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To provide evidence- or consensus-based recommendations concerning the assessment and management of sleep problems in youths with attention-deficit/hyperactivity disorder (ADHD).
PubMed, Ovid, EMBASE, and Web of Knowledge were searched through October 31, 2012. When no evidence was available, consensus of the authors was achieved. The evidence-leve...
Context in source publication
Context 1
... 216 217 218 219 220 221 222 223 224 225 226 227 228 229 230 231 232 233 234 235 236 237 238 239 240 241 242 243 244 245 246 247 248 249 250 251 252 253 254 255 256 257 258 259 260 261 262 263 264 265 266 267 268 269 270 271 272 273 274 275 276 277 278 279 280 281 282 283 284 285 286 287 288 289 290 291 292 293 294 295 296 297 298 299 300 301 302 303 304 305 306 307 308 309 310 311 312 313 314 315 316 317 318 319 320 321 322 (http://www.sleepfoundation.org/) is prefer- able to information in written format. The diagnosis of sleep disorders should be based on formal criteria, such as those of the Interna- tional Classification of Sleep Disorders (ICSD), 2nd ed. 13 Although some disorders can be assessed with a clinical interview, the diagnosis of other disorders, such as sleep apnea or pe- riodic limb movement (PLM) disorder (Table 1), requires polysomnography (PSG) ( Table 2 de- scribes PSG and other objective diagnostic tools). The Multiple Sleep Latency Test can be used to provide an objective measure of an individual's level of daytime sleepiness and is typically used to diagnose narcolepsy or other hypersomnias. ...
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Purpose of review:
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Citations
... In 2013, a group of North American experts in ADHD and sleep published a guidance paper [19] proving recommendations for the management of sleep disorders in children and adolescents with ADHD. The recommendations were based on a total of 139 original articles on sleep and childhood ADHD, including 22 on treatment of sleep disturbances. ...
Introduction:
Sleep disorders represent an important comorbidity in individuals with ADHD. While the links between ADHD and sleep disturbances have been extensively investigated, research on the management of sleep disorders in individuals with ADHD is relatively limited, albeit expanding.
Areas covered:
The authors searched PubMed, Medline, PsycInfo, Embase+Embase Classic, Web of Sciences databases, and clinicaltrials.gov up to 4 January 2024, for randomized controlled trials (RCTs) of any intervention for sleep disorders associated with ADHD. They retained 16 RCTs (eight on pharmacological and eight on non-pharmacological interventions), supporting behavioral intervention and melatonin, and nine ongoing RCTs registered on clinicaltrials.gov.
Expert opinion:
The pool of RCTs testing interventions for sleep disorders in individuals with ADHD is expanding. However, to inform clinical guidelines, there is a need for additional research in several areas, including 1) RCTs based on a precise phenotyping of sleep disorders; 2) pragmatic RCTs recruiting neurodevelopmental populations representative of those seen in clinical services; 3) trials testing alternative interventions (e.g. suvorexant or light therapy) or ways to deliver them (e.g. online); 4) sequential and longer-term RCTs; 5) studies testing the impact of sleep interventions on outcomes other than sleep; 6) and implementation of advanced evidence synthesis and precision medicine approaches.
... Many previous studies have shown that children with ADHD are more likely to have sleep problems than healthy children. [12][13][14] However, our study found that the prevalence of sleep disturbances in preschool children with ADHD was 40%, similar to the findings of the study by Gultekin and Bayik-Temel (2020) 15 , which found that the prevalence of sleep problems in healthy preschool children was 43.4%. This comparison is contradictory with previous studies 12-14 that found a higher prevalence of sleep problems in school-age children and adolescents with ADHD compared to those without ADHD. ...
... 17 In addition, children with ADHD tend to have poorer regulation of their sleep practices than normal children. [12][13][14] Therefore, compared to preschool children with ADHD, schoolage children and adolescents with ADHD who had less parental involvement in sleep practices may have more sleep problems compared to those without ADHD. ...
Objective: This study aimed to investigate the relationship between sleep habits and behavioral problems in preschool-aged children with ADHD. Materials and Methods: A cross-sectional study was conducted in a child developmental clinic at Siriraj Hospital between October and December 2023. Parents of children aged 4-6 years with ADHD completed the Children's Sleep Habits Questionnaire (CSHQ) and the Strengths and Difficulties Questionnaire (SDQ). Descriptive analysis, Pearson correlation, and multivariate linear regression analysis were used to examine the association between sleep habits and behavioral problems. Results: This study recruited 80 preschoolers with ADHD and 75% were boys. The mean total CSHQ score was 43.76 ± 7.38 and 40% of the participants had sleep problems. 31.3 % had clinically significant behavioral problems. The most common behavioral problems were hyperactivity (33.8%), emotional problems (16.3%), and conduct behavior (10%). More sleep disturbances were highly correlated with all behavioral problems in SDQ, with a Pearson correlation between 0.78 and 0.90. After multivariate regression analysis, the total CSHQ score remained the strongest predictor of all domains of behavioral problems in preschool-aged children with ADHD (p < 0.05). Conclusion: More than 1/3 of preschool children with ADHD were affected by sleep disturbances. Furthermore, sleep problems in these children can contribute to significant behavioral problems. Therefore, the treatment of ADHD in preschoolers should always include the management of sleep disturbances.
... Although the pilot findings of TranS-C-Youth seem promising for highly motivated adolescents with ADHD and sleep problems, in a more diverse ADHD group it might be necessary to treat sleep problems together with the mental health disorder they cooccur with, as these are interactive and bidirectionally related to each other (American Psychiatric Association, 2013;Becker et al., 2015;Van Dyk et al., 2019). Moreover, tailoring sleep interventions to the specific needs of adolescents with ADHD and sleep problems has been recommended (Cortese et al., 2013). ...
... Problems with sleep may be an intrinsic feature of ADHD. Regular sleep disturbance can lead to the development of ADHD or ADHD-like symptoms, potentially resulting in misdiagnosis [63,64]. ...
... The interrelationships are further complicated through the use of psychostimulant medications to treat ADHD, which impair sleep in some patients [67] but paradoxically improve sleep in others via a calming effect [68]. For these reasons, it has been recommended that primary sleep disorders should be ruled out before initiating ADHD medication [63]. Behavioral interventions targeted at improving sleep may benefit some patients [69] and should form part of the multimodal ADHD management plan recommended for patients receiving pharmacotherapy [70]. ...
Introduction: Attention deficit hyperactivity disorder (ADHD) is a neurodevelopmental disorder that interferes with multiple aspects of daily functioning and is associated with impairments in several domains. It may affect academic, educational, vocational, social, emotional, interpersonal, and health domains, and worsen risks to health outcomes. Objective: To identify and discuss medical conditions that commonly present with symptoms resembling ADHD. Method: This review is selective and not systematic. It is conducted through a focused literature search through PubMed, Google Scholar, and EMBASE. Search term included “ADHD misdiagnosis”, “medical conditions with ADHD like symptoms”, “ADHD AND medical problems”. Exclusion: giftedness, high IQ, and any article that does not list medical conditions. The limits applied were the following: the work must have been published in the past 20 years, be on humans, and be in the English language. Results: There are several medical conditions that can be misdiagnosed as ADHD and may show a similar presentation to ADHD, particularly with inattentive symptoms. Examples include, but are not limited to, absence seizure disorder, diabetes, thyroid dysfunction, sleep deprivation, post-concussion states, inflammatory bowel disease, iron deficiency states and anemia, and disordered breathing. Conclusions: Our review suggests that a thorough medical evaluation should be conducted prior to the diagnosis of ADHD. Allied health professionals and psychologists who diagnose ADHD should seek medical clearance from a physician prior to making the ADHD diagnosis in order to reduce misdiagnosis rates and improve patient outcomes. ADHD diagnosis should follow guidelines and be carried out under a systematic standardized approach. A full medical evaluation should be conducted to assess for medical conditions that may look like ADHD or be associated with ADHD.
... Inadequate sleep has been reported in up to 70% of children with ADHD [10][11][12][13][14][15][16][17], compared with 20% to 30% of children in the general population [18]. The sleep problems experienced by children with ADHD include unhealthy lifestyle choices, such as excessive between sleep processes and objectively measured NBF, and (5) focused on individuals with ADHD. ...
The objective of the present review was to systematically examine associations between perturbations of the homeostatic or circadian sleep processes and the neurobehavioral functioning (NBF) of individuals with ADHD. Electronic databases were searched for articles published between December 2013 and March 2023. Studies were included if they used objective measures of NBF, used objective or subjective measures of sleep, and focused on individuals with ADHD. Ten studies met these inclusion criteria. Of these, eight studies found perturbations in the interplay between NBF and Process S or Process C, and three studies did not. The quality of the studies was degraded because they failed to address key factors that affect the sleep processes and by the presence of methodological weaknesses. Our review suggests that homeostatic and circadian sleep processes are associated with NBF in individuals with ADHD. However, to confirm the validity of this conclusion, future studies should examine or control for confounders and utilize experimental designs that allow causality to be inferred.
... Across all studies, actigraphy and sleep diaries were completed simultaneously, and sleep diaries were completed immediately prior to PSG. The administration of questionnaires and objective sleep measures was less well described, two studies indicated PSG and questionnaires were completed on the same night [98,99], and one study indicated questionnaires were completed approximately seven days prior to actigraphy [57]. ...
The purpose of this systematic review and meta-analysis is to delineate the concordance of objective and subjective measures of sleep in children with neurodevelopmental conditions (NDCs). A systematic literature search identified 31 studies that compare objective and subjective estimates of sleep parameters in autism, ADHD or rare genetic syndromes associated with intellectual disability. The meta-analyses revealed smaller mean differences and larger correlations indicative of greater concordance for parameters associated with sleep scheduling compared to parameters associated with sleep duration and night awakenings. Relative to objective measures, subjective measures produced: 1) greater estimates of total sleep time, sleep efficiency and time in bed; and 2) lower estimates of wake after sleep onset and number of night awakenings. Subgroup analyses also revealed differences in concordance between measurement comparison types (e.g., stronger correlations between actigraphy and sleep diaries, compared to actigraphy and questionnaires) and NDC diagnostic groups. The results predominantly replicate concordance trends observed in typically-developing samples, although some NDC-specific patterns of concordance were identified. This indicates that objective and subjective sleep measures retain broadly similar properties across populations, although researchers and clinicians should be cautious of the impact of NDC-related characteristics on sleep parameter estimates. These findings should inform sleep assessment design and the interpretation of sleep parameter estimates in NDCs, increasing the rigour of sleep parameter description across research and clinical settings.
... Kratochvil et al. (2005) and McWilliams et al. (2022) have presented that the medication (e.g., melatonin and clonidine) could successfully promoted sleep in ADHD population. However, the use of medication could have a result to worsen of hyperactivity or behavioral difficulties at bedtime and lower daytime activity (Cortese et al., 2013;De Crescenzo et al., 2014). Without a promising conclusion in the application of pharmacological medication, the negative effect of the pharmacological therapy may be consequent to amplify the symptoms of ADHD and affect the daytime activity (Cortese et al., 2013;De Crescenzo et al., 2014). ...
... However, the use of medication could have a result to worsen of hyperactivity or behavioral difficulties at bedtime and lower daytime activity (Cortese et al., 2013;De Crescenzo et al., 2014). Without a promising conclusion in the application of pharmacological medication, the negative effect of the pharmacological therapy may be consequent to amplify the symptoms of ADHD and affect the daytime activity (Cortese et al., 2013;De Crescenzo et al., 2014). ...
Objective
Sleep problems have been commonly observed in children with attention deficit hyperactivity disorder (ADHD). The aim of current study was to investigate the impact of physical activity on sleep quality in young adolescent with attention deficit hyperactivity disorder.
Method
A total of 33 children diagnosed with attention deficit hyperactivity disorder (mean age = 10.12 years) were randomized into intervention group and control group respectively. Mention the intervention detail here. Four specific sleep parameters, including sleep efficiency, sleep onset latency, sleep duration, and wake after sleep onset, were assessed before and after the intervention period in both groups.
Results
Results revealed the significant improvements in sleep efficiency, sleep onset latency and wake after sleep onset in the intervention group but not in the control group.
Conclusion
Current findings highlight the benefits of PA on enhancing sleep quality among children with ADHD.
... Psychostimulants are still considered the most effective therapy for children, adolescents, and adults with ADHD. The first choice drug is MPH [44][45][46][47]. Among noradrenergic modulators approved for the treatment of ADHD, we find tricyclic antidepressants with secondary amine structures such as desipramine and nortriptyline, alpha-2 adrenergic agonists including clonidine and guanfacine, indirect agonists such as bupropion, and atomoxetine, which is a selective blocker of the reuptake of noradrenaline [45,48]. ...
Agomelatine (AGM) is one of the latest atypical antidepressants, prescribed exclusively for the treatment of depression in adults. AGM belongs to the pharmaceutical class of melatonin agonist and selective serotonin antagonist (“MASS”), as it acts both as a selective agonist of melatonin receptors MT1 and MT2, and as a selective antagonist of 5-HT2C/5-HT2B receptors. AGM is involved in the resynchronization of interrupted circadian rhythms, with beneficial effects on sleep patterns, while antagonism on serotonin receptors increases the availability of norepinephrine and dopamine in the prefrontal cortex, with an antidepressant and nootropic effect. The use of AGM in the pediatric population is limited by the scarcity of data. In addition, few studies and case reports have been published on the use of AGM in patients with attention deficit and hyperactivity disorder (ADHD) and autism spectrum disorder (ASD). Considering this evidence, the purpose of this review is to report the potential role of AGM in neurological developmental disorders. AGM would increase the expression of the cytoskeleton-associated protein (ARC) in the prefrontal cortex, with optimization of learning, long-term memory consolidation, and improved survival of neurons. Another important feature of AGM is the ability to modulate glutamatergic neurotransmission in regions associated with mood and cognition. With its synergistic activity a melatoninergic agonist and an antagonist of 5-HT2C, AGM acts as an antidepressant, psychostimulant, and promoter of neuronal plasticity, regulating cognitive symptoms, resynchronizing circadian rhythms in patients with autism, ADHD, anxiety, and depression. Given its good tolerability and good compliance, it could potentially be administered to adolescents and children.
... Some evidence points to a bi-directional relationship between sleep and mental health (Cortese et al., 2013), whereby mental health disorders, such as depression and anxiety, are also predictors of inadequate sleep amongst young people (Shochat et al., 2014). However, this is contested; a well-conducted meta-analysis suggests sleep problems exist only as a precursor to mental health disorders, and that current evidence for such disorders being predictive of poor sleep is weak (Lovato & Gradisar, 2014). ...
Optimal sleep, both in terms of duration and quality, is important for adolescent health. However, young people's sleeping habits have worsened over recent years. Access to and use of interactive electronic devices (e.g., smartphones, tablets, portable gaming devices) and social media have become deep-rooted elements of adolescents' lives and are associated with poor sleep. Additionally, there is evidence of increases in poor mental health and well-being disorders in adolescents; further linked to poor sleep. This review aimed to summarise the longitudinal and experimental evidence of the impact of device use on adolescents' sleep and subsequent mental health. Nine electronic bibliographical databases were searched for this narrative systematic review in October 2022. Of 5779 identified unique records, 28 studies were selected for inclusion. A total of 26 studies examined the direct link between device use and sleep outcomes, and four reported the indirect link between device use and mental health, with sleep as a mediator. The methodological quality of the studies was generally poor. Results demonstrated that adverse implications of device use (i.e., overuse, problematic use, telepressure, and cyber-victimisation) impacted sleep quality and duration; however, relationships with other types of device use were unclear. A small but consistent body of evidence showed sleep mediates the relationship between device use and mental health and well-being in adolescents. Increasing our understanding of the complexities of device use, sleep, and mental health in adolescents are important contributions to the development of future interventions and guidelines to prevent or increase resilience to cyber-bullying and ensure adequate sleep.
... Sleep parameters are the basic structure of sleeping patterns, such as total sleep time (TST). Sleep problems are "nonspecific sleep-related complaints" (Cortese et al., 2013), often associated with mutually exacerbating conditions, such as psychiatric comorbidities. Sleep hygiene refers to the sleep environment, sleep practices, and physiological factors such as caffeine (Martin et al., 2020). ...
Background
Adolescence is characterized by an increase in the rate of sleep problems, which might be even more pronounced in adolescents with ADHD. This systematic review with meta‐analysis aimed to compare sleep in adolescents with and without ADHD, including sleep parameters, both subjectively and objectively measured, sleep problems and sleep hygiene.
Methods
Medline, CINAHL, PsycINFO, EMBASE, ERIC, Web of Science, and PubMed databases were searched for studies with case‐control designs (published between 1980 and 2022) directly comparing sleep in adolescents (12–25 years) with ADHD to typically developing controls. Standardized mean differences were calculated and a random‐effects model was implemented using RevMan.
Results
Overall, 6974 titles/abstracts and 205 full texts were screened, resulting in 13 eligible studies. The sample sizes range from 35 to 9846 with in total 2465 adolescents with ADHD and 18,417 controls. The data suggests that adolescents with ADHD report significantly more disturbed subjective sleep parameters (e.g., total sleep time; n = 7, SMD = 0.47, p < .001) and experience more sleep problems compared to typically developing peers (e.g., daytime sleepiness; n = 5, SMD = 0.54, p = .01). Only few studies objectively measured sleep and no significant differences were found between both groups (n = 3) in any parameter. Differences in sleep hygiene could not be examined due to a limited number of studies.
Conclusions
Adolescents with ADHD report significantly worsened subjectively sleep parameters and more sleep problems compared to controls. These findings are still preliminary as a limited number of studies was identified. Nevertheless, it is advised to routinely include sleep assessment in the ADHD diagnostic process. More research is needed with a focus on objective measurement and sleep hygiene in ADHD.
