Sleep of Children With Attention Deficit Hyperactivity Disorder: Actigraphic and Parental Reports

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.

Advancing a Biopsychosocial and Contextual Model of Sleep in Adolescence: A Review and Introduction to the Special Issue

“…The association between ADHD and sleep problems has been documented for several decades, with restless sleep even included as a symptom of Attention Deficit Disorder in the Third Edition of the DSM (American Psychiatric Association 1980). Importantly, although stimulant medication use may impact sleep onset and sleep duration (Kirov and Brand 2014), some studies find no differences in sleep functioning among medicated versus non-medicated youth with ADHD (e.g., Becker et al 2014;Moreau et al 2014) and other studies show that youth with ADHD who are not taking stimulant medications continue to have significantly higher rates of sleep problems in comparison to their peers (Cohen-Zion and Ancoli-Israel 2004; Stein et al 2012). Accordingly, the high prevalence of sleep problems in youth with ADHD is not solely an artifact of stimulant medication use.…”

“…Several recent studies (Accardo et al 2012;Hansen et al 2011Hansen et al , 2014 have found that youth with comorbid ADHD and internalizing problems (i.e., anxiety, depression) have more sleep problems than youth with ADHD alone, including greater daytime sleepiness in addition to shorter sleep duration and more frequent night awakenings. For example, Moreau et al (2014) found that youth with comorbid ADHD and anxiety had the longest sleep onset delay, shortest sleep duration, and greatest daytime sleepiness in comparison to typically developing youth or youth with ADHD alone. In addition, Sung et al (2008) found comorbid conduct problems to be a strong predictor of sleep problems in youth with ADHD.…”

“…Taken together, studies examining sleep and comorbidity in ADHD samples point to potential bidirectional associations. However, all of these studies were conducted in school-aged children/young adolescents Hansen et al 2011Hansen et al , 2014Lycett et al 2014a, b;Moreau et al 2014) or in samples with a wide age range (ages 5/6-18) (Accardo et al 2012;Sung et al 2008), leaving it unclear how sleep and mental health are interconnected in youth with ADHD during middle and older adolescence when rates of certain mental health problems such as conduct disorder (Merikangas et al 2010), substance use , and depression/ suicidal ideation (Hinshaw et al 2012) are higher. Further, aside from the recent 1-year longitudinal studies by Becker et al (2014) and Lycett et al (2014a), all of the studies completed to date have been cross-sectional, leaving it unclear if comorbidities predict increases in sleep problems (and vice versa) over longer developmental periods or whether comorbid mental health symptoms differentially impact the sleep of adolescents with and without ADHD.…”

“…Importantly, parents report that most of these difficulties are concentrated during the late afternoon and evening hours leading up to bedtime (Coghill et al 2008). Further, homework difficulties and conflict surrounding homework and studying appears to contribute to the night-to-night variability in sleep functioning (e.g., bedtime, sleep onset delay) observed in youth with ADHD (Gruber and Sadeh 2004;Gruber et al 2000;Hvolby et al 2008;Moreau et al 2014). This sleep variability may be due to ''problematic nights'' resulting from a combination of factors, including psychosocial factors described above (i.e., family factors, high rates of comorbid mental health conditions) in addition to homework problems such as procrastination and homework completion difficulties that negatively impact bedtime, sleep latency, and sleep quality (Moreau et al 2014).…”

“…Further, homework difficulties and conflict surrounding homework and studying appears to contribute to the night-to-night variability in sleep functioning (e.g., bedtime, sleep onset delay) observed in youth with ADHD (Gruber and Sadeh 2004;Gruber et al 2000;Hvolby et al 2008;Moreau et al 2014). This sleep variability may be due to ''problematic nights'' resulting from a combination of factors, including psychosocial factors described above (i.e., family factors, high rates of comorbid mental health conditions) in addition to homework problems such as procrastination and homework completion difficulties that negatively impact bedtime, sleep latency, and sleep quality (Moreau et al 2014). As noted above, research in community samples has demonstrated that a single instance of staying-up late to study during the week can have a negative impact on functioning in school the next day (Gillen-O'Neel et al 2013).…”