínica Universidad de Navarra, Pamplona, Spain; Navarra's Health Research Institute (IDISNA), Pamplona, Spain.
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Lunsford-Avery JR, Krystal AD, Kollins SH. Sleep disturbances in adolescents with ADHD: A systematic review and framework for future research. Clin Psychol Rev 2016; 50:159-174. [PMID: 27969004 DOI: 10.1016/j.cpr.2016.10.004] [Citation(s) in RCA: 73] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2016] [Revised: 09/15/2016] [Accepted: 10/21/2016] [Indexed: 12/20/2022]
Abstract
BACKGROUND Biological mechanisms underlying symptom and prognostic heterogeneity in Attention-Deficit/Hyperactivity Disorder (ADHD) are unclear. Sleep impacts neurocognition and daytime functioning and is disrupted in ADHD, yet little is known about sleep in ADHD during adolescence, a period characterized by alterations in sleep, brain structure, and environmental demands as well as diverging ADHD trajectories. METHODS A systematic review identified studies published prior to August 2016 assessing sleep in adolescents (aged 10-19years) with ADHD or participating in population-based studies measuring ADHD symptoms. RESULTS Twenty-five studies were identified (19 subjective report, 6 using actigraphy/polysomnography). Findings are mixed but overall suggest associations between sleep disturbances and 1) ADHD symptoms in the population and 2) poorer clinical, neurocognitive, and functional outcomes among adolescents with ADHD. Common limitations of studies included small or non-representative samples, non-standardized sleep measures, and cross-sectional methodology. CONCLUSIONS Current data on sleep in adolescent ADHD are sparse and limited by methodological concerns. Future studies are critical for clarifying a potential role of sleep in contributing to heterogeneity of ADHD presentation and prognosis. Potential mechanisms by which sleep disturbances during adolescence may contribute to worsened symptom severity and persistence of ADHD into adulthood and an agenda to guide future research are discussed.
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Affiliation(s)
- Jessica R Lunsford-Avery
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, 2608 Erwin Road Suite 300, Durham, NC 27705, United States.
| | - Andrew D Krystal
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, 2608 Erwin Road Suite 300, Durham, NC 27705, United States; Departments of Psychiatry and Neurology, University of California San Francisco School of Medicine, 401 Parnassus Avenue, San Francisco, CA 94143, United States
| | - Scott H Kollins
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, 2608 Erwin Road Suite 300, Durham, NC 27705, United States
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Setoyama A, Ikeda M, Kamibeppu K. Objective assessment of sleep status and its correlates in hospitalized children with cancer: Exploratory study. Pediatr Int 2016; 58:842-9. [PMID: 26767328 DOI: 10.1111/ped.12927] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2014] [Revised: 12/04/2015] [Accepted: 01/13/2016] [Indexed: 11/28/2022]
Abstract
BACKGROUND Children with cancer are known to have sleep problems. Although hospitalization and psychosocial factors are considered to be the factors affecting children's sleep, few studies have confirmed these effects. The aims of this study were to describe the sleep status of hospitalized children with cancer and to explore the correlates. METHODS The sleep status of 11 hospitalized children (aged 2-12 years) with cancer was measured using actigraph and sleep diary during hospitalization and a short home stay. Possible correlates were assessed using a questionnaire. RESULTS The participants had significantly longer sleep onset latency, earlier bedtime, and poorer self-evaluated sleep quality during hospitalization than the short home stay. They had shorter total sleep time, longer wake time after sleep onset, and less sleep efficiency at home, compared with healthy historical controls. Children's age, symptoms, hospitalization period, Cognitive Fatigue, Procedural Anxiety, Treatment Anxiety, Social Anxiety, and Separation Anxiety, as well as caregiver anxiety, Receptive and Focused Attitude, and Regimented Attitude were significantly correlated with sleep variables. CONCLUSIONS Hospitalization decreased self-evaluated sleep quality, and difficulty falling asleep. The sleep of the participants at home was disturbed compared with that of healthy children. Hospitalization, patient characteristics, disease-related, and some psychosocial factors were associated with sleep variables. Medical professionals should develop a favorable environment for falling asleep in hospital for individual children. Children with cancer in the early period of hospitalization need increased care to facilitate good sleep.
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Affiliation(s)
- Ami Setoyama
- Department of Family Nursing, Division of Health Sciences and Nursing, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
| | - Mari Ikeda
- Department of Family Nursing, Division of Health Sciences and Nursing, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
| | - Kiyoko Kamibeppu
- Department of Family Nursing, Division of Health Sciences and Nursing, Graduate School of Medicine, University of Tokyo, Tokyo, Japan.
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Van Herzeele C, Dhondt K, Roels SP, Raes A, Hoebeke P, Groen LA, Vande Walle J. Desmopressin (melt) therapy in children with monosymptomatic nocturnal enuresis and nocturnal polyuria results in improved neuropsychological functioning and sleep. Pediatr Nephrol 2016; 31:1477-84. [PMID: 27067081 DOI: 10.1007/s00467-016-3351-3] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2015] [Revised: 01/15/2016] [Accepted: 02/10/2016] [Indexed: 01/24/2023]
Abstract
BACKGROUND There is a high comorbidity between nocturnal enuresis, sleep disorders and psychological problems. The aim of this study was to investigate whether a decrease in nocturnal diuresis volume not only improves enuresis but also ameliorates disrupted sleep and (neuro)psychological dysfunction, the major comorbidities of this disorder. METHODS In this open-label, prospective phase IV study, 30 children with monosymptomatic nocturnal enuresis (MNE) underwent standardized video-polysomnographic testing and multi-informant (neuro)psychological testing at baseline and 6 months after the start of desmopressin treatment in the University Hospital Ghent, Belgium. Primary endpoints were the effect on sleep and (neuro)psychological functioning. The secondary endpoint was the change in the first undisturbed sleep period or the time to the first void. RESULTS Thirty children aged between 6 and 16 (mean 10.43, standard deviation 3.08) years completed the study. The results demonstrated a significant decrease in periodic limb movements during sleep (PLMS) and a prolonged first undisturbed sleep period. Additionally, (neuro)psychological functioning was improved on several domains. CONCLUSIONS The study demonstrates that the degree of comorbidity symptoms is at least aggravated by enuresis (and/or high nocturnal diuresis rate) since sleep and (neuro)psychological functioning were significantly ameliorated by treatment of enuresis. These results indicate that enuresis is not such a benign condition as has previously been assumed.
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Affiliation(s)
- Charlotte Van Herzeele
- Department of Pediatric Nephrology/Urology and Safepedrug, University Hospital Ghent and Ghent University, De Pintelaan 185, 9000, Ghent, Belgium.
| | - Karlien Dhondt
- Child Neurology & Metabolism, Pediatric Sleep Center, University Hospital Ghent, Ghent, Belgium
| | - Sanne P Roels
- Department of Data Analysis, University Ghent, Ghent, Belgium
| | - Ann Raes
- Department of Pediatric Nephrology/Urology and Safepedrug, University Hospital Ghent and Ghent University, De Pintelaan 185, 9000, Ghent, Belgium
| | - Piet Hoebeke
- Department of Pediatric Nephrology/Urology and Safepedrug, University Hospital Ghent and Ghent University, De Pintelaan 185, 9000, Ghent, Belgium
| | - Luitzen-Albert Groen
- Department of Pediatric Nephrology/Urology and Safepedrug, University Hospital Ghent and Ghent University, De Pintelaan 185, 9000, Ghent, Belgium
| | - Johan Vande Walle
- Department of Pediatric Nephrology/Urology and Safepedrug, University Hospital Ghent and Ghent University, De Pintelaan 185, 9000, Ghent, Belgium
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Becker SP, Sidol CA, Van Dyk TR, Epstein JN, Beebe DW. Intraindividual variability of sleep/wake patterns in relation to child and adolescent functioning: A systematic review. Sleep Med Rev 2016; 34:94-121. [PMID: 27818086 DOI: 10.1016/j.smrv.2016.07.004] [Citation(s) in RCA: 148] [Impact Index Per Article: 18.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2016] [Revised: 07/11/2016] [Accepted: 07/12/2016] [Indexed: 01/09/2023]
Abstract
Substantial research attention has been devoted to understanding the importance and impact of sleep in children and adolescents. Traditionally, this has focused on mean sleep variables (e.g., a child's "typical" or average sleep duration), yet research increasingly suggests that intraindividual variability (IIV) of sleep/wake patterns (sometimes referred to as sleep variability or night-to-night variability) regularly occurs and may have implications for adjustment. A systematic search of five electronic databases identified 52 empirical studies published between 2000 and 2015 that examined correlates of sleep IIV in children and adolescents, with a recent increase in the publication rate of such studies. Identified studies were often atheoretical and included post hoc analyses, though IIV in select aspects of sleep does appear to be associated with increasing age/pubertal status, non-White race, physical and neurodevelopmental conditions (e.g., attention-deficit/hyperactivity disorder; autism), psychopathology symptoms (e.g., anxiety, depression, inattention), body weight, stress, aspects of cognitive functioning, and poorer sleep functioning/habits. The limited intervention work examining sleep IIV in adolescents is promising, though studies are needed using more rigorous intervention designs. Clinical sleep recommendations may not only need to address overall sleep duration and sleep habits but also the stability of sleep duration and timing. It will be important for future research examining sleep IIV in children and adolescents to use a developmental framework in advancing theory pertaining to the causes, mechanisms, moderators, and outcomes of sleep IIV in youth, and a conceptual model is proposed to help guide such efforts.
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Affiliation(s)
- Stephen P Becker
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA; Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA.
| | - Craig A Sidol
- Department of Psychology, University of Cincinnati, Cincinnati, OH, USA
| | - Tori R Van Dyk
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA; Department of Psychology, University of Nebraska-Lincoln, Lincoln, NE, USA
| | - Jeffery N Epstein
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA; Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA; Department of Psychology, University of Cincinnati, Cincinnati, OH, USA
| | - Dean W Beebe
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA; Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
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Ramnaraine LD, Rahmani M, Khurshid KA. Sleep Problems and Disorders in Children and Adolescents with Attention-Deficit/Hyperactivity Disorder. Psychiatr Ann 2016. [DOI: 10.3928/00485713-20160518-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Díaz-Román A, Hita-Yáñez E, Buela-Casal G. Sleep Characteristics in Children with Attention Deficit Hyperactivity Disorder: Systematic Review and Meta-Analyses. J Clin Sleep Med 2016; 12:747-56. [PMID: 26951416 DOI: 10.5664/jcsm.5810] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2015] [Accepted: 12/17/2015] [Indexed: 11/13/2022]
Abstract
STUDY OBJECTIVES Sleep disturbances have been associated with attention deficit hyperactivity disorder (ADHD), but such relationship is still unclear. The results from the studies conducted do not provide enough evidence to support a sleep physiology inherent to ADHD. This study tries to determine if that sleep physiology really exists by comparing children with ADHD and control children in some sleep parameters. METHODS A search was conducted in several databases (Web of Science, Scopus, Pubmed and PsycINFO), and a manual search, to retrieve all the articles available from 1987 until March 2014. Of 8,678 non-duplicate studies retrieved, 11 studies met the inclusion and methodological quality criteria. Two meta-analyses were performed with eight of those studies, depending on data provided by them: polysomnographic or actigraphic. A fixed-effects model, and the standardized mean difference (SMD) as the index of effect size, were used in both meta-analyses. RESULTS Significant differences were found only in the meta-analysis with polysomnography as outcome. Children with ADHD were found to spend more time in stage 1 sleep than controls (pooled SMD = 0.32, 95% CI = 0.08-0.55, p value = 0.009). CONCLUSIONS Although few differences in sleep between children with ADHD and controls have been found in this review, further studies are required on this matter. Those studies should consider some variables discussed in this review, in order to obtain useful and reliable conclusions for research and clinical practice. Particularly, the influence of assessment criteria and ADHD subtypes in the sleep characteristics of children with ADHD should be addressed.
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Affiliation(s)
- Amparo Díaz-Román
- Mind, Brain and Behavior Research Center, CIMCYC, University of Granada, Granada, Spain
| | - Eva Hita-Yáñez
- Mind, Brain and Behavior Research Center, CIMCYC, University of Granada, Granada, Spain
| | - Gualberto Buela-Casal
- Mind, Brain and Behavior Research Center, CIMCYC, University of Granada, Granada, Spain
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De Crescenzo F, Licchelli S, Ciabattini M, Menghini D, Armando M, Alfieri P, Mazzone L, Pontrelli G, Livadiotti S, Foti F, Quested D, Vicari S. The use of actigraphy in the monitoring of sleep and activity in ADHD: A meta-analysis. Sleep Med Rev 2016; 26:9-20. [DOI: 10.1016/j.smrv.2015.04.002] [Citation(s) in RCA: 66] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2014] [Revised: 04/15/2015] [Accepted: 04/15/2015] [Indexed: 11/27/2022]
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Bergwerff CE, Luman M, Oosterlaan J. No objectively measured sleep disturbances in children with attention-deficit/hyperactivity disorder. J Sleep Res 2016; 25:534-540. [PMID: 27027862 DOI: 10.1111/jsr.12399] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2015] [Accepted: 01/25/2016] [Indexed: 11/30/2022]
Abstract
The main goal of this study was to gain more insight into sleep disturbances in children with attention-deficit/hyperactivity disorder, using objective measures of sleep quality and quantity. The evidence for sleep problems in children with attention-deficit/hyperactivity disorder thus far is inconsistent, which might be explained by confounding influences of comorbid internalizing and externalizing problems and low socio-economic status. We therefore investigated the mediating and moderating role of these factors in the association between attention-deficit/hyperactivity disorder and sleep problems. To control for the effects of stimulant medication use, all participants were tested free of medication. Sixty-three children with attention-deficit/hyperactivity disorder and 61 typically developing children, aged 6-13 years, participated. Sleep was monitored for one to three school nights using actigraphy. Parent and teacher questionnaires assessed symptoms of attention-deficit/hyperactivity disorder, internalizing behaviour, oppositional defiant disorder and conduct disorder. Results showed no differences between the attention-deficit/hyperactivity disorder and typically developing group in any sleep parameter. Within the attention-deficit/hyperactivity disorder group, severity of attention-deficit/hyperactivity disorder symptoms was not related to sleep quality or quantity. Moderation analyses in the attention-deficit/hyperactivity disorder group showed an interaction effect between attention-deficit/hyperactivity disorder symptoms and internalizing and externalizing behaviour on total sleep time, time in bed and average sleep bout duration. The results of our study suggest that having attention-deficit/hyperactivity disorder is not a risk factor for sleep problems. Internalizing and externalizing behaviour moderate the association between attention-deficit/hyperactivity disorder and sleep, indicating a complex interplay between psychiatric symptoms and sleep.
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Affiliation(s)
- Catharina E Bergwerff
- Clinical Neuropsychology section, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands.
| | - Marjolein Luman
- Clinical Neuropsychology section, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Jaap Oosterlaan
- Clinical Neuropsychology section, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
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Becker SP, Pfiffner LJ, Stein MA, Burns GL, McBurnett K. Sleep habits in children with attention-deficit/hyperactivity disorder predominantly inattentive type and associations with comorbid psychopathology symptoms. Sleep Med 2015; 21:151-9. [PMID: 26922623 DOI: 10.1016/j.sleep.2015.11.011] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2015] [Revised: 10/17/2015] [Accepted: 11/16/2015] [Indexed: 02/06/2023]
Abstract
OBJECTIVES Much of what is currently known about the sleep functioning of children with attention-deficit/hyperactivity disorder (ADHD) is based on samples of children with ADHD combined type, and no study to date has examined the association between sluggish cognitive tempo (SCT) and sleep functioning in children diagnosed with ADHD. Accordingly, the objectives of this study were to (1) describe the sleep habits of children diagnosed with ADHD predominantly inattentive type (ADHD-I) and (2) examine whether comorbid internalizing, oppositional, and/or SCT symptoms are associated with poorer sleep functioning in children with ADHD-I. This study extends the current literature by using a large, clinical sample of children with ADHD-I to examine the association between SCT and other psychopathology symptoms with children's sleep functioning. METHODS Participants included 147 children (age: 6-11, 59% male, 55% White) diagnosed with ADHD-I using a semi-structured diagnostic interview. Parents completed measures assessing their child's sleep habits as well as comorbid anxiety, depression, oppositionality, and SCT symptoms. RESULTS Fourteen percent of children with ADHD-I obtain less sleep than recommended and 31% have a sleep onset latency of greater than 20 minutes. The few children taking medication for ADHD had a longer sleep onset latency than those without medication. Twenty-seven percent of parents indicated that it is "difficult" to get their child out of bed on school days and 41% of parents indicated that their child needs to catch-up on sleep on the weekend "at least a little". Regression analyses found anxiety and SCT sleepy/tired symptoms to be the most consistent dimensions of psychopathology associated with sleep functioning, with little support for depression or oppositionality being associated with sleep. CONCLUSIONS A sizeable minority of children with ADHD-I experience impaired sleep. In addition to SCT sleepy/tired symptoms, comorbid anxiety was most consistently associated with poorer sleep functioning in children with ADHD-I. SCT daydreaming and working memory symptoms were unassociated with sleep functioning, and the size of the effects between SCT sleepy/tired and sleep functioning indicates that these are not overlapping constructs. Longitudinal studies are needed to evaluate the interrelations of sleep problems and comorbid psychopathology symptoms and their impact on the daytime functioning of children with ADHD-I.
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Affiliation(s)
- Stephen P Becker
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA; Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA.
| | - Linda J Pfiffner
- Department of Psychiatry, University of California, San Francisco, San Francisco, CA, USA
| | - Mark A Stein
- Department of Psychiatry and Behavioral Medicine, University of Washington, Seattle, WA, USA
| | - G Leonard Burns
- Department of Psychology, Washington State University, Pullman, WA, USA
| | - Keith McBurnett
- Department of Psychiatry, University of California, San Francisco, San Francisco, CA, USA
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47
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Sangal RB, Sangal JM. Use of EEG Beta-1 Power and Theta/Beta Ratio Over Broca's Area to confirm Diagnosis of Attention Deficit/Hyperactivity Disorder in Children. Clin EEG Neurosci 2015; 46:177-82. [PMID: 24973230 DOI: 10.1177/1550059414527284] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2014] [Accepted: 02/08/2014] [Indexed: 11/17/2022]
Abstract
The Food and Drug Administration has approved a medical device using the electroencephalogram (EEG) theta/beta ratio (tbr) to help assess pediatric attention deficit/hyperactivity disorder (ADHD). Tbr is reported to be higher in ADHD, with increased theta and decreased beta. This study examined theta and beta-1 power differences between ADHD and normal children, during tasks of selective attention, and elucidated topographical differences. EEGs were collected from 28 normal and 58 ADHD children, aged 6 to 14 years, using 31 scalp electrodes during auditory and visual tasks requiring selective attention. Spectral analysis was performed. Tbr was higher in ADHD than in normal children (2.60 vs 2.25, P = .007), with lower beta-1 (3.66 vs 4.22, P = .01), but no difference in theta power. There was lower beta-1 (P < .001) and higher tbr (P = .002) over Broca's area (electrode locations F7 and FC5). Beta-1 power over Broca's area was the best diagnostic test, with sensitivity 0.86 and specificity 0.57. Tbr is higher and beta-1 power lower in ADHD than in normal children, especially over Broca's area. Beta-1 power and tbr assist in confirming the diagnosis of ADHD in a sample with moderate pretest probability of ADHD.
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Affiliation(s)
- R Bart Sangal
- Attention Disorders Institute, Sterling Heights, MI, USA Oakland University William Beaumont School of Medicine, Rochester, MI, USA
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48
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Anxiety disorders and comorbid sleep problems in school-aged youth: review and future research directions. Child Psychiatry Hum Dev 2015; 46:376-92. [PMID: 24962165 DOI: 10.1007/s10578-014-0478-y] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
This review examines the relationship between anxiety disorders and sleep related problems (SRPs) in school-aged youth. Following an overview of normative sleep patterns and maturational sleep changes, the review addresses issues related to sleep measurement. SRPs are reviewed in relation to executive functions (e.g. affect regulation) as is the shared role of neurological regions in the regulation of anxiety and sleep. Studies of the association between SRPs and anxiety in anxiety-disordered samples are reviewed with explicit consideration of the potential mechanisms underlying the sleep-anxiety relationship (e.g., arousal, sleep hygiene, parental accommodation). Specific cognitive-behavioral treatments for SRPs and anxiety are reviewed with regard to their impact on comorbid anxiety or SRPs. Methodological limitations are noted and recommendations for future research are proposed.
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49
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Singh K, Zimmerman AW. Sleep in Autism Spectrum Disorder and Attention Deficit Hyperactivity Disorder. Semin Pediatr Neurol 2015; 22:113-25. [PMID: 26072341 DOI: 10.1016/j.spen.2015.03.006] [Citation(s) in RCA: 75] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Sleep problems are common in autism spectrum disorder (ASD) and attention deficit hyperactivity disorder (ADHD). Sleep problems in these disorders may not only worsen daytime behaviors and core symptoms of ASD and ADHD but also contribute to parental stress levels. Therefore, the presence of sleep problems in ASD and ADHD requires prompt attention and management. This article is presented in 2 sections, one each for ASD and ADHD. First, a detailed literature review about the burden and prevalence of different types of sleep disorders is presented, followed by the pathophysiology and etiology of the sleep problems and evaluation and management of sleep disorders in ASD and ADHD.
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Affiliation(s)
- Kanwaljit Singh
- Department of Pediatrics, University of Massachusetts Medical School, Worcester, MA
| | - Andrew W Zimmerman
- Department of Pediatrics, University of Massachusetts Medical School, Worcester, MA.
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50
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Attention deficit-hyperactivity disorder symptoms and daytime voiding symptoms in children with primary enuresis: an observational study to evaluate the effectiveness of desmopressin treatment. ScientificWorldJournal 2015; 2015:356121. [PMID: 25866838 PMCID: PMC4381655 DOI: 10.1155/2015/356121] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2014] [Revised: 01/25/2015] [Accepted: 02/24/2015] [Indexed: 11/18/2022] Open
Abstract
Purpose. To evaluate the effectiveness of presence of desmopressin in treating primary enuresis (PE) for children with attention deficit-hyperactivity disorder (ADHD) symptoms. Materials and Methods. Children aged from 5 to 12 years with the chief complaint of PE treated with desmopressin were enrolled in pediatric urology clinics. The parent-reported SNAP-IV questionnaire was used to evaluate ADHD symptoms (cut-off value: 90th percentile). Voiding symptoms were assessed by the Dysfunctional Voiding Scoring System (DVSS) questionnaire. The responses to desmopressin were analyzed in children with and without ADHD symptoms. Results. The study sample comprised 68 children; 27 (39.7%) presented with ADHD symptoms and 41 (60.3%) with non-ADHD symptoms. The children collected from a tertiary referral center may explain the high prevalence of ADHD symptoms in the present study. The total DVSS score in the ADHD symptoms group was significantly higher than in the non-ADHD symptoms group (7.72 versus 5.65, P = 0.05). In the ADHD symptoms group, there were significantly higher score in the “pee 1-2 times/day” and “can't wait” subscales of DVSS and lower sleep quality based on the Pediatric Sleep Quality questionnaire, as well as significantly lower peak flow rate and voided volume. The responses to desmopressin for enuresis were comparable between children with ADHD and non-ADHD symptoms. Conclusions. Approximately 39.7% of PE children presented with ADHD symptoms at urologic clinics. PE children with ADHD symptoms had higher risk of daytime LUTS and comparable response to desmopressin treatment for PE. To evaluate ADHD symptoms and daytime voiding symptoms is important in children with PE.
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