Sleep disorders in attention-deficit hyperactivity disorder and autism spectrum disorder: a pragmatic approach to assessment and management

Shanahan, Paul; Isaac, Miriam; Blackwell, Jane

doi:10.1192/bja.2020.65

Cited by 3 publications

(28 citation statements)

References 69 publications

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“…As youths with ASD and ADHD often have communication deficits, clinically diagnosing PLMD in these children based on self-reported symptoms is challenging. 4,37…”

Section: Resultsmentioning

confidence: 99%

“…66 Parent education, support and training must be considered key components. 37,52,66,69 Interventions delivered virtually have promise. 37,70 Table 2 summarises considerations that should guide interventions.…”

Section: Resultsmentioning

confidence: 99%

“…37,52,66,69 Interventions delivered virtually have promise. 37,70 Table 2 summarises considerations that should guide interventions.…”

Section: Resultsmentioning

confidence: 99%

“…Interventions begin best by first recognising the significant prevalence of sleep disorders and other comorbidities 37 in ASD and ADHD in order to diminish the risk of misattributing symptoms of inattention and hyperactivity to the primary diagnoses. Approaches to distinguish between sleep disruptions in clinical practice, and treatment rationales guiding differing dosages and times of administration, follow.…”

Section: Resultsmentioning

confidence: 99%

“…4,52,66,68 Figure 2 provides a flow chart showing an overview of the process from screening for sleep disruption to interventions. 37

Fig. 2Flowchart describing approach to the complex developmental phenotypes of autism spectrum disorder (ASD), attention-deficit hyperactivity disorder (ADHD) and sleep disruption (SD).…”

Section: Resultsmentioning

confidence: 99%

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Management of sleep disorders in autism spectrum disorder with co-occurring attention-deficit hyperactivity disorder: update for clinicians

Petti,

Gupta,

Fradkin

et al. 2023

BJPsych open

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Aims To update and examine available literature germane to the recognition, assessment and treatment of comorbid autism spectrum disorder (ASD), attention-deficit hyperactivity disorder (ADHD) and sleep disruption, with a predominant focus on children, adolescents and emerging adults. Background Considerable overlaps exist among ASD, ADHD and sleep disruption. Literature and guidance for clinicians, administrators, policy makers and families have been limited, as such deliberations were rarely considered until 2013. Method This narrative review of the literature addressing sleep disruption issues among those with ASD, ADHD and comorbid ASD and ADHD involved searching multiple databases and use of reverse citations up to the end of September 2022. Emphasis is placed on secondary sources and relevant data for clinical practice. Results Complex clinical presentations of ASD/ADHD/sleep disruption are frequently encountered in clinical practice. Prior to 2013, prevalence, clinical presentation, pathophysiology, prognosis, other sleep-related factors and interventions were determined separately for each disorder, often with overlapping objective and subjective methods employed in the process. High percentages of ADHD and ASD patients have both disorders and sleep disruption. Here, the extant literature is integrated to provide a multidimensional understanding of the relevant issues and insights, allowing enhanced awareness and better care of this complex clinical population. Database limitations are considered. Conclusions Assessment of ASD symptomatology in youth with ADHD, and the reverse, in cases with disrupted sleep is critical to address the special challenges for case formulation and treatment. Evidence-based approaches to treatment planning and multi-treatment modalities should consider combining psychosocial and biological interventions to address the complexities of each case.

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“…As youths with ASD and ADHD often have communication deficits, clinically diagnosing PLMD in these children based on self-reported symptoms is challenging. 4,37…”

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

“…37,52,66,69 Interventions delivered virtually have promise. 37,70 Table 2 summarises considerations that should guide interventions.…”

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

“…4,52,66,68 Figure 2 provides a flow chart showing an overview of the process from screening for sleep disruption to interventions. 37

Fig. 2Flowchart describing approach to the complex developmental phenotypes of autism spectrum disorder (ASD), attention-deficit hyperactivity disorder (ADHD) and sleep disruption (SD).…”

Section: Resultsmentioning

confidence: 99%

See 3 more Smart Citations

Management of sleep disorders in autism spectrum disorder with co-occurring attention-deficit hyperactivity disorder: update for clinicians

Petti,

Gupta,

Fradkin

et al. 2023

BJPsych open

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Sleep problems at ages 8–9 and ADHD symptoms at ages 10–11: evidence in three cohorts from INMA study

González-Safont,

Rebagliato,

Arregi

et al. 2023

Eur J Pediatr

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Sleep problems and attention deficit hyperactivity disorder (ADHD) are interrelated during childhood and preadolescence. The objective of this work is assessing if sleep problems at ages 8–9 represent an alarm sign for presenting ADHD problems at ages 10–11 in three cohorts from INMA Study. Participants were 1244 children from Gipuzkoa, Sabadell, and Valencia cohorts. Sleep problems were assessed (ages 8–9) with the sleep items of the Child’s Behaviour Checklist (CBCL), and ADHD problems were collected through the Conner’s Parent Rating Scales-Revised: Short Form (CPRS-R:S) (age 10–11). Minimally and fully adjusted negative binomial models were fitted for each CPRS-R:S scale. Linearity of the relationship was assessed with generalized additive models (cubic smoothing splines with 2, 3, and 4 knots). For sensitivity analyses, children with previous symptoms, those born preterm and small for gestational age, and cases with extreme values, were excluded. Sleep problems presented IRR (95% CI) of 1.14 (1.10–1.19), 1.20 (1.14–1.26), 1.18 (1.11–1.25), and 1.18 (1.13–1.23) for opposition, inattention, hyperactivity, and ADHD scales, respectively. Fully adjusted models slightly decreased the IRR, but the association remained similar and significant. Sensitivity analyses showed similar results to fully adjusted models with only hyperactivity shown a slight decrease on significance (p = 0.051) when ADHD cases at age 9 were excluded. Conclusion: Sleep problems are an alarm sign for later neurodevelopment problems such as ADHD. Healthcare systems could take advantage implementing policies to pay special attention on the sleep habits and sleep hygiene. This could contribute to add evidence to public health programmes such as the Healthy Child Programme. What is Known:• Sleep problems and Attention Deficit Hyperactivity Disorder (ADHD) are common problems during childhood and preadolescence, with prevalences of 20-40% and 3.0-7.5%, respectively.• Sleep problems are even more common in children with ADHD condition. What is New:• Sleep problems at ages 8-9 increased the risk of ADHD symptoms at ages 10-11.• This association remained strong even when considering child’s previous (5 years) and concurrent (8-9 years) ADHD symptoms, and other clinical conditions, such as being born preterm or small for gestational age.

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Sleeping soundly? Testing the links between sleep quality and neurodevelopmental characteristics

Bettencourt,

Mareva,

Astle

2024

Neurodiversity

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Sleep plays a major role in child development and sleep problems have been implicated in several neurodevelopmental conditions. However, its exact role in these conditions remains unknown. Co-occurrence is a core challenge of the existing diagnostic framework, with many advocating for a transdiagnostic approach to studying neurodevelopment. In this exploratory investigation, we look at a transdiagnostic sample of 299 children to (1) identify and compare data-driven sleep profiles and explore their links to behaviour, cognition and learning and (2) use a network approach to simultaneously characterise the relationship between sleep and symptoms of behaviour, communication and mental health. Cluster analysis identified two sleep profiles – regular sleepers and poor sleepers. Between-group comparisons showed that poor sleepers disproportionately experienced poorer emotion regulation, peer relationships and structural language. The network analysis suggested that after statistically accounting for the overlap between symptoms of behaviour, communication and mental health, sleep remained directly linked to multiple symptoms, with a particularly strong relationship with emotion regulation. These findings advance our knowledge of the role of sleep in neurodevelopmental conditions, highlighting its importance as a transdiagnostic process and priority in neurodevelopmental research. Lay abstract Sleep quality and quantity are essential in children’s development. Children diagnosed with neurodevelopmental conditions tend to present more sleep problems. However, the exact interaction between sleep and these conditions is still under discussion. Here, novel statistical approaches were used to explore the relationship between sleep and aspects of children’s behaviour, communication, and mental health. These methods identified two groups of children based on their sleep quality: poor sleepers and regular sleepers. The two groups were compared across a broad set of measures including neurodevelopmental difficulties, learning outcomes and mental health. The regular sleepers performed better than those with sleep problems on all measures, with poor sleepers presenting crucial difficulties in emotion regulation, peer relationships and structural language. Using network models, an explorative global analysis of all the participants together reiterated the influence of structural language on other behaviours and uncovered a strong connection between sleep and emotion regulation. Overall, this study improves our knowledge of the role of sleep in conditions affecting brain development and its relationship with behaviour, communication and mental health.

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Sleep disorders in attention-deficit hyperactivity disorder and autism spectrum disorder: a pragmatic approach to assessment and management

Cited by 3 publications

References 69 publications

Management of sleep disorders in autism spectrum disorder with co-occurring attention-deficit hyperactivity disorder: update for clinicians

Management of sleep disorders in autism spectrum disorder with co-occurring attention-deficit hyperactivity disorder: update for clinicians

Sleep problems at ages 8–9 and ADHD symptoms at ages 10–11: evidence in three cohorts from INMA study

Sleeping soundly? Testing the links between sleep quality and neurodevelopmental characteristics

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