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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] [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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2
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Swisher V, Tooker M, Qu C, Burgess HJ, Coles ME, Bennett S, Piacentini J, Colwell CS, Ricketts EJ. Sleep Disorders, Sleep Medication Use, and Predictors of Sleep Disturbance in Children with Persistent Tic Disorders. CHILDRENS HEALTH CARE 2023; 53:23-40. [PMID: 38435344 PMCID: PMC10904019 DOI: 10.1080/02739615.2023.2175682] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/01/2023]
Abstract
The present study examined rates of sleep disorders and sleep medication use, and predictors of sleep disturbance in children with persistent tic disorders (PTD). Sixty-three parents of children aged 10 to 17 years with PTDs completed an internet survey evaluating sleep patterns and clinical symptoms. Insomnia (19.4%), nightmares (16.1%), and bruxism (13.1%) were the most commonly reported lifetime sleep disorders. Fifty-two percent endorsed current sleep medication use. Higher ADHD severity, overall life impairment, and female sex predicted greater sleep disturbance. Findings suggest the utility of clinical management of co-occurring ADHD and impairment to mitigate sleep disturbance in children with PTDs.
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Affiliation(s)
- Valerie Swisher
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles
| | - Maya Tooker
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles
| | - Christine Qu
- Department of Biological Sciences, Columbia University
| | | | | | - Shannon Bennett
- Department of Psychiatry, Weill Cornell Medicine, New York, NY 10065
| | - John Piacentini
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles
| | - Christopher S. Colwell
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles
| | - Emily J. Ricketts
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles
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3
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Frick MA, Meyer J, Isaksson J. The Role of Comorbid Symptoms in Perceived Stress and Sleep Problems in Adolescent ADHD. Child Psychiatry Hum Dev 2022:10.1007/s10578-022-01320-z. [PMID: 35094182 DOI: 10.1007/s10578-022-01320-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/16/2022] [Indexed: 11/24/2022]
Abstract
We examined perceived stress and sleep problems in adolescent ADHD and whether this varies as a function of ADHD presentation and sex. Further, we mapped structural associations between ADHD symptoms, comorbid symptoms, perceived stress, and sleep problems. Participants were 306 adolescents aged 13-19 years (66.8% females, 193 had an ADHD diagnosis, 113 were controls). Parents rated ADHD symptoms, all other constructs were self-rated. Adolescents with ADHD had elevated levels of perceived stress and sleep problems. Girls with ADHD reported the highest levels of perceived stress. Emotional symptoms mediated the effect of inattention whereas conduct problems mediated the effect of hyperactivity/impulsivity on stress and sleep. Perceived stress and sleep problems should be considered when mapping ADHD-related problems. Comorbid symptoms are potential intervention targets that may increase treatment response.
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Affiliation(s)
- Matilda A Frick
- Department of Medical Sciences, Child and Adolescent Psychiatry Unit, Uppsala University, Uppsala, Sweden.
- Department of Psychology, Division of Emotion Psychology, Uppsala University, Uppsala, Sweden.
| | - Jenny Meyer
- Department of Medical Sciences, Child and Adolescent Psychiatry Unit, Uppsala University, Uppsala, Sweden
| | - Johan Isaksson
- Department of Medical Sciences, Child and Adolescent Psychiatry Unit, Uppsala University, Uppsala, Sweden
- Center of Neurodevelopmental Disorders (KIND), Centre for Psychiatry Research, Department of Women's and Children's Health, Karolinska Institutet & Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
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4
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Van Meter AR, Anderson EA. Evidence Base Update on Assessing Sleep in Youth. JOURNAL OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY 2020; 49:701-736. [PMID: 33147074 DOI: 10.1080/15374416.2020.1802735] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND Sleep is vital to youth well-being and when it becomes disturbed - whether due to environmental or individual factors - mental and physical health suffer. Sleep problems can also be a symptom of underlying mental health disorders. Assessing different components of sleep, including quality and hygiene, can be useful both for identifying mental health problems and for measuring changes in well-being over time. However, there are dozens of sleep-related measures for youth and it can be difficult to determine which to select for a specific research or clinical purpose. The goal of this review was to identify sleep-related measures for clinical and/or research use in youth mental health settings, and to update the evidence base on this topic. METHOD We generated a list of candidate measures based on other reviews and searched in PubMed and PsycINFO using the terms "sleep" AND (measure OR assessment OR questionnaire) AND (psychometric OR reliability OR validity). Search results were limited to studies about children and adolescents (aged 2-17) published in English. Additional criteria for inclusion were that there had to be at least three publications reporting on the measure psychometrics in community or mental health populations. Sleep measures meeting these criteria were evaluated using the criteria set by De Los Reyes and Langer (2018). RESULTS Twenty-six measures, across four domains of sleep - insomnia, sleep hygiene, sleepiness, sleep quality - met inclusion criteria. Each measure had at least adequate clinical utility. No measure(s) emerged as superior across psychometric domains. CONCLUSION Clinicians and researchers must evaluate sleep measures for each use case, as the intended purpose will dictate which measure is best. Future research is necessary to evaluate measure performance in transdiagnostic mental health populations, including youth with serious mental illness.
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Affiliation(s)
- Anna R Van Meter
- Department of Psychiatry, Zucker Hillside Hospital.,Feinstein Institutes for Medical Research, Institute for Behavioral Science.,Department of Psychiatry, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell
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5
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Shen C, Luo Q, Chamberlain SR, Morgan S, Romero-Garcia R, Du J, Zhao X, Touchette É, Montplaisir J, Vitaro F, Boivin M, Tremblay RE, Zhao XM, Robaey P, Feng J, Sahakian BJ. What Is the Link Between Attention-Deficit/Hyperactivity Disorder and Sleep Disturbance? A Multimodal Examination of Longitudinal Relationships and Brain Structure Using Large-Scale Population-Based Cohorts. Biol Psychiatry 2020; 88:459-469. [PMID: 32414481 PMCID: PMC7445427 DOI: 10.1016/j.biopsych.2020.03.010] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2019] [Revised: 03/17/2020] [Accepted: 03/17/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND Attention-deficit/hyperactivity disorder (ADHD) comorbid with sleep disturbances can produce profound disruption in daily life and negatively impact quality of life of both the child and the family. However, the temporal relationship between ADHD and sleep impairment is unclear, as are underlying common brain mechanisms. METHODS This study used data from the Quebec Longitudinal Study of Child Development (n = 1601, 52% female) and the Adolescent Brain Cognitive Development Study (n = 3515, 48% female). Longitudinal relationships between symptoms were examined using cross-lagged panel models. Gray matter volume neural correlates were identified using linear regression. The transcriptomic signature of the identified brain-ADHD-sleep relationship was characterized by gene enrichment analysis. Confounding factors, such as stimulant drugs for ADHD and socioeconomic status, were controlled for. RESULTS ADHD symptoms contributed to sleep disturbances at one or more subsequent time points in both cohorts. Lower gray matter volumes in the middle frontal gyrus and inferior frontal gyrus, amygdala, striatum, and insula were associated with both ADHD symptoms and sleep disturbances. ADHD symptoms significantly mediated the link between these structural brain abnormalities and sleep dysregulation, and genes were differentially expressed in the implicated brain regions, including those involved in neurotransmission and circadian entrainment. CONCLUSIONS This study indicates that ADHD symptoms and sleep disturbances have common neural correlates, including structural changes of the ventral attention system and frontostriatal circuitry. Leveraging data from large datasets, these results offer new mechanistic insights into this clinically important relationship between ADHD and sleep impairment, with potential implications for neurobiological models and future therapeutic directions.
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Affiliation(s)
- Chun Shen
- Institute of Science and Technology for Brain-Inspired Intelligence, MOE Key Laboratory of Computational Neuroscience and Brain-Inspired Intelligence, Fudan University, Shanghai, China; Shanghai Research Center for Brain Science and Brain-Inspired Intelligence, Institute of Brain-Intelligence Technology, Zhangjiang Laboratory, Shanghai, China
| | - Qiang Luo
- Institute of Science and Technology for Brain-Inspired Intelligence, MOE Key Laboratory of Computational Neuroscience and Brain-Inspired Intelligence, Fudan University, Shanghai, China; State Key Laboratory of Medical Neurobiology and MOE Frontiers Center for Brain Science, Institutes of Brain Science and Human Phenome Institute, Fudan University, Shanghai, China; Behavioural and Clinical Neuroscience Institute, Department of Psychology, University of Cambridge, Cambridge, United Kingdom; Shanghai Research Center for Brain Science and Brain-Inspired Intelligence, Institute of Brain-Intelligence Technology, Zhangjiang Laboratory, Shanghai, China.
| | | | - Sarah Morgan
- Department of Psychiatry, University of Cambridge, Cambridge, United Kingdom; Alan Turing Institute, London, United Kingdom
| | | | - Jingnan Du
- Institute of Science and Technology for Brain-Inspired Intelligence, MOE Key Laboratory of Computational Neuroscience and Brain-Inspired Intelligence, Fudan University, Shanghai, China
| | - Xingzhong Zhao
- Institute of Science and Technology for Brain-Inspired Intelligence, MOE Key Laboratory of Computational Neuroscience and Brain-Inspired Intelligence, Fudan University, Shanghai, China
| | - Évelyne Touchette
- Department of Psychoeducation, Université du Québec à Trois-Rivières, Trois-Rivières, Québec, Canada
| | - Jacques Montplaisir
- Department of Psychiatry, Université de Montréal, Montréal, Québec, Canada; Center for Advanced Research in Sleep Medicine, CIUSSS-NIM, Montréal, Québec, Canada
| | - Frank Vitaro
- School of Psychoeducation, Université de Montréal, Montréal, Québec, Canada
| | - Michel Boivin
- School of Psychology, Université Laval, Québec City, Québec, Canada
| | - Richard E Tremblay
- Department of Pediatrics and Psychology, Université de Montréal, Montréal, Québec, Canada; School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin, Ireland
| | - Xing-Ming Zhao
- Institute of Science and Technology for Brain-Inspired Intelligence, MOE Key Laboratory of Computational Neuroscience and Brain-Inspired Intelligence, Fudan University, Shanghai, China
| | - Philippe Robaey
- Department of Psychiatry, Université de Montréal, Montréal, Québec, Canada; Department of Psychiatry, University of Ottawa, Ottawa, Ontario, Canada; Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
| | - Jianfeng Feng
- Institute of Science and Technology for Brain-Inspired Intelligence, MOE Key Laboratory of Computational Neuroscience and Brain-Inspired Intelligence, Fudan University, Shanghai, China; Collaborative Innovation Center for Brain Science, Fudan University, Shanghai, China; School of Mathematical Sciences, Fudan University, Shanghai, China; Department of Computer Science, University of Warwick, Coventry, United Kingdom; Shanghai Research Center for Brain Science and Brain-Inspired Intelligence, Institute of Brain-Intelligence Technology, Zhangjiang Laboratory, Shanghai, China.
| | - Barbara J Sahakian
- Institute of Science and Technology for Brain-Inspired Intelligence, MOE Key Laboratory of Computational Neuroscience and Brain-Inspired Intelligence, Fudan University, Shanghai, China; Behavioural and Clinical Neuroscience Institute, Department of Psychology, University of Cambridge, Cambridge, United Kingdom; Department of Psychiatry, University of Cambridge, Cambridge, United Kingdom
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6
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Hvolby A, Christensen J, Gasse C, Dalsgaard S, Dreier JW. Cumulative incidence and relative risk of sleep problems among children and adolescents with newly diagnosed neurodevelopmental disorders: A nationwide register-based study. J Sleep Res 2020; 30:e13122. [PMID: 32564480 DOI: 10.1111/jsr.13122] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2019] [Revised: 04/22/2020] [Accepted: 05/20/2020] [Indexed: 11/29/2022]
Abstract
We estimated the absolute and relative risk of sleep problems in children and adolescents with newly diagnosed neurodevelopmental disorders. This was a population-based cohort study of individuals born in Denmark in 1993-2014 and followed in nationwide registers in 2011-2016. We estimated the 5-year cumulative incidence of sleep problems in incident cases of attention-deficit/hyperactivity disorder (ADHD; n = 12,844), autism spectrum disorder (ASD; n = 8,073), oppositional defiant disorder/conduct disorder (ODD/CD; n = 2,234) and epilepsy (n = 3,709). Hazard ratios (HRs) for sleep problems were estimated by Cox regression. The 5-year risk of sleep problems was highest in ADHD (29.2%; 95% CI, 28.4-30.1), ASD (24.2%; 95% CI, 23.1-25.3) and ODD/CD (27.1% 95% CI, 25.0%-29.2%) and lowest in epilepsy (11.3%; 95% CI, 10.2%-12.6%). For ADHD and ASD, sleep problems were more common in females than in males. Furthermore, sleep problems were predicted by high parental socioeconomic status and varied with the geographical region of residence, suggesting that different clinical practices exist across Denmark and that sleep problems may be more likely to go undetected in families of lower socioeconomic position. Compared with individuals without these disorders, the likelihood of sleep problems was increased in individuals with ADHD (HR, 33.81; 95% CI, 32.78-34.87), ASD (HR, 16.77; 95% CI, 16.15-17.41), ODD/CD (HR, 14.73; 95% CI, 13.88-15.64) and epilepsy (HR, 6.01; 95% CI, 5.67-6.37). After mutual adjustment for comorbidity, HRs were attenuated, especially in ASD, ODD/CD and epilepsy when adjusted for ADHD, suggesting that the increased risk of sleep problems in individuals with ASD, ODD/CD and epilepsy is driven largely by comorbid ADHD.
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Affiliation(s)
- Allan Hvolby
- Department of Child and Adolescent Psychiatry, Psychiatry in Region of South Denmark, Esbjerg, Denmark.,Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
| | - Jakob Christensen
- National Centre for Register-Based Research, Aarhus University, Aarhus, Denmark.,Centre for Integrated Register-Based Research (CIRRAU), Aarhus University, Aarhus, Denmark.,Department of Neurology, Aarhus University Hospital, Aarhus, Denmark
| | - Christiane Gasse
- Department of Depression and Anxiety and Psychosis Research Unit, Aarhus University Hospital Psychiatry, Aarhus, Denmark
| | - Søren Dalsgaard
- National Centre for Register-Based Research, Aarhus University, Aarhus, Denmark.,iPSYCH - The Lundbeck Foundation Initiative for Integrative Psychiatric Research, Aarhus, Denmark
| | - Julie Werenberg Dreier
- National Centre for Register-Based Research, Aarhus University, Aarhus, Denmark.,Centre for Integrated Register-Based Research (CIRRAU), Aarhus University, Aarhus, Denmark
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7
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Hasslinger J, D’Agostini Souto M, Folkesson Hellstadius L, Bölte S. Neurofeedback in ADHD: A qualitative study of strategy use in slow cortical potential training. PLoS One 2020; 15:e0233343. [PMID: 32497051 PMCID: PMC7272030 DOI: 10.1371/journal.pone.0233343] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2019] [Accepted: 05/03/2020] [Indexed: 12/03/2022] Open
Abstract
Neurofeedback (NF) as a treatment for children and adolescents with attention deficit hyperactivity disorder (ADHD) has gained growing interest in recent years. Most research has been quantitative, focusing on treatment outcomes, while qualitative approaches exploring the treatment process and participants’ experiences are scarce. The objective of this study was to examine NF participants’ use of cognitive and other strategies for approaching and solving NF tasks, their development over the course of the training and the influence of participants’ compliance.
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Affiliation(s)
- John Hasslinger
- Center of Neurodevelopmental Disorders (KIND), Centre for Psychiatry Research, Department of Women’s and Children’s Health, Karolinska Institutet & Child and Adolescent Psychiatry, Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
- * E-mail:
| | - Manoela D’Agostini Souto
- Center of Neurodevelopmental Disorders (KIND), Centre for Psychiatry Research, Department of Women’s and Children’s Health, Karolinska Institutet & Child and Adolescent Psychiatry, Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
| | - Lisa Folkesson Hellstadius
- Center of Neurodevelopmental Disorders (KIND), Centre for Psychiatry Research, Department of Women’s and Children’s Health, Karolinska Institutet & Child and Adolescent Psychiatry, Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
| | - Sven Bölte
- Center of Neurodevelopmental Disorders (KIND), Centre for Psychiatry Research, Department of Women’s and Children’s Health, Karolinska Institutet & Child and Adolescent Psychiatry, Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
- Curtin Autism Research Group, School of Occupational Therapy, Social Work and Speech Pathology, Curtin University, Perth, Western Australia
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8
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Rzepka-Migut B, Paprocka J. Efficacy and Safety of Melatonin Treatment in Children with Autism Spectrum Disorder and Attention-Deficit/Hyperactivity Disorder-A Review of the Literature. Brain Sci 2020; 10:brainsci10040219. [PMID: 32272607 PMCID: PMC7226342 DOI: 10.3390/brainsci10040219] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Revised: 03/19/2020] [Accepted: 03/19/2020] [Indexed: 02/07/2023] Open
Abstract
Autism spectrum disorder (ASD) and attention-deficit/hyperactivity disorder (ADHD) are neurodevelopmental disorders with disturbed melatonin secretion profile and sleep problems. The growing incidence of ASD and ADHD inspires scientists to research the underlying causes of these conditions. The authors focused on two fundamental aspects, the first one being the presentation of the role of melatonin in ASD and ADHD and the second of the influence of melatonin treatment on sleep disorders. The authors present the use of melatonin both in the context of causal and symptomatic treatment and discuss melatonin supplementation: Dosage patterns, effectiveness, and safety. Sleep disorders may have a different clinical picture, so the assessment of exogenous melatonin efficacy should also refer to a specific group of symptoms. The review draws attention to the wide range of doses of melatonin used in supplementation and the need to introduce unified standards especially in the group of pediatric patients.
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Affiliation(s)
- Beata Rzepka-Migut
- Department of Pediatric Neurology and Pediatrics, St. Queen Jadwiga’s Regional Clinical Hospital No 2, 35-301 Rzeszów, Poland;
| | - Justyna Paprocka
- Department of Pediatric Neurology, Faculty of Medical Science in Katowice, Medical University of Silesia, 40-752 Katowice, Poland
- Correspondence:
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9
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Hoffman NL, Weber ML, Broglio SP, McCrea M, McAllister TW, Schmidt JD. Influence of Postconcussion Sleep Duration on Concussion Recovery in Collegiate Athletes. Clin J Sport Med 2020; 30 Suppl 1:S29-S35. [PMID: 32132474 DOI: 10.1097/jsm.0000000000000538] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To determine whether decreased sleep duration postconcussion influences days to asymptomatic and assessment of performance throughout recovery. DESIGN Prospective. SETTING Institutional Clinical Research Laboratory. PATIENTS Four hundred twenty-three collegiate athletes were diagnosed with concussion. INTERVENTIONS Multidimensional concussion assessment battery was conducted at baseline, within 24 to 48 hours, daily [2-4 days postinjury (PI); symptoms only], once asymptomatic, and after return-to-play. The battery included the following: 22-item symptom checklist, Standardized Assessment of Concussion (SAC), Balance Error Scoring System (BESS), and computerized neurocognitive test [Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT)]. MAIN OUTCOME MEASURES We subtracted baseline sleep duration from 24 to 48 hours postconcussion sleep duration and categorized athletes into the following groups: shorter sleep (≤-1 hour), no change (>-1 hour, <+1 hour), and longer sleep (≥+1 hour). A 1-way analysis of variance (ANOVA) was conducted to compare days to asymptomatic and separate mixed-model ANOVAs to compare total symptom scores, SAC total scores, BESS total error scores, and ImPACT composite scores between sleep categories across time points (α = 0.05). RESULTS Sleep groups did not differ in days to asymptomatic. The shorter sleep group had greater symptom severity than no sleep change and longer sleep groups at 24 to 48 hours (shorter: 39.1 ± 20.7; no change: 25.1 ± 18.4, P = 0.007; longer: 25.7 ± 21.8, P = 0.004), and at 2 to 4 days PI (shorter: 21.8 ± 21.8; no change: 10.5 ± 10.8, P = 0.013; longer: 11.9 ± 14.2, P = 0.007), but did not differ at other time points (ie, asymptomatic and return-to-play). Participants with shorter sleep exhibited slower ImPACT reaction times at 24 to 48 hours (shorter: 0.68 ± 0.14; no change: 0.61 ± 0.09, P = 0.016; and longer: 0.62 ± 0.12, P = 0.028) and asymptomatic time points (shorter: 0.62 ± 0.11; no change: 0.56 ± 0.05; P = 0.015). CONCLUSION Postinjury sleep declines may be associated with symptom severity and worsened reaction time during initial stages of recovery or may be the result of the concussion itself. Clinicians should be aware of alterations in sleep duration and manage appropriately to mitigate initial symptom burden postconcussion.
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Affiliation(s)
- Nicole L Hoffman
- Department of Kinesiology, University of Georgia, Athens, Georgia
- UGA Concussion Research Laboratory, University of Georgia, Athens, Georgia
| | - Michelle L Weber
- Department of Kinesiology, University of Georgia, Athens, Georgia
- UGA Concussion Research Laboratory, University of Georgia, Athens, Georgia
| | - Steven P Broglio
- NeuroTrauma Research Laboratory, University of Michigan Injury Center, University of Michigan, Ann Arbor, Michigan
| | - Michael McCrea
- Departments of Neurosurgery and Neurology, Medical College of Wisconsin, Milwaukee, Wisconsin; and
| | - Thomas W McAllister
- Department of Psychiatry, Indiana University School of Medicine, Indianapolis, Indiana
| | - Julianne D Schmidt
- Department of Kinesiology, University of Georgia, Athens, Georgia
- UGA Concussion Research Laboratory, University of Georgia, Athens, Georgia
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10
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Langberg JM, Molitor SJ, Oddo LE, Eadeh HM, Dvorsky MR, Becker SP. Prevalence, Patterns, and Predictors of Sleep Problems and Daytime Sleepiness in Young Adolescents With ADHD. J Atten Disord 2020; 24:509-523. [PMID: 28162039 DOI: 10.1177/1087054717690810] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective: The primary objective of this study was to evaluate the prevalence of multiple types of sleep problems in young adolescents with ADHD. Method: Adolescents comprehensively diagnosed with ADHD (N = 262) and their caregivers completed well-validated measures of sleep problems and daytime sleepiness. Participants also completed measures related to medication use, comorbidities, and other factors that could predict sleep problems. Results: Daytime sleepiness was by far the most common sleep problem, with 37% of adolescents meeting the clinical threshold according to parent report and 42% according to adolescent report. In contrast, prevalence rates for specific nighttime sleep problems ranged from 1.5% to 7.6%. Time spent in bed, bedtime resistance, ADHD inattentive symptoms, and Sluggish Cognitive Tempo (SCT) symptoms were significant in the final model predicting daytime sleepiness. Conclusion: Adolescents with ADHD commonly experience problems with daytime sleepiness that may significantly affect their functioning, but this may not be directly attributable to specific sleep problems.
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11
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Becker SP, Kapadia DK, Fershtman CEM, Sciberras E. Evening circadian preference is associated with sleep problems and daytime sleepiness in adolescents with ADHD. J Sleep Res 2019; 29:e12936. [PMID: 31651076 DOI: 10.1111/jsr.12936] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2019] [Revised: 10/02/2019] [Accepted: 10/02/2019] [Indexed: 12/12/2022]
Abstract
Adolescence is a developmental period characterized by disruptions in sleep and changes in circadian preferences. Although adolescents with attention-deficit/hyperactivity disorder (ADHD) are at even higher risk of sleep disruption than their peers, no study has examined whether circadian preference is associated with sleep problems and daytime sleepiness in adolescents with ADHD. This study provides an initial test of the hypothesis that greater evening preference would be associated with more sleep problems and daytime sleepiness in adolescents diagnosed with ADHD. Participants were 80 adolescents (69% male), aged 13-17 years, with ADHD. Adolescents completed measures assessing circadian preference, pubertal development, anxiety/depressive symptoms and weeknight sleep duration. Both adolescents and parents completed measures of sleep problems and daytime sleepiness. In regression analyses controlling for a number of other variables (i.e., age, sex, pubertal development, ADHD medication use, and ADHD, oppositional defiant disorder and internalizing symptom severity), greater evening preference was associated with both adolescent- and parent-reported sleep problems and daytime sleepiness. Greater evening preference remained significantly associated with each of these sleep problems and daytime sleepiness when also controlling for weeknight sleep duration. This is the first study to demonstrate that evening circadian preference is associated with both sleep problems and daytime sleepiness in adolescents with ADHD. The results indicate that it is important to consider circadian function as research examining sleep in adolescents with ADHD continues to advance.
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Affiliation(s)
- Stephen P Becker
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA.,Division of Behavioral Medicine and Clinical Psychology, Center for ADHD, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Delna K Kapadia
- Department of Psychology, Smith College, Northampton, MA, USA
| | | | - Emma Sciberras
- Deakin University, Geelong, VIC, Australia.,Murdoch Children's Research Institute, Melbourne, VIC, Australia.,University of Melbourne, Melbourne, VIC, Australia
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12
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Papadopoulos N, Stavropoulos V, McGinley J, Bellgrove M, Tonge B, Murphy A, Cornish K, Rinehart N. Moderating Effect of Motor Proficiency on the Relationship Between ADHD Symptoms and Sleep Problems in Children With Attention Deficit Hyperactivity Disorder-Combined Type. Behav Sleep Med 2019. [PMID: 29528702 DOI: 10.1080/15402002.2018.1443455] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
OBJECTIVES/BACKGROUND A high proportion of children with Attention Deficit Hyperactivity Disorder- Combined type (ADHD-CT) experience sleep and motor problems. This study investigated (a) whether motor proficiency moderated the relationship between ADHD symptoms and sleep problems in children with and without ADHD-CT and (b) whether this moderation differed as a function of ADHD diagnosis. PARTICIPANTS A sample of 70 primary school male children between 8-15 years were recruited; children with ADHD-CT (n = 38; mean age 10 years, 2 months [SD = 1 year, 6 months]) and a typically developing (TD) (n = 32; mean age 9 years, 6 months [SD = 1 year, 5 months]) group. METHODS Motor proficiency was measured using the Movement Assessment Battery for Children-2nd Edition (MABC-2), ADHD symptoms were measured using the Conners' Parent Rating Scale (CPRS) and parent reported sleep problems were measured using the Children's Sleep Habits Questionnaire (CSHQ). RESULTS Children who reported higher ADHD symptoms and lower motor proficiency scores reported more sleep problems. The moderation effect only held in children with a diagnosis of ADHD-CT and not in the typically developing group. CONCLUSIONS These findings indicate that children who experience greater severity of ADHD symptoms who also have lower motor proficiency may be at increased risk of experiencing sleep problems. These findings also illustrate the importance of considering motor proficiency when exploring risk factors for sleep problems in children with ADHD-CT as well as sleep interventions.
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Affiliation(s)
- Nicole Papadopoulos
- a Deakin University, Geelong, Australia, Deakin Child Study Centre, School of Psychology, Faculty of Health , Geelong , Australia
| | | | - Jennifer McGinley
- c Department of Physiotherapy, The University of Melbourne , Melbourne , Australia
| | - Mark Bellgrove
- d Monash Institute of Cognitive and Clinical Neuroscience & School of Psychological Sciences, Monash University , Melbourne , Australia
| | - Bruce Tonge
- e Centre for Developmental Psychiatry and Psychology, Monash University , Melbourne , Australia
| | - Anna Murphy
- f Clinical Research Centre for Movement Disorders & Gait, Monash Health, Melbourne, Australia
| | - Kim Cornish
- d Monash Institute of Cognitive and Clinical Neuroscience & School of Psychological Sciences, Monash University , Melbourne , Australia
| | - Nicole Rinehart
- a Deakin University, Geelong, Australia, Deakin Child Study Centre, School of Psychology, Faculty of Health , Geelong , Australia
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13
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Ricketts EJ, Sturm A, McMakin DL, McGuire JF, Tan PZ, Smalberg FB, McCracken JT, Colwell CS, Piacentini J. Changes in Sleep Problems Across Attention-Deficit/Hyperactivity Disorder Treatment: Findings from the Multimodal Treatment of Attention-Deficit/Hyperactivity Disorder Study. J Child Adolesc Psychopharmacol 2018; 28:690-698. [PMID: 30388029 PMCID: PMC7364298 DOI: 10.1089/cap.2018.0038] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
Objective: Stimulant medication and behavior therapy are efficacious for youth with attention-deficit/hyperactivity disorder (ADHD). However, research suggests that stimulants may start and/or worsen sleep problems for youth. Further, the impact of behavior therapy for ADHD on sleep is unknown. This study examined the frequency of sleep problems and effects of stimulant medication, behavior therapy, and their combination on sleep problems in youth with ADHD. This study also explored the influence of dimensional baseline ratings of ADHD symptom subtype and psychiatric comorbidity on sleep outcomes. Methods: Participants were 576 children (aged 7-9 years) with ADHD-Combined type from the Multimodal Treatment of ADHD study that compared methylphenidate, behavior therapy, and their combination to community care. Before treatment, parents completed the Child Behavior Checklist used to derive a total sleep problems score. Parents also completed ratings of oppositionality and ADHD symptom severity, whereas youth completed ratings of depression and anxiety. These ratings were readministered after treatment. Results: General linear mixed-effects models were used to assess change in total sleep problems across treatment. The combined group exhibited a statistically significant reduction in total sleep problems (z = -5.81, p < 0.001). Reductions in total sleep problems in methylphenidate (z = -3.11, p = 0.05), behavior therapy (z = -2.99, p = 0.08), or community care (z = -1.59, p > 0.99) did not reach statistical significance. Change in psychiatric symptoms did not significantly moderate change in total sleep problems by treatment assignment. Greater baseline oppositional defiant disorder severity predicted less reduction in total sleep problems, χ2(1) = 3.86, p < 0.05. Conclusions: Findings suggest that combination of methylphenidate and behavior therapy is efficacious for reducing parent-reported sleep problems in young children with ADHD-Combined type relative to community care. However, potential ameliorative effects of monotherapy treatments (i.e., methylphenidate, behavior therapy) should be examined. Future replication is needed to confirm findings.
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Affiliation(s)
- Emily J. Ricketts
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, California.,Address correspondence to: Emily J. Ricketts, PhD, Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, 760 Westwood Plz, Los Angeles, CA 90024
| | - Alexandra Sturm
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, California
| | - Dana L. McMakin
- Department of Psychology, Florida International University, Miami, Florida.,Department of Neurology, Nicklaus Children's Hospital, Miami, Florida
| | - Joseph F. McGuire
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, California.,Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Patricia Z. Tan
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, California
| | - Fallon B. Smalberg
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, California
| | - James T. McCracken
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, California
| | - Christopher S. Colwell
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, California
| | - John Piacentini
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, California
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14
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Davidson F, Rusak B, Chambers C, Corkum P. The Impact of Sleep Restriction on Daytime Functioning in School-Age Children With and Without ADHD: A Narrative Review of the Literature. CANADIAN JOURNAL OF SCHOOL PSYCHOLOGY 2018. [DOI: 10.1177/0829573518770593] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The purpose of this narrative review was to synthesize the existing literature on the impact of sleep on daytime functioning in both typically developing (TD) children and children with attention-deficit/hyperactivity disorder (ADHD). Correlational studies in children suggest that insufficient sleep and impaired daytime functioning are significantly associated; however, this does not address the causal relationships between sleep and daytime functioning. The review results indicated that there is limited experimental sleep manipulation research in children. In the eight studies that employed experimental methods to examine sleep restriction, the consequences of insufficient sleep were greatest for attention and inconsistent for other domains, such as cognition and emotion regulation. Despite the significant co-occurrence of ADHD and sleep problems, the experimental sleep research focused on the daytime impact of shorter sleep in children with ADHD is extremely limited and as such more research is needed.
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Affiliation(s)
| | | | | | - Penny Corkum
- Dalhousie University, Halifax, Nova Scotia, Canada
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15
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Becker SP, Cusick CN, Sidol CA, Epstein JN, Tamm L. The impact of comorbid mental health symptoms and sex on sleep functioning in children with ADHD. Eur Child Adolesc Psychiatry 2018; 27:353-365. [PMID: 28983772 PMCID: PMC5854508 DOI: 10.1007/s00787-017-1055-2] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2017] [Accepted: 09/21/2017] [Indexed: 12/28/2022]
Abstract
Children with attention-deficit/hyperactivity disorder (ADHD) display more sleep problems than their peers, but it remains unclear whether comorbid mental health symptoms [i.e., anxiety, depression, oppositional-defiant disorder (ODD)] are uniquely related to sleep functioning. It is also largely unknown whether boys and girls with ADHD differ in their sleep functioning. This study (1) examined whether boys or girls with ADHD differ in their sleep functioning, (2) evaluated comorbid symptoms as uniquely related to sleep functioning domains, and (3) explored whether sex moderated associations between comorbid symptoms and sleep. Participants were 181 children (ages 7-13; 69% male; 82% White) diagnosed with ADHD. Parents completed measures assessing their child's ADHD symptoms, comorbid symptoms, and sleep functioning. Girls had poorer sleep functioning than boys across most sleep functioning domains. Sixty percent of children met cutoff criteria for having sleep problems, though rates differed significantly between girls (75%) and boys (53%). No differences in rates of sleep problems were found between ADHD subtypes/presentations or between younger and older children. In path models including ADHD and comorbid symptom dimensions, anxiety symptoms were uniquely associated with increased bedtime resistance and sleep anxiety, ADHD hyperactive-impulsive symptoms were associated with more night wakings and more parasomnia behaviors, and ODD and depressive symptoms were associated with shorter sleep duration. Depression was also uniquely associated with increased daytime sleepiness and overall sleep problems. Sex did not moderate associations between comorbid symptoms and sleep problems. This study provides important preliminary evidence that girls with ADHD experience more sleep problems than boys with ADHD. Findings also demonstrate that the associations between comorbid symptoms and sleep functioning in children with ADHD vary based on both the specific symptoms and sleep domains examined.
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Affiliation(s)
- Stephen P. Becker
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, USA,College of Medicine, University of Cincinnati, Cincinnati, Ohio, USA,Address correspondence to Stephen Becker, Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children’s Hospital Medical Center, 3333 Burnet Avenue, MLC 10006, Cincinnati, Ohio 45229-3039; (513) 803-2066 (phone); (513) 803-0084 (fax);
| | - Caroline N. Cusick
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, USA
| | - Craig A. Sidol
- Department of Psychology, University of Cincinnati, Cincinnati, Ohio, USA
| | - Jeffery N. Epstein
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, USA,College of Medicine, University of Cincinnati, Cincinnati, Ohio, USA,Department of Psychology, University of Cincinnati, Cincinnati, Ohio, USA
| | - Leanne Tamm
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, USA,College of Medicine, University of Cincinnati, Cincinnati, Ohio, USA
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16
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Bériault M, Turgeon L, Labrosse M, Berthiaume C, Verreault M, Berthiaume C, Godbout R. Comorbidity of ADHD and Anxiety Disorders in School-Age Children: Impact on Sleep and Response to a Cognitive-Behavioral Treatment. J Atten Disord 2018; 22:414-424. [PMID: 26396144 DOI: 10.1177/1087054715605914] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE This exploratory study measured the impact of comorbid anxiety disorders on sleep in children with ADHD and tested the effect of cognitive-behavioral therapy (CBT) on these measures. METHOD Fifty-seven children (8-12 years old) were assessed with the Child Sleep Habits Questionnaire. Four groups were formed: ADHD ( n = 20), ADHD + Anxiety ( n = 20), Anxiety ( n = 8), and Healthy Controls ( n = 9). A subgroup of 10 children with ADHD + Anxiety underwent CBT for anxiety. RESULTS The results showed that sleep difficulties were better associated with anxiety than with ADHD. CBT reduced sleep onset latency and marginally decreased the total amount of sleep problems. CONCLUSION The present study demonstrates that comorbid anxiety in ADHD children is linked with specific sleep disturbances and is sensitive to CBT aimed at reducing anxiety.
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Affiliation(s)
| | - Lyse Turgeon
- 2 Université de Montréal, Montreal, Quebec, Canada
| | | | - Claude Berthiaume
- 1 Hôpital Rivière-des-Prairies, Montreal, Quebec, Canada.,3 Institut universitaire en santé mentale de Montréal, Quebec, Canada
| | - Martine Verreault
- 3 Institut universitaire en santé mentale de Montréal, Quebec, Canada
| | | | - Roger Godbout
- 1 Hôpital Rivière-des-Prairies, Montreal, Quebec, Canada.,2 Université de Montréal, Montreal, Quebec, Canada
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17
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Comorbidity prevalence and treatment outcome in children and adolescents with ADHD. Eur Child Adolesc Psychiatry 2017; 26:1443-1457. [PMID: 28527021 DOI: 10.1007/s00787-017-1005-z] [Citation(s) in RCA: 197] [Impact Index Per Article: 28.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2017] [Accepted: 05/14/2017] [Indexed: 12/14/2022]
Abstract
Although ADHD comorbidity has been widely studied, some issues remain unsolved. This multicenter observational study aims to examine comorbid psychiatric disorders in a clinical sample of newly diagnosed, treatment naïve children and adolescents with and without ADHD and, to compare treatment efficacy based on the type of comorbidity. We performed an analysis of the medical records of patients identified from the Regional ADHD Registry database, enrolled in 18 ADHD centers in the 2011-2016 period. 1919 of 2861 subjects evaluated (67%) met the diagnostic criteria for ADHD: 650 (34%) had only ADHD, while 1269 (66%) had at least one comorbid psychiatric disorder (learning disorders, 56%; sleep disorders, 23%; oppositional defiant disorder, 20%; anxiety disorders, 12%). Patients with ADHD of combined type and with severe impairment (CGI-S ≥5) were more likely to present comorbidity. 382 of 724 (53%) followed up patients improved after 1 year of treatment. ADHD with comorbidity showed greater improvement when treated with combined interventions or methylphenidate alone. Specifically, combined treatment showed significant superiority for ADHD with learning disorders (ES 0.66) and ODD (ES 0.98), lower for ADHD with sleep or anxiety disorders. Training intervention alone showed only medium efficacy (ES 0.50) for ADHD and learning disorders. This study was the first describing comorbidity patterns of ADHD in Italy, confirming, in a multicenter clinical setting, that ADHD is more often a complex disorder. Findings highlight important diagnostic, therapeutic, and service organization aspects that should be broadly extended to ensure an appropriate and homogenous ADHD management.
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18
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Caporino NE, Read KL, Shiffrin N, Settipani C, Kendall PC, Compton SN, Sherrill J, Piacentini J, Walkup J, Ginsburg G, Keeton C, Birmaher B, Sakolsky D, Gosch E, Albano AM. Sleep-Related Problems and the Effects of Anxiety Treatment in Children and Adolescents. JOURNAL OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY : THE OFFICIAL JOURNAL FOR THE SOCIETY OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY, AMERICAN PSYCHOLOGICAL ASSOCIATION, DIVISION 53 2017; 46:675-685. [PMID: 26467211 PMCID: PMC4833728 DOI: 10.1080/15374416.2015.1063429] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
This study examined (a) demographic and clinical characteristics associated with sleep-related problems (SRPs) among youth with anxiety disorders, and (b) the impact of anxiety treatment: cognitive-behavioral therapy (CBT; Coping Cat), medication (sertraline), their combination, and pill placebo on SRPs. Youth (N = 488, ages 7-17, 50% female, 79% White) with a principal diagnosis of generalized anxiety disorder, separation anxiety disorder, or social phobia participated. SRPs were reported by parents and youth. Findings differed by informant and by type of SRP, with evidence that SRPs are associated with age, anxiety severity, externalizing problems, functional impairment, and family burden at pretreatment. Anxiety treatment reduced SRPs; effect sizes were small to medium. Reductions in parent-reported separation-related sleep difficulties were significantly greater in active treatment than in the placebo condition, with the greatest reductions reported by parents of youth whose active treatment was multimodal or included sertraline. Youth whose anxiety treatment involved CBT reported significantly greater decreases in dysregulated sleep (e.g., sleeplessness). Both CBT for anxiety and sertraline appear to be somewhat effective in reducing SRPs, and multimodal treatment may be preferable depending on the symptom presentation. To inform practice, future research should examine a broad range of SRPs, incorporate objective measures of sleep, and evaluate the impact of behavioral strategies that directly target SRPs in youth with anxiety disorders.
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Affiliation(s)
| | | | | | | | | | - Scott N Compton
- c Department of Psychiatry and Behavioral Services , Duke University Medical Center
| | - Joel Sherrill
- d Division of Services and Intervention Research , National Institute of Mental Health
| | - John Piacentini
- e Semel Institute for Neuroscience and Human Behavior , University of California Los Angeles
| | - John Walkup
- f Division of Child and Adolescent Psychiatry , Weill Cornell Medical College
| | | | - Courtney Keeton
- h Division of Child and Adolescent Psychiatry , The Johns Hopkins University School of Medicine
| | - Boris Birmaher
- i Western Psychiatric Institute and Clinic , University of Pittsburgh Medical Center
| | - Dara Sakolsky
- i Western Psychiatric Institute and Clinic , University of Pittsburgh Medical Center
| | - Elizabeth Gosch
- j Department of Psychology , Philadelphia College of Osteopathic Medicine
| | - Anne M Albano
- k Department of Psychiatry , Columbia Medical Center
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19
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Reynolds KC, Patriquin M, Alfano CA, Loveland KA, Pearson DA. Parent-Reported Problematic Sleep Behaviors in Children with Comorbid Autism Spectrum Disorder and Attention-Deficit/Hyperactivity Disorder. RESEARCH IN AUTISM SPECTRUM DISORDERS 2017; 39:20-32. [PMID: 29081833 PMCID: PMC5656274 DOI: 10.1016/j.rasd.2017.04.003] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
BACKGROUND Sleep problems are frequent and well documented in children with Autism Spectrum Disorders (ASD), children with Attention Deficit/Hyperactivity Disorder (ADHD) and children with internalizing problems, however limited work has examined sleep problems in children presenting with comorbid ASD/ADHD. In healthy children, sleep problems negatively impact social, emotional, and academic functioning. The current study sought to examine diagnostic severity as predictors of sleep problems in children with comorbid ASD/ADHD. Additionally, the association between sleep and "real-life" functional domains (i.e., intellectual functioning, academic achievement, and executive functioning) were assessed. METHOD Sleep, internalizing difficulties, intellectual functioning, academic achievement and executive functioning were assessed in 85 children with who carried the dual diagnoses of ASD and ADHD. RESULTS Internalizing difficulties, rather than ASD or ADHD symptom severity, was the most consistent predictor of problematic sleep behaviors (i.e., nightmares overtiredness, sleeping less than other children, trouble sleeping, and Total Problematic Sleep Behaviors) in this sample. Further, parent report of problematic sleep behaviors was significantly associated with functional domains after controlling for ASD, ADHD, and internalizing symptoms. CONCLUSIONS Results suggest that internalizing symptoms are associated with problematic sleep behaviors in children with comorbid ASD/ADHD and may have implications for the "real-life" functioning among children with comorbid ASD/ADHD.
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Affiliation(s)
- Katharine C. Reynolds
- University of Houston, Department of Psychology; 3695 Cullen Boulevard Room 126 Houston, TX 77204-5022
| | - Michelle Patriquin
- The Menninger Clinic; 12301 S. Main St. Houston TX 77035
- Department of Psychiatry and Behavioral Science, Baylor College of Medicine
| | - Candice A. Alfano
- University of Houston, Department of Psychology; 3695 Cullen Boulevard Room 126 Houston, TX 77204-5022
| | - Katherine A. Loveland
- University of Texas Medical School at Houston; 1941 East Road, Rm. 3.126 BBSB; Houston, TX, 77054
| | - Deborah A. Pearson
- University of Texas Medical School at Houston; 1941 East Road, Rm. 3.126 BBSB; Houston, TX, 77054
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20
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Abstract
OBJECTIVE To investigate clinical and functional outcomes in military men with ADHD. METHOD Clinical outcomes were measured via the Zung Self-Rating Depression Scale (Zung SDS) and the Zung Self-Rating Anxiety Scale (Zung SAS). Functional outcomes were measured using the "Car, Relax, Alone, Forget, Friends, Trouble" (CRAFFT) questionnaire and questionnaires about relationships, conduct problems, substance use, and sleep. RESULTS Men with ADHD ( n = 52) reported more depressive (34 [67.3%] vs. 19 [38%], p = .008) and anxiety symptoms (31 [61.5%] vs. 14 [28%], p = .009) compared with those without ( n = 50). They had relationships lasting less than 1 year (24 [80%] vs. 9 [37.5%], p = .006), were more likely to smoke (17 [32.7%] vs. 5 [10%], p = .005), were most likely to use illicit substances (6 [11.5%] vs. 0 [0%], p < .001), had more conduct problems at school (27 [51.9%] vs. 5 [10%], p < .001), and had longer sleep latency (53.96 min ± 46.48 vs. 25.78 min ± 25.93, p = .006). CONCLUSION Military men with ADHD are significantly associated with worse clinical and functional outcomes. They should be screened and monitored for depression, anxiety, sleep disorders, and substance use.
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Affiliation(s)
| | - Rui Kwan
- 1 Institute of Mental Health, Singapore
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21
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Coskun M, Ahmetoglu E, Ozturk M. Mirtazapine Treatment for Comorbid Anxiety/Depressive Disorders in Young Subjects with Attention-Deficit Hyperactivity Disorder: Case Series. ACTA ACUST UNITED AC 2016. [DOI: 10.1080/10177833.2010.11790666] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Murat Coskun
- Kadın Doğum ve Çocuk Hastalıkları Hastanesi, Trabzon
| | - Emine Ahmetoglu
- Trakya University Education Faculty, Preschool Education Department
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22
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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: 70] [Impact Index Per Article: 8.8] [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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23
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Hysing M, Lundervold AJ, Posserud MB, Sivertsen B. Association Between Sleep Problems and Symptoms of Attention Deficit Hyperactivity Disorder in Adolescence: Results From a Large Population-Based Study. Behav Sleep Med 2016; 14:550-64. [PMID: 26503122 DOI: 10.1080/15402002.2015.1048448] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Sleep problems and symptoms of ADHD are common in adolescence, but detailed epidemiological assessment of their association is lacking. Using data from a recent population-based study, 9,846 adolescents aged 16 to 19 provided detailed information on sleep and symptoms of ADHD. Results confirmed a large overlap between self-reported symptoms of ADHD and all sleep variables studied. Symptoms of ADHD were linked to shorter sleep duration, longer sleep latency, and nocturnal wake time, as well as larger sleep deficiency. ADHD symptoms also increased the odds of insomnia and delayed sleep phase syndrome. The associations were only partially explained by confounders (mainly depression). The findings suggest that sleep problems should be included as a treatment target in efforts to reduce symptoms of ADHD in adolescence.
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Affiliation(s)
- Mari Hysing
- a Regional Centre for Child and Youth Mental Health and Child Welfare , Uni Research Health , Bergen , Norway
| | - Astri J Lundervold
- a Regional Centre for Child and Youth Mental Health and Child Welfare , Uni Research Health , Bergen , Norway.,b Department of Biological and Medical Psychology , University of Bergen , Norway.,c K. G. Jebsen Centre for Research on Neuropsychiatric Disorders , University of Bergen , Norway
| | - Maj-Britt Posserud
- a Regional Centre for Child and Youth Mental Health and Child Welfare , Uni Research Health , Bergen , Norway.,c K. G. Jebsen Centre for Research on Neuropsychiatric Disorders , University of Bergen , Norway.,d Department of Child and Adolescent Psychiatry , Haukeland University Hospital , Bergen , Norway
| | - Børge Sivertsen
- a Regional Centre for Child and Youth Mental Health and Child Welfare , Uni Research Health , Bergen , Norway.,e Division of Mental Health , Norwegian Institute of Public Health , Bergen , Norway.,f Department of Psychiatry , Helse Fonna HF , Haugesund , Norway
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The role of sleep quality and quantity in moderating the effectiveness of medication in the treatment of children with ADHD. ACTA ACUST UNITED AC 2016; 9:31-38. [PMID: 27515452 DOI: 10.1007/s12402-016-0204-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2016] [Accepted: 08/04/2016] [Indexed: 10/21/2022]
Abstract
The current study examined: (1) whether long-acting stimulant medication is effective in improving performance on measures of memory, attention, and academic productivity; and (2) whether sleep impacts the relationship between medication and performance. Participants were 21 newly diagnosed, medication-naïve children (mean age = 9.1 years) with ADHD, who participated in a 4-week blinded placebo-controlled randomized trial of long-acting MPH. Participants underwent assessments of sleep (i.e., polysomnography) and of cognitive performance. Long-acting stimulant medication was found to be an effective treatment for enhancing alerting attention, executive attention, working memory, and academic productivity, but resulted in poorer sleep. Moreover, sleep duration was found to impact the treatment response to medication, in that longer sleep duration at baseline was related to improved executive attention. These results underscore the importance of evaluating and monitoring sleep when prescribing stimulant medication as a treatment for ADHD in children.
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25
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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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26
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Subjective - Objective Sleep Comparisons and Discrepancies Among Clinically-Anxious and Healthy Children. JOURNAL OF ABNORMAL CHILD PSYCHOLOGY 2016; 43:1343-53. [PMID: 25896729 DOI: 10.1007/s10802-015-0018-7] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
We compared subjective and objective sleep patterns and problems, and examined cross-method correspondence across parent reports, child reports, and actigraphy-derived sleep variables in clinically-anxious children and healthy controls. In a multi-site, cross-sectional study, 75 pre-adolescent children (6 to 11 years; M = 8.7 years; SD = 1.4; n = 39/52 % female) were examined including 39 with a diagnosis of primary generalized anxiety disorder (GAD) and 36 controls recruited from university-based clinics in Houston, TX and Washington, DC. Structured interviews, validated sleep questionnaires, and 1 week of actigraphy data were utilized. Despite subjective reports of significantly greater sleep problems among anxious children, actigraphy data revealed no significant differences between the groups. All parents estimated earlier bedtimes and greater total sleep duration relative to actigraphy, and all children endorsed more sleep problems than parents. With few exceptions, subjective reports exhibited low and non-significant correspondence with actigraphy-based sleep patterns and problems. Our findings suggest that high rates of sleep complaints found among children with GAD (and their parents) are not corroborated by objective sleep abnormalities, with the exception of marginally prolonged sleep onset latency compared to controls. Objective-subjective sleep discrepancies were observed in both groups but more apparent overall in the GAD group. Frequent complaints of sleep problems and daytime tiredness among anxious youth might more accurately reflect difficulties prior to the actual sleep period, cognitive-affective biases associated with sleep, and/or poor sleep quality. Findings highlight the importance of considering sleep from multiple perspectives.
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Sleep Problem Trajectories and Well-Being in Children with Attention-Deficit Hyperactivity Disorder: A Prospective Cohort Study. J Dev Behav Pediatr 2016; 37:405-14. [PMID: 27152767 DOI: 10.1097/dbp.0000000000000276] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Sleep problems affect up to 70% of children with attention-deficit/hyperactivity disorder (ADHD) and are associated with poorer child and family well-being in cross-sectional studies. However, whether these associations hold longitudinally is unclear. The authors aimed to examine the longitudinal relationship between sleep problem trajectories and well-being in children with ADHD. METHOD Children with ADHD (n = 186), aged 5 to 13 years, were recruited from 21 pediatric practices across the state of Victoria, Australia. Sleep problem severity data were collected at 3 time points (baseline, 6, and 12 mo) and were used to classify sleep problem trajectories. Child and family well-being (e.g., child emotional and behavioral problems, quality of life [QoL]) were measured at baseline and 12 months by teacher and/or caregiver-report. The well-being of children with "transient" and "persistent" sleep problems was compared with those "never" experiencing sleep problems using a series of hierarchical linear regression models. RESULTS After accounting for socio-demographic factors, children with transient and persistent sleep trajectories experienced more caregiver-reported behavioral and emotional problems (effect size [ES] both 0.7) and poorer child QoL (ES: -0.7 and -1.2, respectively). These associations remained after also accounting for ADHD medication and symptom severity and comorbidities, but after accounting for baseline measures many associations weakened to the point of nonsignificance. In the fully adjusted model-transient sleep problems were associated with behavioral and emotional problems (ES: 0.2). These associations were not evident by teacher-report. CONCLUSION Children with ADHD experiencing transient or persistent sleep problems have poorer caregiver-reported well-being. Managing sleep problems in children with ADHD may improve child well-being.
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Abstract
OBJECTIVE To examine the effects of stimulant medication on the sleep functioning of children with attention-deficit/hyperactivity disorder (ADHD) and identify predictors of sleep problems as a side effect of taking stimulant medication. METHOD One hundred sixty-three stimulant-naïve children (72% boys) aged 7 to 11 years diagnosed with ADHD (120 with ADHD predominantly inattentive type, 43 with ADHD combined type) participated in a 4-week, randomized, double-blind, placebo-controlled trial of once-daily (long-acting) methylphenidate (MPH). Parents completed weekly side-effect ratings including an item related to sleep problems. RESULTS Ten percent of patients had parent-rated sleep problems before the initiation of medication. Rates of parent-rated sleep problems during MPH titration generally increased with increasing MPH dose (placebo: 8%; low dose: 18%; medium dose: 15%; high dose: 25%). Differences emerged between children with (n = 16) or without (n = 147) preexisting sleep problems. Although 23% of children without preexisting sleep problems went on to have sleep problems at the highest MPH dose, only 37.5% of children with preexisting sleep problems still had sleep problems at the highest MPH dose. Lower weight and lower body mass index (BMI) were associated with increased sleep problems during MPH titration. CONCLUSION This study demonstrated a general association between increased MPH dose and increased sleep problems in children with ADHD, particularly for children of lower weight/BMI. However, a substantial proportion of children with preexisting sleep difficulties no longer had sleep problems on the highest MPH dose, which may help explain mixed findings reported to date in studies examining the impact of MPH on sleep functioning in children with ADHD and suggests that MPH dose titration should not be avoided solely on the basis of a child's premorbid sleep problems. Future research is needed to replicate and extend these findings to more specific domains of sleep functioning and to identify differences between children with persistent or improved sleep functioning as a result of MPH use.
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Mulraney M, Giallo R, Lycett K, Mensah F, Sciberras E. The bidirectional relationship between sleep problems and internalizing and externalizing problems in children with ADHD: a prospective cohort study. Sleep Med 2016; 17:45-51. [PMID: 26847973 DOI: 10.1016/j.sleep.2015.09.019] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2015] [Revised: 09/09/2015] [Accepted: 09/11/2015] [Indexed: 10/22/2022]
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Abstract
OBJECTIVE The purpose of this study is to assess the sleep behaviors, sleep problems and frequency, and relationship with psychiatric comorbidities in ADHD Combined type and to evaluate the effect of sleep problems on quality of life. METHOD Forty-six boys, aged 7 to 13 years, with ADHD-combined type and 31 healthy boys were included. ADHD children were never treated for sleep or psychiatric disorders. Intelligence quotient (IQ) test scores were minimum 80, body mass index were normal and did not have medical disorders. Parents completed Children's Sleep Habits Questionnaire, Conners' Parent Rating Scale and The Pediatric Quality of Life Inventory (PedsQL) and participants were asked about sleep behaviors and were administered PedsQL and Schedule for Affective Disorders and Schizophrenia. RESULTS The frequency of sleep problems in ADHD is 84.8%, higher than the control group (p = .002). Evaluating PedsQL scores, the quality of life is worse in physical, psychosocial health, and total life quality (p < .05). ADHD group with sleep problems have more night wakings than control group with sleep problems (p = .02). The comorbidity do not increase sleep problems. The frequency of parasomnias is increased in group with learning disorders (p = .05). CONCLUSION The results of this study, which controls for a number of possible confounders found in previous examinations of ADHD and sleep, support the results of a number of other studies that have found an increased overall prevalence of parent-reported sleep disturbances in children with ADHD compared with healthy control participants. As the ADHD group have more night wakings than the control group through the night, it is thought that night wakings that cause a partitioned sleep may be important signs seen in ADHD. That could be suggested by two hypotheses. First one is that, daytime sleepiness is more common in ADHD and those children present excessive hyperactivity during the day to stay awake and the second one is the improvement of ADHD signs when the drugs for sleepiness are used. Usage of standardized and valid diagnostic criteria, exclusion of adolescence, gender, socioeconomic level, primary sleep problems, medical disorders and low IQ level, making allowances for effect of comorbidities and having compared with the control group are the important methodological features of this study. The most important limitation of this study is small sample size that makes the findings less generalizable to other groups of children with ADHD, and another one is not having used objective measurements together with subjective measurements. In conclusion, these results underscore the importance of screening all children who have a symptom constellation suggestive of ADHD for sleep problems that may either play a causative role or exacerbate the clinical appearance of ADHD in a given child. Correct evaluation and treatment of sleep problems increase the life quality of family and child and also decrease the severity of ADHD symptoms.
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Affiliation(s)
- Esra Yürümez
- Kocaeli Derince Training and Research Hospital, Turkey
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Lycett K, Sciberras E, Mensah FK, Hiscock H. Behavioral sleep problems and internalizing and externalizing comorbidities in children with attention-deficit/hyperactivity disorder. Eur Child Adolesc Psychiatry 2015; 24:31-40. [PMID: 24633694 DOI: 10.1007/s00787-014-0530-2] [Citation(s) in RCA: 49] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2013] [Accepted: 02/21/2014] [Indexed: 11/24/2022]
Abstract
Behavioral sleep problems are common in children with attention-deficit/hyperactivity disorder (ADHD), as are internalizing and externalizing comorbidities. The prevalence of these difficulties and the extent to which they co-exist in children with ADHD could inform clinical practice, but remains unclear. Therefore, we examined the association between sleep problems and internalizing and externalizing comorbidities in children with ADHD. Children aged 5-13 years were recruited from 21 pediatric practices across Victoria, Australia (N = 392). Internalizing and externalizing comorbidities (none, internalizing, externalizing, co-occurring) were assessed by the telephone-administered Anxiety Disorders Interview Schedule for Children IV/Parent version. Sleep problem severity was assessed by primary caregiver report (no, mild, moderate or severe problem). Moderate/severe sleep problems were confirmed using International Classification of Sleep Disorders. Seven specific sleep problem domains (bedtime resistance, sleep anxiety, sleep onset delay, sleep duration, night waking, parasomnias and daytime sleepiness) were assessed using the Children's Sleep Habits Questionnaire. Data were analyzed using adjusted logistic and linear regression models. Compared to children without comorbidities, children with co-occurring internalizing and externalizing comorbidities were more likely to have moderate/severe sleep problems (adjusted OR 2.4, 95 % CI 1.2; 4.5, p = 0.009) and problematic sleep across six of seven sleep domains. Children with either comorbidity alone were not at risk of moderate/severe sleep problems, but at the sleep domain level, children with internalizing alone had more sleep anxiety, and those with externalizing alone had less night waking. In conclusion, children with ADHD experiencing co-occurring internalizing and externalizing comorbidities are at an increased risk of sleep problems.
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Affiliation(s)
- Kate Lycett
- Department of Paediatrics, The University of Melbourne, Parkville, VIC, Australia,
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Becker SP, Luebbe AM, Langberg JM. Attention-deficit/hyperactivity disorder dimensions and sluggish cognitive tempo symptoms in relation to college students' sleep functioning. Child Psychiatry Hum Dev 2014; 45:675-85. [PMID: 24515313 DOI: 10.1007/s10578-014-0436-8] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
This study examined separate inattentive, hyperactive, and impulsive dimensions of attention-deficit/hyperactivity disorder (ADHD), as well as sluggish cognitive tempo (SCT) symptoms, in relation to college students' sleep functioning. Participants were 288 college students (ages 17-24; 65 % female; 90 % non-Hispanic White; 12 % self-reported having an ADHD diagnoses) who completed measures of ADHD/SCT symptoms and sleep functioning. Participants reported obtaining an average of 6.8 h of sleep per night (only 26 % reported obtaining ≥8 h of sleep) and having a sleep onset latency of 25 min. 63 % were classified as "poor sleepers," and poor sleepers had higher rates of ADHD and SCT symptoms than "good sleepers". Path analysis controlling for ADHD status and psychiatric medication use was used to determine associations between psychopathology and sleep functioning domains. Above and beyond covariates and other psychopathologies, hyperactivity (but not impulsivity) was significantly associated with poorer sleep quality, longer sleep latency, shorter sleep duration, and more use of sleep medications. SCT symptoms (but not inattention) were significantly associated with poorer sleep quality and increased nighttime sleep disturbance (e.g., having bad dreams, waking up in the middle of the night, feeling too cold or too hot). Both inattention and SCT were associated with greater daytime dysfunction. Regression analyses demonstrated that hyperactivity predicted sleep quality above and beyond the influence of daytime dysfunction, and inattention and SCT predicted daytime dysfunction above and beyond sleep quality. Further studies are needed to examine the interrelations of nighttime sleep functioning, ADHD/SCT, and daytime dysfunction, as well to elucidate mechanisms contributing to related functional impairments.
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Affiliation(s)
- Stephen P Becker
- Department of Psychology, Miami University, 90 North Patterson Avenue, Oxford, OH, 45056, USA,
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A prospective study of sleep problems in children with ADHD. Sleep Med 2014; 15:1354-61. [DOI: 10.1016/j.sleep.2014.06.004] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2014] [Revised: 06/13/2014] [Accepted: 06/14/2014] [Indexed: 12/17/2022]
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Targum SD, Fava M, Alphs LD, Lynn Starr H, Wessel TC, Hilt DC. Fatigue across the CNS spectrum: a clinical review. FATIGUE-BIOMEDICINE HEALTH AND BEHAVIOR 2014. [DOI: 10.1080/21641846.2014.959802] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
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Associations of sleep disturbance with ADHD: implications for treatment. ACTA ACUST UNITED AC 2014; 7:1-18. [PMID: 25127644 PMCID: PMC4340974 DOI: 10.1007/s12402-014-0151-0] [Citation(s) in RCA: 170] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2014] [Accepted: 07/08/2014] [Indexed: 01/08/2023]
Abstract
Attention-deficit/hyperactivity disorder (ADHD) is commonly associated with disordered or disturbed sleep. The relationships of ADHD with sleep problems, psychiatric comorbidities and medications are complex and multidirectional. Evidence from published studies comparing sleep in individuals with ADHD with typically developing controls is most concordant for associations of ADHD with: hypopnea/apnea and peripheral limb movements in sleep or nocturnal motricity in polysomnographic studies; increased sleep onset latency and shorter sleep time in actigraphic studies; and bedtime resistance, difficulty with morning awakenings, sleep onset difficulties, sleep-disordered breathing, night awakenings and daytime sleepiness in subjective studies. ADHD is also frequently coincident with sleep disorders (obstructive sleep apnea, peripheral limb movement disorder, restless legs syndrome and circadian-rhythm sleep disorders). Psychostimulant medications are associated with disrupted or disturbed sleep, but also ‘paradoxically’ calm some patients with ADHD for sleep by alleviating their symptoms. Long-acting formulations may have insufficient duration of action, leading to symptom rebound at bedtime. Current guidelines recommend assessment of sleep disturbance during evaluation of ADHD, and before initiation of pharmacotherapy, with healthy sleep practices the first-line option for addressing sleep problems. This review aims to provide a comprehensive overview of the relationships between ADHD and sleep, and presents a conceptual model of the modes of interaction: ADHD may cause sleep problems as an intrinsic feature of the disorder; sleep problems may cause or mimic ADHD; ADHD and sleep problems may interact, with reciprocal causation and possible involvement of comorbidity; and ADHD and sleep problems may share a common underlying neurological etiology.
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Moreau V, Rouleau N, Morin CM. Sleep of children with attention deficit hyperactivity disorder: actigraphic and parental reports. Behav Sleep Med 2014; 12:69-83. [PMID: 23473239 DOI: 10.1080/15402002.2013.764526] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
The objectives of this study were to characterize the sleep of children with attention deficit hyperactivity disorder (ADHD), using actigraphy and parental questionnaires, and examine the potentially moderating role of psychostimulant medication and psychiatric comorbidity. Children with ADHD significantly differed from controls on parental and actigraphic measures of sleep, with parental reports indicating more severe sleep disturbances, and actigraphic recordings of longer sleep onset latency, lower sleep efficiency, and lower total sleep time. Both medicated and unmedicated ADHD subgroups differed from the control group on sleep measures, but did not differ from each other. Only the subgroup with comorbid psychiatric symptoms differed from the control group on actigraphic measures. The presence of psychiatric comorbidity, but not psychostimulant medication use, was associated with more severe sleep disturbances. The main implication of these findings is that clinicians should systematically attend to sleep disturbances in children with ADHD, particularly when other psychiatric symptoms are also present.
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Affiliation(s)
- Vincent Moreau
- a École de Psychologie, Université Laval , Quebec City , Quebec , Canada
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Lycett K, Sciberras E, Mensah FK, Gulenc A, Hiscock H. Behavioural sleep problems in children with attention-deficit/hyperactivity disorder (ADHD): protocol for a prospective cohort study. BMJ Open 2014; 4:e004070. [PMID: 24523423 PMCID: PMC3927707 DOI: 10.1136/bmjopen-2013-004070] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2013] [Revised: 12/17/2013] [Accepted: 01/14/2014] [Indexed: 01/08/2023] Open
Abstract
INTRODUCTION Children with attention-deficit/hyperactivity disorder (ADHD) commonly experience behavioural sleep problems, yet these difficulties are not routinely assessed and managed in this group. Presenting with similar symptoms to ADHD itself, sleep problems are complex in children with ADHD and their aetiology is likely to be multifactorial. Common internalising and externalising comorbidities have been associated with sleep problems in children with ADHD; however, this relationship is yet to be fully elucidated. Furthermore, limited longitudinal data exist on sleep problems in children with ADHD, thus their persistence and impact remain unknown. In a diverse sample of children with ADHD, this study aims to: (1) quantify the relationship between sleep problems and internalising and externalising comorbidities; (2) examine sleep problem trajectories and risk factors; and (3) examine the longitudinal associations between sleep problems and child and family functioning over a 12-month period. METHODS AND ANALYSIS A prospective cohort study of 400 children with ADHD (150 with no/mild sleep problems, 250 with moderate/severe sleep problems) recruited from paediatric practices across Victoria, Australia. The children's parents and teacher provide data at baseline and 6-month and 12-month post enrolment. KEY MEASURES Parent report of child's sleep problem severity (no, mild, moderate, severe); specific sleep domain scores assessed using the Child Sleep Habits Questionnaire; internalising and externalising comorbidities assessed by the Anxiety Disorders Interview Schedule for Children IV/Parent version. ANALYSES Multiple variable logistic and linear regression models examining the associations between key measures, adjusted for confounders identified a priori. ETHICS AND DISSEMINATION Ethics approval has been granted. Findings will contribute to our understanding of behavioural sleep problems in children with ADHD. Clinically, they could improve the assessment and management of sleep problems in this group. We will seek to publish in leading paediatric journals, present at conferences and inform Australian paediatricians through the Australian Paediatric Research Network.
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Affiliation(s)
- Kate Lycett
- Community Child Health, Murdoch Childrens Research Institute, Parkville, Victoria, Australia
- Department of Paediatrics, The University of Melbourne, Parkville, Australia
| | - E Sciberras
- Community Child Health, Murdoch Childrens Research Institute, Parkville, Victoria, Australia
- The Royal Children's Hospital, Parkville, Victoria, Australia
| | - F K Mensah
- Department of Paediatrics, The University of Melbourne, Parkville, Australia
- The Royal Children's Hospital, Parkville, Victoria, Australia
- Clinical Epidemiology and Biostatistics Unit, Murdoch Childrens Research Institute, Royal Children's Hospital, Parkville, Victoria, Australia
| | - A Gulenc
- Community Child Health, Murdoch Childrens Research Institute, Parkville, Victoria, Australia
| | - H Hiscock
- Community Child Health, Murdoch Childrens Research Institute, Parkville, Victoria, Australia
- Department of Paediatrics, The University of Melbourne, Parkville, Australia
- The Royal Children's Hospital, Parkville, Victoria, Australia
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Lee HK, Jeong JH, Kim NY, Park MH, Kim TW, Seo HJ, Lim HK, Hong SC, Han JH. Sleep and cognitive problems in patients with attention-deficit hyperactivity disorder. Neuropsychiatr Dis Treat 2014; 10:1799-805. [PMID: 25258537 PMCID: PMC4172104 DOI: 10.2147/ndt.s69562] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES Attention-deficit hyperactivity disorder (ADHD) is characterized by inattentive and impulsive behavior. Many ADHD patients reportedly have cognitive dysfunction and sleep problems, including longer sleep latency, lower sleep efficiency, and shorter total sleep time. The purpose of this study was to examine neurocognitive functions and nocturnal sleep parameters in patients with ADHD, using a cognitive function test and actigraphy. METHODS Subjects included 37 male patients with ADHD and 32 controls (7-12 years of age). For each participant, we determined intelligence quotient (IQ) and administered the Matching Familiar Figures Test (MFFT) and 72-hour actigraphy. The relationships between sleep parameters and cognitive functions were assessed. RESULTS ADHD patients significantly differed from controls in several cognitive functions and sleep variables. In the MFFT, response error rate (P<0.001) and error counts (P=0.003) were significantly increased in ADHD patients compared with control children. MFFT response latency was significantly shorter in ADHD patients than in controls (P<0.001). In addition, sleep latency (P=0.01), wake after sleep onset (WASO) (P<0.001), and fragmentation index (P<0.001) were evaluated by actigraphy and found to be significantly increased in patients with ADHD compared with controls. However, no significant differences in total sleep time or sleep efficiency were observed. WASO and response error rates were positively correlated in patients with ADHD (rho =0.52, P=0.012). Furthermore, fragmentation index sleep variables were significantly positively correlated with response error (rho =0.44, P=0.008) and response latency rates (rho =0.4, P=0.018) in the MFFT. Reaction error rate was significantly associated with the fragmentation index (beta =0.94, P=0.024). CONCLUSION Patients with ADHD had more sleep problems, including significantly increased sleep latency, WASO, and fragmentation index, and poorer cognitive function, compared with controls. Some of these sleep problems, including WASO and the fragmentation index, were positively correlated with impulsivity, illustrated by the cognitive function tests in patients with ADHD. However, further studies with large sample sizes and the addition of polysomnography and determination of ADHD subtypes should be performed to confirm our results regarding sleep and cognitive problems in patients with ADHD.
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Affiliation(s)
- Hae Kook Lee
- Department of Psychiatry, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Jong-Hyun Jeong
- Department of Psychiatry, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Na-Young Kim
- Department of Psychiatry, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Min-Hyeon Park
- Department of Psychiatry, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Tae-Won Kim
- Department of Psychiatry, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Ho-Jun Seo
- Department of Psychiatry, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Hyun-Kook Lim
- Department of Psychiatry, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Seung-Chul Hong
- Department of Psychiatry, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Jin-Hee Han
- Department of Psychiatry, College of Medicine, The Catholic University of Korea, Seoul, Korea
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Gruber R, Fontil L, Bergmame L, Wiebe ST, Amsel R, Frenette S, Carrier J. Contributions of circadian tendencies and behavioral problems to sleep onset problems of children with ADHD. BMC Psychiatry 2012; 12:212. [PMID: 23186226 PMCID: PMC3534002 DOI: 10.1186/1471-244x-12-212] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2012] [Accepted: 11/21/2012] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Children with attention-deficit/hyperactivity disorder (ADHD) are two to three times more likely to experience sleep problems. The purpose of this study is to determine the relative contributions of circadian preferences and behavioral problems to sleep onset problems experienced by children with ADHD and to test for a moderation effect of ADHD diagnosis on the impact of circadian preferences and externalizing problems on sleep onset problems. METHODS After initial screening, parents of children meeting inclusion criteria documented child bedtime over 4 nights, using a sleep log, and completed questionnaires regarding sleep, ADHD and demographics to assess bedtime routine prior to PSG. On the fifth night of the study, sleep was recorded via ambulatory assessment of sleep architecture in the child's natural sleep environment employing portable polysomnography equipment. Seventy-five children (26 with ADHD and 49 controls) aged 7-11 years (mean age 8.61 years, SD 1.27 years) participated in the present study. RESULTS In both groups of children, externalizing problems yielded significant independent contributions to the explained variance in parental reports of bedtime resistance, whereas an evening circadian tendency contributed both to parental reports of sleep onset delay and to PSG-measured sleep-onset latency. No significant interaction effect of behavioral/circadian tendency with ADHD status was evident. CONCLUSIONS Sleep onset problems in ADHD are related to different etiologies that might require different interventional strategies and can be distinguished using the parental reports on the CSHQ.
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Affiliation(s)
- Reut Gruber
- McGill University, Montreal, QC, Canada
- Attention, Behavior and Sleep Lab, Douglas Mental Health University Institute, Montreal, QC, Canada
- Department of Psychiatry, McGill, University, Douglas Mental Health University Institute, 6875 LaSalle Blvd, Verdun, QC, H4H 1R3, Canada
| | - Laura Fontil
- Attention, Behavior and Sleep Lab, Douglas Mental Health University Institute, Montreal, QC, Canada
| | - Lana Bergmame
- Attention, Behavior and Sleep Lab, Douglas Mental Health University Institute, Montreal, QC, Canada
| | - Sabrina T Wiebe
- McGill University, Montreal, QC, Canada
- Attention, Behavior and Sleep Lab, Douglas Mental Health University Institute, Montreal, QC, Canada
| | | | - Sonia Frenette
- Centre du Sommeil et des Rythmes Biologiques, Hôpital du Sacré-Coeur de Montréal, Montreal, QC, Canada
- Département de Psychologie, Université de Montréal, Montreal, QC, Canada
| | - Julie Carrier
- Centre du Sommeil et des Rythmes Biologiques, Hôpital du Sacré-Coeur de Montréal, Montreal, QC, Canada
- Département de Psychologie, Université de Montréal, Montreal, QC, Canada
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Imeraj L, Sonuga-Barke E, Antrop I, Roeyers H, Wiersema R, Bal S, Deboutte D. Altered circadian profiles in attention-deficit/hyperactivity disorder: An integrative review and theoretical framework for future studies. Neurosci Biobehav Rev 2012; 36:1897-919. [DOI: 10.1016/j.neubiorev.2012.04.007] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2011] [Revised: 04/20/2012] [Accepted: 04/23/2012] [Indexed: 12/26/2022]
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Associations between psychiatric comorbidities and sleep disturbances in children with attention-deficit/hyperactivity disorder. J Dev Behav Pediatr 2012; 33:97-105. [PMID: 22261833 PMCID: PMC4078726 DOI: 10.1097/dbp.0b013e31823f6853] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
OBJECTIVE Children with attention-deficit/hyperactivity disorder (ADHD) often have sleep complaints and also higher rates of psychiatric comorbidities such as mood and anxiety disorders that may affect sleep. The authors hypothesized that children with ADHD and psychiatric comorbidities would have higher overall sleep disturbance scores as measured by a sleep questionnaire than children with ADHD without comorbidities. METHODS This cross-sectional analysis in an academic center studied 317 children with ADHD; 195 subjects had no comorbid conditions, 60 were anxious and 62 were depressed. Participants completed the Schedule for Affective Disorders and Schizophrenia for School-Age Children-Present State, 4th Revised Edition and the Children's Sleep Habits Questionnaire. RESULTS Median age (range) was 8.9 (6-18.7) years; 78% were male. Median (interquartile range) Total Sleep Disturbance Score (TSDS) on Children's Sleep Habits Questionnaire for subjects with no comorbidities was 44 (40-49); anxiety, 48 (43-54); and depression, 46 (41-52). Compared with subjects without comorbidities, TSDS in anxious subjects was greater (p = .008). TSDS in depressed subjects was not significantly different. Compared with subjects without comorbidities, anxious subjects had higher Bedtime Resistance, Sleep Onset Delay, and Night Wakings subscales (p = .03, .007, and .007, respectively); depressed subjects had higher Sleep Onset Delay and Sleep Duration subscales (p = .003 and .01, respectively). CONCLUSIONS Anxiety in children with ADHD contributed to higher overall sleep disturbance scores, compared with children with ADHD alone. Both comorbidities were associated with higher Sleep Onset Latency subscale scores. Further study of the impact of psychiatric comorbidities on sleep in children with ADHD is warranted.
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Spruyt K, Gozal D. Sleep disturbances in children with attention-deficit/hyperactivity disorder. Expert Rev Neurother 2011; 11:565-77. [PMID: 21469929 DOI: 10.1586/ern.11.7] [Citation(s) in RCA: 70] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
In this article, we advocate the need for better understanding and treatment of children exhibiting inattentive, hyperactive, impulsive behaviors, by in-depth questioning on sleepiness, sleep-disordered breathing or problematic behaviors at bedtime, during the night and upon awakening, as well as night-to-night sleep duration variability. The relationships between sleep and attention-deficit/hyperactivity disorder (ADHD) are complex and are routinely overlooked by practitioners. Motricity and somnolence, the most consistent complaints and objectively measured sleep problems in children with ADHD, may develop as a consequence of multidirectional and multifactorial pathways. Therefore, subjectively perceived or reported restless sleep should be evaluated with specific attention to restless legs syndrome or periodic limb movement disorder, and awakenings should be queried with regard to parasomnias, dyssomnias and sleep-disordered breathing. Sleep hygiene logs detailing sleep onset and offset quantitatively, as well as qualitatively, are required. More studies in children with ADHD are needed to reveal the 24-h phenotype, or its sleep comorbidities.
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Affiliation(s)
- Karen Spruyt
- Department of Pediatrics, Comer Children's Hospital, Pritzker School of Medicine, The University of Chicago, Chicago, Illinois 60637, USA
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Sleep in attention-deficit/hyperactivity disorder in children and adults: past, present, and future. Sleep Med Rev 2011; 16:371-88. [PMID: 22033171 DOI: 10.1016/j.smrv.2011.07.001] [Citation(s) in RCA: 136] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2011] [Revised: 07/01/2011] [Accepted: 07/05/2011] [Indexed: 11/20/2022]
Abstract
The understanding that sleep can give rise to, or exacerbate symptoms of attention-deficit/hyperactivity disorder (ADHD), and that good sleep hygiene improves attention and concentration tasks has sparked interest in the investigation of possible etiological relationships between sleep disorders and ADHD. Studies indicate that 30% of children and 60-80% of adults with ADHD have symptoms of sleep disorders such as daytime sleepiness, insomnia, delayed sleep phase syndrome, fractured sleep, restless legs syndrome, and sleep disordered breathing. The range and diversity of findings by different researchers have posed challenges in establishing whether sleep disturbances are intrinsic to ADHD or whether disturbances occur due to co-morbid sleep disorders. As a result, understanding of the nature of the relationship between sleep disturbances/disorders and ADHD remains unclear. In this review, we present a comprehensive and critical account of the research that has been carried out to investigate the association between sleep and ADHD, as well as discuss mechanisms that have been proposed to account for the elusive relationship between sleep disturbances, sleep disorders, and ADHD.
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Jan YW, Yang CM, Huang YS. Comorbidity and confounding factors in attention-deficit/hyperactivity disorder and sleep disorders in children. Psychol Res Behav Manag 2011; 4:139-50. [PMID: 22114544 PMCID: PMC3218783 DOI: 10.2147/prbm.s14055] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Sleep problems are commonly reported in children with attention-deficit/hyperactivity disorder (ADHD) symptoms. Research data regarding the complex and reciprocal relationship between ADHD and sleep disturbances has now accumulated. This paper is focused on the types of sleep problems that are associated with ADHD symptomatology, and attempts to untangle confounding factors and overlapping symptoms. The goal is also to present an updated overview of the pathophysiology of and treatment strategies for sleep problems in children with ADHD. The review also points out that future research will be needed to clarify further the other psychiatric comorbidities and side effects of medication in order to improve treatment outcomes and prevent misdiagnosis in clinical practice.
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Affiliation(s)
- Ya-Wen Jan
- Department of Psychology, National Cheng-Chi University, Taipei
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Imeraj L, Antrop I, Roeyers H, Deschepper E, Bal S, Deboutte D. Diurnal variations in arousal: a naturalistic heart rate study in children with ADHD. Eur Child Adolesc Psychiatry 2011; 20:381-92. [PMID: 21626226 DOI: 10.1007/s00787-011-0188-y] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2010] [Accepted: 05/18/2011] [Indexed: 01/04/2023]
Abstract
Previous studies suggest an altered circadian regulation of arousal in children with attention-deficit hyperactivity disorder (ADHD) as measured by activity, circadian preference, and sleep-wake patterns. Although heart rate is an important measure to evaluate arousal profiles, to date it is unknown whether 24-h heart rate patterns differentiate between children with and without ADHD. In this study, 24-h heart rate data were collected in 30 non-medicated children with ADHD (aged 6-11) and 30 sex-, class-, and age-matched normal controls in their naturalistic home and school setting, during 5 days. Simultaneously, 24-h activity patterns were registered. Confounding effects of demographic variables (e.g., age, sex, BMI, pubertal stage) and comorbid internalizing and externalizing problems on heart rate levels were additionally assessed. Longitudinal analysis showed that heart rate levels were overall higher in the ADHD group (p < 0.01)--with the largest effects during afternoon and night--in a model controlling for age. Other factors did not significantly contribute to variations in heart rate levels. Compared to controls, children with ADHD showed higher activity levels during daytime (especially early afternoon), but not during nighttime (p < 0.05). Post hoc analyses showed that environmental effects might influence daytime variations. Findings suggest an autonomic imbalance in children with ADHD as compared to controls, with higher heart rate levels in the ADHD group. Nighttime tachycardia in this group could not be explained by nighttime activity levels or comorbid externalizing/internalizing problems. Further research on autonomic functioning in ADHD is recommended because of the major impact of higher resting heart rate on health outcomes.
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Affiliation(s)
- Lindita Imeraj
- Department of Psychiatry and Medical Psychology, Ghent University, De Pintelaan 185, 9000, Ghent, Belgium.
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Corkum P, Davidson F, Macpherson M. A framework for the assessment and treatment of sleep problems in children with attention-deficit/hyperactivity disorder. Pediatr Clin North Am 2011; 58:667-83. [PMID: 21600348 DOI: 10.1016/j.pcl.2011.03.004] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Children with attention-deficit/hyperactivity disorder (ADHD) have high rates of sleep problems and sleep disorders. It is critical that pediatricians assess for sleep problems during the course of ADHD assessment and when treating children with stimulant medication. Sleep must be considered in the differential diagnosis and in terms of comorbidity with ADHD. The most common sleep problem in children with ADHD is insomnia, and the first line of treatment should be the implementation of behavioral interventions rather than medication. More research is needed to determine if children with ADHD respond to behavioral interventions in a similar manner as typically developing children.
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Affiliation(s)
- Penny Corkum
- Department of Psychology, Dalhousie University, Halifax, Nova Scotia, Canada.
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Comparison of sleep problems in children with anxiety and attention deficit/hyperactivity disorders. Eur Child Adolesc Psychiatry 2011; 20:321-30. [PMID: 21533911 DOI: 10.1007/s00787-011-0179-z] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2010] [Accepted: 04/13/2011] [Indexed: 10/18/2022]
Abstract
This cross-sectional case-control study compared sleep problems in consecutively referred children aged 7-13 years meeting DSM-IV criteria for anxiety disorder, attention deficit/hyperactivity disorder (ADHD), comorbid anxiety disorder and ADHD, and a group of control children of similar age and gender. Diagnoses were assessed with the Kiddie-SADS PL interview, parent form, and the sleep problems with a standardized sleep questionnaire, the Children's Sleep Habits Questionnaire (CSHQ), as reported by the mother. A total of 141 children were included (anxiety disorder (n = 41), ADHD (n = 39), comorbid condition (n = 25), controls (n = 36)). Children in the clinical groups had more sleep problems than controls. Children with anxiety disorders and children with comorbid condition were reported to have more sleep problems than children with ADHD alone. Night waking was associated with comorbid anxiety disorder and ADHD. Bedtime resistance was associated with anxiety disorder, while daytime sleepiness affected all clinical groups. Clinical management of children with ADHD and anxiety disorders needs to include assessment of sleep problems.
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Hvolby A, Bilenberg N. Use of Ball Blanket in attention-deficit/hyperactivity disorder sleeping problems. Nord J Psychiatry 2011; 65:89-94. [PMID: 20662681 DOI: 10.3109/08039488.2010.501868] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVES Based on actigraphic surveillance, attention-deficit/hyperactivity disorder (ADHD) symptom rating and sleep diary, this study will evaluate the effect of Ball Blanket on sleep for a sample of 8-13-year-old children with ADHD. DESIGN Case-control study. SETTING A child and adolescent psychiatric department of a teaching hospital. PARTICIPANTS 21 children aged 8-13 years with a diagnosis of ADHD and 21 healthy control subjects. INTERVENTION Sleep was monitored by parent-completed sleep diaries and 28 nights of actigraphy. For 14 of those days, the child slept with a Ball Blanket. MAIN OUTCOME MEASURES The sleep latency, number of awakenings and total length of sleep was measured, as was the possible influence on parent- and teacher-rated ADHD symptom load. RESULTS The results of this study will show that the time it takes for a child to fall asleep is shortened when using a Ball Blanket. The time it takes to fall asleep when using the Ball Blanket is found to be at the same level as the healthy control subjects. Teacher rating of symptoms show an improvement in both activity levels and attention span of approximately 10% after using the Ball Blankets. CONCLUSIONS The results of this study show that the use of Ball Blankets is a relevant and effective treatment method with regard to minimizing sleep onset latency. We find that the use of Ball Blankets for 14-days improves the time it takes to fall asleep, individual day-to-day variation and the number of awakenings to a level that compares with those found in the healthy control group. Furthermore, we find that the use of Ball Blankets significantly reduces the number of nights that the ADHD child spends more than 30 min falling asleep from 19% to 0%.
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Affiliation(s)
- Allan Hvolby
- Department of Child and Adolescent Psychiatry, Region of Southern Denmark, Gl. Vardevej 101, 6715 Esbjerg N, Denmark.
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Landau R, Sadeh A, Vassoly P, Berger A, Atzaba-Poria N, Auerbach JG. Sleep patterns of 7-week-old infants at familial risk for attention deficit hyperactivity disorder. Infant Ment Health J 2010; 31:630-646. [DOI: 10.1002/imhj.20275] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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Fakier N, Wild LG. Associations among sleep problems, learning difficulties and substance use in adolescence. J Adolesc 2010; 34:717-26. [PMID: 20952052 DOI: 10.1016/j.adolescence.2010.09.010] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2008] [Revised: 04/16/2010] [Accepted: 09/10/2010] [Indexed: 10/18/2022]
Abstract
This study investigated the relationships among sleep problems, learning difficulties and substance use in adolescence. Previous research suggests that these variables share an association with executive functioning deficits, and are intertwined. The sample comprised 427 adolescents (M age = 16 years) attending remedial schools and 276 adolescents (M age = 15 years) attending a mainstream school in Cape Town, South Africa. Participants completed anonymous self-report questionnaires. Results indicated that adolescents without learning difficulties were more likely to use tobacco, methamphetamine and cannabis, whereas those with learning difficulties engaged in more inhalant use. Adolescents who had more sleep problems were more likely to use tobacco, alcohol, methamphetamine, cannabis, inhalants, cocaine, ecstasy and any other illegal drug. Adolescents with learning difficulties had more sleep problems than those without learning difficulties. However, sleep problems remained independently associated with tobacco, cannabis and inhalant use when learning difficulties were taken into account.
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Affiliation(s)
- Nuraan Fakier
- Department of Psychology, University of Cape Town, Rondebosch 7701, South Africa.
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