Sleep Problems in Children With Attention‐Deficit/Hyperactivity Disorder: Impact of Subtype, Comorbidity, and Stimulant Medication

Ontario Institute for Studies in Education, University of Toronto, Canada.
Journal of the American Academy of Child & Adolescent Psychiatry (Impact Factor: 7.26). 11/1999; 38(10):1285-93. DOI: 10.1097/00004583-199910000-00018
Source: PubMed


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.

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    • "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). "
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    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.
    Journal of Abnormal Child Psychology 12/2015; 43(8):(in press). DOI:10.1007/s10802-015-0018-7 · 3.48 Impact Factor
    • "Others have suggested that the association between ADHD symptoms and sleep are accounted for partly or fully by comorbid conditions (Gau & Chiang, 2009; Mick, Biederman, Jetton, & Faraone, 2000) and medication use (Corkum, Moldofsky, Hogg-Johnson, Humphries, & Tannock, 1999; Mick et al., 2000). Comorbid emotional and behavioral problems in children with ADHD have indeed been related to increased risk of sleep problems in children (Corkum et al., 1999; Hansen, Skirbekk, Oerbeck, Richter, & Kristensen, 2011; Lycett, Sciberras, Mensah, Gulenc, & Hiscock, 2014). The type and frequency of comorbid conditions are likely to be developmentally dependent, and while anxiety is often related to childhood sleep, other cooccurring mental health problems may be important for adolescents. "
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    ABSTRACT: Sleep problems and symptoms of ADHD are common in adolescence, but detailed epidemiological assessment of their association is lacking. Using data from a recent population-based study, 9,846 adolescents aged 16 to 19 provided detailed information on sleep and symptoms of ADHD. Results confirmed a large overlap between self-reported symptoms of ADHD and all sleep variables studied. Symptoms of ADHD were linked to shorter sleep duration, longer sleep latency, and nocturnal wake time, as well as larger sleep deficiency. ADHD symptoms also increased the odds of insomnia and delayed sleep phase syndrome. The associations were only partially explained by confounders (mainly depression). The findings suggest that sleep problems should be included as a treatment target in efforts to reduce symptoms of ADHD in adolescence.
    Behavioral Sleep Medicine 10/2015; DOI:10.1080/15402002.2015.1048448 · 2.34 Impact Factor
    • "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). "
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    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
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