Difficult to Bed and Difficult to Rise: Complex Interplay Among ADHD, Sleep, and Adolescence

Self Cite

Background: The field's understanding of the association between sluggish cognitive tempo (SCT) and sleep is severely limited by the lack of multi-method and multi-informant research designs that move beyond global ratings, often focused on a limited number of sleep-related domains, such as daytime sleepiness. The current study begins to address these limitations by using actigraphy, daily sleep diary, and self-and parent-report global ratings of sleep in adolescents, a developmental period marked by changes in SCT, sleep, and circadian function. As SCT and sleep are also associated with ADHD symptoms, we tested these associations in a sample of adolescents with and without ADHD. Methods: Adolescents (N = 302; M age = 13.17 years, 44.7% female) with (n = 162) and without ADHD (n = 140) and parents completed global ratings of sleep and daytime sleepiness, and adolescents completed a measure of circadian preference. Adolescents also wore actigraphs for approximately two weeks, during which daily diaries were completed. Results: Above and beyond demographic characteristics (i.e., sex, race, and family income), pubertal development, medication use, and ADHD group status, adolescents' self-reported SCT symptoms were uniquely associated with shorter sleep duration and later sleep onset per both actigraphy and daily diary. SCT symptoms were also uniquely associated with longer sleep onset latency and poorer overall sleep (per daily diary), more sleep/wake problems and daytime sleepiness (per adolescent rating), more difficulties initiating and maintaining sleep (per parent rating), and later eveningness preference (per adolescent rating). Nearly all significant effects remained in sensitivity analyses controlling for adolescent-or parent-reported ADHD symptom dimensions. Conclusions: Findings provide the strongest evidence to date for SCT being uniquely linked to poorer sleep, greater daytime sleepiness, and a later evening circadian preference across subjective and objective measures. Longitudinal studies are needed to evaluate predictive and bidirectional associations.

Section: Discussionmentioning

confidence: 99%

A multi‐method examination of sluggish cognitive tempo in relation to adolescent sleep, daytime sleepiness, and circadian preference

Fredrick

Yeaman

et al. 2022

Self Cite

“…First, this was a cross‐sectional study and we were unable to evaluate whether sleep differentially changes over time for adolescents with and without ADHD. Relatedly, we were unable to examine possible reasons for increased sleep problems in adolescents with ADHD compared to their peers, and longitudinal research examining predictors of sleep problems is sorely needed (Becker & Langberg, ; Lunsford‐Avery et al., ). In addition, although we incorporated global ratings, daily sleep diaries, and actigraphy, none of these methods is without limitations.…”

Section: Discussionmentioning

confidence: 99%

Sleep and daytime sleepiness in adolescents with and without ADHD: differences across ratings, daily diary, and actigraphy

Becker

Langberg

Eadeh

et al. 2019

Self Cite

Background Children with attention‐deficit/hyperactivity disorder (ADHD) experience greater sleep problems than their peers. Although adolescence is generally a developmental period characterized by insufficient sleep, few studies have used a multi‐informant, multi‐method design, to examine whether sleep differs in adolescents with and without ADHD. Methods Targeted recruitment was used to enroll an approximately equal number of eighth‐grade adolescents (mean age = 13 years) with (n = 162) and without ADHD (n = 140). Adolescents and parents completed global ratings of sleep problems; adolescents, parents, and teachers completed ratings of daytime sleepiness. Adolescents wore actigraphs and completed a daily sleep diary for approximately 2 weeks. Results Adolescents with ADHD were more likely than adolescents without ADHD to obtain insufficient sleep on school days (per diary) and weekends (per diary and actigraphy). Adolescents with ADHD were also more likely to report falling asleep in class and to have stayed up all night at least twice in the previous 2 weeks (14% and 5% reported all‐nighters for ADHD and comparison, respectively). In regression analyses controlling for a number of variables known to impact sleep (e.g. pubertal development, sex, medication use, having an externalizing, anxiety, or depression diagnosis), ADHD remained associated with shorter diary and actigraphy school night sleep duration, adolescent‐ and parent‐reported daytime sleepiness, and parent‐reported difficulties initiating and maintaining sleep and total sleep disturbance. Controlling for other variables, the odds of being classified with clinically elevated parent‐reported sleep disturbance were 6.20 times greater for adolescents with ADHD. Conclusions Findings provide some of the clearest evidence yet that adolescents with ADHD experience more sleep problems and sleepiness than their peers without ADHD. It may be especially important to assess for sleep problems in adolescents with ADHD and to evaluate whether existing sleep interventions are effective, or can be optimized, for use in adolescents with ADHD who also have sleep problems.

“…Although there has been long‐standing interest in whether youth with ADHD have more variable sleep/wake patterns than their peers without ADHD (Becker et al., ) all but one study in this area has been conducted in school‐aged children or samples spanning childhood and adolescence. Adolescents with ADHD may be especially prone to variable sleep/wake patterns since parents have less oversight of bedtimes (Short et al., ), adolescents with ADHD are likely to experience impairments such as homework problems and parent–teen conflict that can impact sleep (Becker & Langberg, ; Lunsford‐Avery et al., ), and adolescents with ADHD may be more likely than their peers without ADHD to have a greater eveningness preference/later chronotype that can exacerbate phase delay (Coogan & McGowan, ). The one prior study examining sleep/wake IIV in adolescents with ADHD was a preliminary study with a small sample size that relied on parent report of a previous diagnosis of ADHD (Moore et al., ).…”

Section: Discussionmentioning

confidence: 99%

Intraindividual variability of sleep/wake patterns in adolescents with and without attention‐deficit/hyperactivity disorder

Langberg

Breaux

Cusick

et al. 2019

Self Cite

Background: Prior studies examining the sleep of adolescents with and without attention-deficit/hyperactivity disorder (ADHD) have relied on mean values such as average sleep duration, which masks intraindividual variability (IIV). The objective was to investigate whether adolescents with ADHD have greater IIV of sleep/wake patterns than adolescents without ADHD using actigraphy and daily sleep diaries. Method: Adolescents (ages 13.17 AE 0.40 years; 45% female) with (n = 162) and without (n = 140) ADHD were recruited from middle schools at two sites. Participants wore actigraphs and completed sleep diaries for an average of 2 weeks. Results: Multilevel models were conducted with sex, sleep medication use, ADHD medication use, number of days with data, and social jetlag controlled for in analyses. For actigraphy, adolescents with ADHD had greater variability for time in bed, sleep onset and offset, and wake after sleep onset than adolescents without ADHD. For sleep diary data, adolescents with ADHD had greater variability in bedtime, wake time, sleep duration, sleep onset latency, sleep quality, and night wakings than adolescents without ADHD. Social jetlag was a significant predictor of variability in sleep measures based on both actigraph and daily diaries; however, ADHD status was not associated with social jetlag. Conclusions: This is the first study to show that adolescents with ADHD have more variable sleep/wake patterns than their peers using both objective and subjective sleep measures. IIV of sleep/wake patterns may be important for clinicians to assess and monitor as part of treatment. Research is needed to understand the mechanisms underlying increased IIV of sleep/ wake patterns in adolescents with ADHD and potential consequences for daytime functioning.