DSM-5 Changes in Attention Deficit Hyperactivity Disorder and Autism Spectrum Disorder: Implications for Comorbid Sleep Issues

Abstract

Attention Deficit Hyperactivity Disorder (ADHD) and Autism Spectrum Disorder (ASD) are the most common neurodevelopmental disorders. Despite significant comorbidity, the previous diagnostic criteria prohibited the simultaneous diagnosis of both disorders. Sleep problems are highly prevalent in both disorders; however, these have been studied independently for ADHD and ASD. In the context of revised criteria in the Diagnostic Statistical Manual of Mental Disorders 5th edition (DSM-5) that allows combined diagnosis of ADHD and ASD, this short review presents an overview of relationship between sleep problems, ADHD and ASD, as well as conceptualizing the shared pathophysiology. The practical considerations for clinical management of sleep problems in combination with ADHD and ASD are also discussed.

Criterion Validity of the Yale-Brown Obsessive-Compulsive Scale Second Edition for Diagnosis of Obsessive-Compulsive Disorder in Adults

“…Obsessive-compulsive disorder (OCD) is a chronic and incapacitating neuropsychiatric condition, with a lifetime prevalence of 2.3% in the United States and an estimated prevalence of 5.3% in Portugal ( 1 – 3 ). It is characterized by the presence of obsessions (recurrent and persistent thoughts, experienced as intrusive or inappropriate and causing marked anxiety or distress) and/or compulsions (repetitive behaviors or mental acts that the person feels driven to perform, typically to reduce the anxiety caused by the obsessions) ( 4 – 7 ). Accurate assessment of OCD is critical due to its under-diagnosis, difficulty in establishing accurate diagnosis and need for careful and specific treatment planning and evaluation ( 8 ).…”

Who should be “controls” in studies on the neurobiology of psychiatric disorders?

“…For example, the prevalence of sleep disturbances is estimated to be up to 80% in individuals with schizophrenia-spectrum disorders, 80% in those with major depression, 40%-90% during various phases of bipolar disorder, 80% in those with autism and 50%-75% in those with ADHD. [25][26][27][28] More objective evidence of sleep alterations has been provided by recent meta-analyses of controlled polysomnographic studies documenting alterations in sleep characteristics in schizophrenia; major depression; and anxiety, eating, pervasive developmental, borderline personality and antisocial personality disorders. 29,30 There is emerging evidence that sleep quality alone has measurable effects on brain structure and function in healthy humans.…”

Colors of Autism Spectrum: A Single Paradigm Explains the Heterogeneity in Autism Spectrum Disorder

“…According to a recent review (Ramtekkar, 2017), there are considerable similarities between the sleep problems experienced in ADHD and ASD and in the memory consolidation problems in both disorders. The increased REM sleep latency present both in ADHD and ASD (see (Ramtekkar, 2017) and the cited references therein) is one of many similarities, and REM sleep has been considered important for memory consolidation (Siegel, 2005;Diekelmann and Born, 2010). However, its direct role has been debated (Stickgold and Walker, 2005).…”

“…In turn, the consolidation of contextual memory formation can be impaired in many ways, including when SW sleep is reduced (which occurs in ADHD but not in ASD (Ramtekkar, 2017)); when REM sleep latency is increased, which occurs in both ADHD and ASD (Ramtekkar, 2017); and when REM sleep theta rhythm is impaired (Boyce et al, 2016). Contextual memory consolidation is critical for component learning since the context disambiguates the meaning of the component (Fig.…”