Sleep disturbances in adolescents with ADHD: A systematic review and framework for future research

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 10–19 years) 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.

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

“…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., ).…”

“…There is clearly a link between attention‐deficit/hyperactivity disorder (ADHD) and sleep/wake problems (Cortese, Faraone, Konofal, & Lecendreux, ; Lunsford‐Avery, Krystal, & Kollins, ). However, the vast majority of studies have compared the sleep/wake patterns of individuals with and without ADHD using mean, summary variables, such as average sleep duration or bedtime.…”

“…The vast majority of research conducted on sleep and ADHD has focused on school‐aged children. A recent review found only 19 studies that focused on sleep in adolescents with ADHD, and these studies were generally limited by small or nonrepresentative samples and the use of nonstandardized sleep measures (Lunsford‐Avery et al., ). Relatedly, most studies of sleep in adolescents with ADHD have relied upon subjective ratings rather than on objective measures of sleep, with only a few studies using actigraphy to examine sleep in adolescents with ADHD or ADHD symptoms (Lunsford‐Avery et al., ).…”

“…A recent review found only 19 studies that focused on sleep in adolescents with ADHD, and these studies were generally limited by small or nonrepresentative samples and the use of nonstandardized sleep measures (Lunsford‐Avery et al., ). Relatedly, most studies of sleep in adolescents with ADHD have relied upon subjective ratings rather than on objective measures of sleep, with only a few studies using actigraphy to examine sleep in adolescents with ADHD or ADHD symptoms (Lunsford‐Avery et al., ). It is crucial to examine both subjective and objective sleep in adolescents with and without ADHD given the vast developmental, neurobiological, and sociocontextual changes that occur during this period that impact sleep (Colrain & Baker, ; Dahl, ; Feinberg & Campbell, ; Steinberg, ; Tarokh, Saletin, & Carskadon, ).…”

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

“…It is plausible that associations between ADHD and sleep are nonspecific and instead speak to the transdiagnostic importance of sleep functioning (Harvey, Murray, Chandler, & Soehner, 2011). There is also certainly a need to examine possible differences in sleep physiology and circadian preference between adolescents with and without ADHD (Lunsford-Avery et al, 2016), and whether differences vary over time.…”