To determine the relationship of sleep problems to attention-deficit/hyperactivity disorder (ADHD), diagnostic subtype, comorbid disorders, and the effects of stimulant treatment.
On the basis of clinical diagnostic interviews, children aged 6 to 12 years were assigned to 4 groups: unmedicated ADHD (n = 79), medicated ADHD (n = 22), clinical comparison (n = 35), and healthy nonclinical comparison (n = 36). These groups were compared on 2 sleep questionnaires completed by the parents that assessed current sleep problems and factors associated with sleep difficulties (i.e., sleep routines, sleep practices, child and family sleep history).
Factor analysis revealed 3 sleep problem categories: dyssomnias, parasomnias, and sleep-related involuntary movements. Linear regression analyses showed that (1) dyssomnias were related to confounding factors (i.e., comorbid oppositional defiant disorder and stimulant medication) rather than ADHD; (2) parasomnias were similar in clinical and nonclinical children; and (3) the DSM-IV combined subtype of ADHD was associated with sleep-related involuntary movements. However, sleep-related involuntary movements were more highly associated with separation anxiety.
The results suggest that the relationship between sleep problems and ADHD is complex and depends on the type of sleep problem assessed as well as confounding factors such as comorbid clinical disorders and treatment with stimulant medication.
"Based on parent and child reports at least one type of sleep-related problem, including delayed sleep onset, frequent nighttime awakenings, nightmares, and/or bedtime resistance, affects nearly all (i.e., 90 %) children diagnosed with generalized anxiety disorder (GAD) (Alfano et al. 2006; Alfano et al. 2007; Alfano et al. 2010; Chase and Pincus 2011; Hudson et al. 2009; Reynolds and Alfano 2015). Even among children with other primary forms of psychopathology, the presence of comorbid anxiety is uniquely linked with sleep complaints (Corkum et al. 1999; Mick et al. 2000). Such problems appear to contribute to overall symptom severity and day-to-day impairment experienced by anxious youth (Alfano et al. 2007, 2010; Chase and Pincus 2011). "
[Show abstract][Hide abstract] ABSTRACT: We compared subjective and objective sleep patterns and problems, and examined cross-method correspondence across parent reports, child reports, and actigraphy-derived sleep variables in clinically-anxious children and healthy controls. In a multi-site, cross-sectional study, 75 pre-adolescent children (6 to 11 years; M=8.7 years; SD=1.4; 39/52% female) were examined including 39 with a diagnosis of primary generalized anxiety disorder (GAD) and 36 controls recruited from university-based clinics in Houston, TX and Washington, DC. Structured interviews, validated sleep questionnaires, and 1-week of actigraphy data were utilized. Despite subjective reports of significantly greater sleep problems among anxious children, actigraphy data revealed no significant differences between the groups. All parents estimated earlier bedtimes and greater total sleep duration relative to actigraphy, and all children endorsed more sleep problems than parents. With few exceptions, subjective reports exhibited low and non-significant correspondence with actigraphy-based sleep patterns and problems. Our findings suggest that high rates of sleep complaints found among children with GAD (and their parents) are not corroborated by objective sleep abnormalities, with the exception of marginally prolonged sleep onset latency compared to controls. Objective-subjective sleep discrepancies were observed in both groups but more apparent overall in the GAD group. Frequent complaints of sleep problems and daytime tiredness among anxious youth might more accurately reflect difficulties prior to the actual sleep period, cognitive-affective biases associated with sleep, and/or an increased sleep need. Findings highlight the importance of considering sleep from multiple perspectives.
"The DSM-5 diagnostic criteria for ADHD include two symptom presentations— inattention and hyperactivity/impulsivity (APA 2013). Past studies have found that between 55 and 95 % of parents reported that their children diagnosed with ADHD had at least one sleep problem (Corkum et al. 1998) and that children with moderate-to-severe sleep problems were 12 times more likely to be diagnosed with ADHD than children with no sleep problems (Hiscock et al. 2007). Additionally , parent and teacher reports of hyperactive and impulsive symptoms have been associated with greater daytime sleepiness in children compared to matched controls (Fallone et al. 2002). "
[Show abstract][Hide abstract] ABSTRACT: The current study investigated the link between poor sleep and ADHD symptomatology. The effects of extending versus restricting sleep on subjective (questionnaires) and objective (actigraphy) measures of daytime movement were examined in 25 typically developing children aged 8-12 years. Subjective measures demonstrated an increase in ADHD symptomology following sleep restriction, with follow-up analyses indicating that findings were due to poorer attention, not changes in hyperactivity. The results of actigraphy data indicated that there were no differences found for mean or median daytime activity, but the standard deviation of activity was found to be significantly higher following sleep restriction. Contrary to the popular belief that sleep restriction results in increased overall activity, this study instead found an increase in variability of activity. This suggests that a sleep-restricted child's activity level may appear as alternating periods of high and low activity levels throughout the day.
ADHD Attention Deficit and Hyperactivity Disorders 07/2015; DOI:10.1007/s12402-015-0180-3
"Unhealthy sleep practices thus may impair moral reasoning and lead to defiant thinking or a defiant attitude. While research on the linkage between sleep problem and defiant attitude is sparse, a few studies have demonstrated that sleep problems are correlated with an oppositional defiant attitude (ODD) (Corkum et al. 1999; Cortese et al. 2009; Stein 1999); in particular, short sleep duration is documented to relate to ODD (Pesonen et al. 2010). Somewhat related to the defiant/oppositional attitude is that researchers have found a relationship between sleep problems and attention-deficit/hyperactivity disorder (ADHD) (Corkum et al. 2001; Mayes et al. 2009), which in turn is highly correlated with ODD (Pliszka 2007). "
[Show abstract][Hide abstract] ABSTRACT: Although sleep has been linked to activities in various domains of life, one under-studied link is the relationship between unhealthy sleep practices and conduct problems among adolescents. The present study investigates the influence of adolescents' unhealthy sleep practices-short sleep (e.g., less than 6 h a day), inconsistent sleep schedule (e.g., social jetlag), and sleep problems-on conduct problems (e.g., substance use, fighting, and skipping class). In addition, this study examines unhealthy sleep practices in relationship to adolescent emotional well-being, defiant attitudes, and academic performance, as well as these three domains as possible mediators of the longitudinal association between sleep practices and conduct problems. Three waves of the Taiwan Youth Project (n = 2,472) were used in this study. At the first time-point examined in this study, youth (51 % male) were aged 13-17 (M = 13.3). The results indicated that all three measures of unhealthy sleep practices were related to conduct problems, such that short sleep, greater social jetlag, and more serious sleep problems were concurrently associated with greater conduct problems. In addition, short sleep and sleep problems predicted conduct problems one year later. Furthermore, these three unhealthy sleep practices were differently related to poor academic performance, low levels of emotional well-being, and defiant attitudes, and some significant indirect effects on later conduct problems through these three attributes were found. Cultural differences and suggestions for prevention are discussed.
Journal of Youth and Adolescence 08/2014; 44(2). DOI:10.1007/s10964-014-0169-9 · 2.72 Impact Factor
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