The role of sleep quality and quantity in moderating the effectiveness of medication in the treatment of children with ADHD

Abstract

The current study examined: (1) whether long-acting stimulant medication is effective in improving performance on measures of memory, attention, and academic productivity; and (2) whether sleep impacts the relationship between medication and performance. Participants were 21 newly diagnosed, medication-naïve children (mean age = 9.1 years) with ADHD, who participated in a 4-week blinded placebo-controlled randomized trial of long-acting MPH. Participants underwent assessments of sleep (i.e., polysomnography) and of cognitive performance. Long-acting stimulant medication was found to be an effective treatment for enhancing alerting attention, executive attention, working memory, and academic productivity, but resulted in poorer sleep. Moreover, sleep duration was found to impact the treatment response to medication, in that longer sleep duration at baseline was related to improved executive attention. These results underscore the importance of evaluating and monitoring sleep when prescribing stimulant medication as a treatment for ADHD in children.

Sleep and circadian rhythm function and trait impulsivity: An actigraphy study

“…It is unclear to what degree sleep and circadian rhythm disturbances in ADHD constitute epiphenomena of the disorder, or might be moderated/mediated by stimulant medications which are the mainstay of treatment (Ironside et al, 2010;Morash-Conway et al, 2017). Studies in at-risk groups absent of psychiatric diagnosis can enable an investigation of sleep and circadian functioning shed of these confounds.…”

Future Directions in Sleep and Developmental Psychopathology

“…Morash-Conway and colleagues (2016) also examined the impact of long-acting MPH on school-age children with ADHD, with sleep measured by overnight PSG. In this study, total sleep time was decreased by 40 minutes on MPH compared to placebo (Morash-Conway et al, 2016). However, they also found that children who were considered "good sleepers" prior to medication were more likely to have improvements in attention accuracy with medication than "poor sleepers."…”

Associations between cognitive performance and sigma power during sleep in children with attention-deficit/hyperactivity disorder, healthy children, and healthy adults

“…This could confirm our observation that the interplay between cognitive performance, sigma activity, and maturation is also dependent on the complexity of the cognitive task. Finally, the inclusion of medication-naïve patients would be desirable since MPH affects sleep behavior [70, 71], and it is unclear whether a discontinuation of MPH for 48 hours is sufficient to adjust for potential withdrawal or rebound effects.…”