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Sleep problems in children and adolescents in an attention deficit hyperactivity disorder service
Published online by Cambridge University Press: 31 August 2023
Abstract
Objectives:
Sleep problems are common amongst children and adolescents with attention deficit hyperactivity disorder (ADHD). The purpose of this study was to investigate sleep problems in children and adolescents attending a specialist ADHD service.
Methods:
This was a cross-sectional online survey combined with a retrospective chart review, conducted in the ADHD Assessment, Diagnosis, Management, initiation, Research and Education (ADMiRE) service, the first public specialist ADHD service for young people in Ireland. Participants were caregivers of children and adolescents with ADHD attending ADMiRE. Sleep was assessed using The Children’s Sleep Habits Questionnaire (CSHQ) and ADHD symptoms were assessed using an abbreviated version of the Swanson, Nolan and Pelham Teacher and Parent Rating Scale (SNAP-IV). Details regarding patient demographics, co-morbidities and medication were collected from patient records.
Results:
Eighty-four percent of young people scored above the clinical cut-off for a sleep disorder. The most frequently reported sleep problems were related to sleep onset and sleep duration, and 64% of respondents met the criteria for two or more sleep problems. ADHD severity was associated with greater sleep problems. Co-morbid physical, neurodevelopmental, and mental health disorders as well as stimulant use were not associated with greater sleep problems.
Conclusion:
Sleep problems are very common amongst children and adolescents with ADHD. This study has demonstrated an association between more sleep problems and ADHD severity. These findings highlight the need for both effective ADHD treatment to ensure optional sleep in young people as well as effective interventions for sleep problems to prevent worsening of ADHD symptoms.
Keywords
- Type
- Original Research
- Information
- Copyright
- © The Author(s), 2023. Published by Cambridge University Press on behalf of The College of Psychiatrists of Ireland
References
American Psychiatric Association (2000). Diagnostic and Statistical Manual of Mental Disorders, 4th edn. American Psychiatric Association: Washington, DC.Google Scholar
Anand, S, Tong, H, Besag, FMC, Chan, EW, Cortese, S, Wong, ICK (2017). Safety, tolerability and efficacy of drugs for treating behavioural insomnia in children with attention-deficit/hyperactivity disorder: a systematic review with methodological quality assessment. Paediatric Drugs 19, 235–250.CrossRefGoogle ScholarPubMed
Arns, M, Clark, CR, Trullinger, M, deBeus, R, Mack, M, Aniftos, M (2020). Neurofeedback and attention-deficit/hyperactivity-disorder (ADHD) in children: rating the evidence and proposed guidelines. Applied Psychophysiology and Biofeedback 45, 39–48.CrossRefGoogle ScholarPubMed
Aronen, ET, Lampenius, T, Fontell, T, Simola, P (2014). Sleep in children with disruptive behavioural disorders. Behavioural Sleep Medicine 12, 373–388.CrossRefGoogle Scholar
Åslund, L, Lekander, M, Wicksell, RK, Henje, E, Jernelöv, S (2020). Cognitive-behavioural therapy for insomnia in adolescents with comorbid psychiatric disorders: a clinical pilot study. Clinical Child Psychology and Psychiatry 25, 958–971.CrossRefGoogle ScholarPubMed
Bartholomew, K, Owens, J (2006). Sleep and ADHD: a review. Rhode Island Medical Journal 89, 91–93.Google ScholarPubMed
Becker, SP, Langberg, JM, Eadeh, HM, Isaacson, PA, Bourchtein, E (2019). Sleep and daytime sleepiness in adolescents with and without ADHD: differences across ratings, daily diary, and actigraphy. Journal of Child Psychology and Psychiatry 60, 1021–1031.Google ScholarPubMed
Boafo, A, Greenham, S, Alenezi, S, Robillard, R, Pajer, K, Tavakoli, P, De Koninck, J (2019). Could long-term administration of melatonin to pre-pubertal children affect timing of puberty? A clinician’s perspective. Nature of Science and Sleep 11, 1–10.CrossRefGoogle Scholar
Bondopadhyay, U, Diaz-Orueta, U, Coogan, AN (2022). A systematic review of sleep and circadian rhythms in children with attention deficit hyperactivity disorder. Journal of Attention Disorders 26, 149–224.CrossRefGoogle ScholarPubMed
Bussing, R, Fernandez, M, Harwood, M, Hou., Wei, Garvan, CW, Eyberg, SM, Swanson, JM (2008). Parent and teacher SNAP-IV ratings of attention deficit hyperactivity disorder symptoms: psychometric properties and normative ratings from a school district sample. Assessment 15, 317–328.CrossRefGoogle ScholarPubMed
Central Statistics Office (2017). Census 2016 Summary Results. Central Statistics Office: Ireland.Google Scholar
Chuang, YC, Wang, CY, Huang, WL, Wang, LJ, Kuo, HC, Chen, YC, Huang, YJ (2022). Two meta-analyses of the association between atopic diseases and core symptoms of attention deficit hyperactivity disorder. Scientific Reports 12, 3377.CrossRefGoogle ScholarPubMed
Conners, CK (1997). Conners’ Rating Scales-Revised: Technical Manual. Multi Health Systems: North Tonawanda, New York.Google Scholar
Connor, DF, Doerfler, LA (2008). ADHD with comorbid oppositional defiant disorder or conduct disorder: discrete or non-distinct disruptive behaviour disorders? Journal of Attentional Disorders 12, 126–134.CrossRefGoogle ScholarPubMed
Coogan, AN, McGowan, NM (2017). A systematic review of circadian function, chronotype and chronotherapy in attention deficit hyperactivity disorder. Attention Deficit Hyperactivity Disorder 9, 129–147.CrossRefGoogle ScholarPubMed
Cuomo, BM, Vaz, S, Lee, EAL, Thompson, C, Rogerson, JM, Falkmer, T (2017). Effectiveness of sleep-based interventions for children with autism spectrum disorder: a meta-synthesis. Pharmacotherapy 37, 555–578.CrossRefGoogle ScholarPubMed
Dewald, JF, Meijer, AM, Oort, FJ, Kerkhof, GA, Bögels, SM (2010). The influence of sleep quality, sleep duration and sleepiness on school performance in children and adolescents: a meta-analytic review. Sleep Medicine Reviews 14, 179–189.CrossRefGoogle ScholarPubMed
Fincham, JE (2008). Response rates and responsiveness for surveys, standards, and the Journal. American Journal of Pharmaceutical Education 72, 43.CrossRefGoogle ScholarPubMed
Fisher, BC, Garges, DM, Yoon, SY, Maguire, K, Zipay, D, Gambino, M, Shapiro, CM (2014). Sex differences and the interaction of age and sleep issues in neuropsychological testing performance across the lifespan in an ADD/ADHD sample from the years 1989 to 2009. Psychology Reports 114, 404–438.CrossRefGoogle Scholar
Fortier-Brochu, E, Beaulieu-Bonneau, S, Ivers, H, Morin, CM (2012). Insomnia and daytime cognitive performance: a meta-analysis. Sleep Medicine Reviews 16, 83–94.CrossRefGoogle ScholarPubMed
Gruber, R (2009). Sleep characteristics of children and adolescents with attention deficit-hyperactivity disorder. Child Adolescent Psychiatry Clinics of North America 18, 863–876.CrossRefGoogle ScholarPubMed
Gruber, R, Fontil, L, Bergmame, L, Wiebe, ST, Amsel, R, Frenette, S, Carrier, J (2012). Contributions of circadian tendencies and behavioural problems to sleep onset problems of children with ADHD. BMC Psychiatry 12, 212.CrossRefGoogle Scholar
Haase, T, Pratschke, J (2017). The 2016 Pobal HP Deprivation Index for Small Areas (SA), Trutz Haase. Available at: (https://www.pobal.ie/app/uploads/2018/06/The-2016-Pobal-HP-Deprivation-Index-Introduction-07.pdf). Accessed 4 June 2022.Google Scholar
Haase, T, Pratschke, J, Gleeson, J (2015). All-island deprivation index: towards the development of consistent deprivation measures for the island of Ireland. Borderlands: The Journal of Spatial Planning in Ireland 2, 21–37.Google Scholar
Hartz, A, Ross, JJ (2012). Cohort study of the association of hypnotic use with mortality in postmenopausal women. BMJ Open 2, e001413.CrossRefGoogle ScholarPubMed
Health Service Executive. (2013). Fifth Annual Child & Adolescent Mental Health Service Report 2012–2013. Health Service Executive: Ireland.Google Scholar
Hvolby, A (2015). Associations of sleep disturbance with ADHD: implications for treatment. Attention Deficit and Hyperactivity Disorders 7, 1–18.CrossRefGoogle ScholarPubMed
International Business Machine Corp. (2013). IBM SPSS Statistics for Windows, Version 22.0. IBM Corp: Armonk, New York.Google Scholar
Irish, LA, Kline, CE, Gunn, HE, Buysse, DJ, Hall, MH (2015). The role of sleep hygiene in promoting public health: a review of empirical evidence. Sleep Medicine Reviews 22, 23–36.CrossRefGoogle ScholarPubMed
Jernelöv, S, Larsson, Y, Llenas, M, Nasri, B, Kaldo, V (2019). Effects and clinical feasibility of a behavioural treatment for sleep problems in adult attention deficit hyperactivity disorder (ADHD): a pragmatic within-group pilot evaluation. BMC Psychiatry 19, 226.CrossRefGoogle ScholarPubMed
Kirov, R, Brand, S (2014). Sleep problems and their effect in ADHD. Expert Reviews of Neurotherapeutics 14, 287–299.CrossRefGoogle ScholarPubMed
Kooij, S (2017). Circadian rhythm and sleep in ADHD – cause of lifestyle factor? In: 30th Annial European Neuropsychopharmacology Congress, Paris, France.CrossRefGoogle Scholar
Kuriyan, A B, Pelham, WE Jr., Molina, BS, Waschbusch, DA, Gnagy, EM, Sibley, MH, Babinski, DE, Walther, C, Cheong, J, Yu, J, Kent, KM (2013). Young adult educational and vocational outcomes of children diagnosed with ADHD. Journal of Abnormal Child Psychology 41, 27–41.CrossRefGoogle ScholarPubMed
LeBourgeois, MK, Avis, K, Mixon, M, Olmi, J, Harsh, J (2004). Snoring, sleep quality, and sleepiness across attention-deficit/hyperactivity disorder subtypes. Sleep 27, 520–525.Google ScholarPubMed
Lecendreux, M, Konofal, E, Bouvard, M, Falissard, B, Mouren-Siméoni, MC (2000). Sleep and alertness in children with ADHD. Journal of Child Psychology and Psychiatry 41, 803–812.CrossRefGoogle ScholarPubMed
Liu, X, Liu, ZZ, Liu, BP, Sun, SH, Jia, CX (2020). Associations between sleep problems and ADHD symptoms among adolescents: findings from the Shandong Adolescent Behaviour and Health Cohort (SABHC). Sleep 43, 294.CrossRefGoogle ScholarPubMed
Lunsford-Avery, JR, Krystal, AD, Kollins, SH (2016). Sleep disturbances in adolescents with ADHD: a systematic review and framework for future research. Clinical Psychology Review 50, 159–174.CrossRefGoogle ScholarPubMed
Masi, G, Fantozzi, P, Villafranca, A, Tacchi, A, Ricci, F, Ruglioni, L, Inguaggiato, E, Pfanner, C, Cortese, S (2019). Effects of melatonin in children with attention-deficit/hyperactivity disorder with sleep disorders after methylphenidate treatment. Neuropsychiatric Disease and Treatment 15, 663–667.CrossRefGoogle ScholarPubMed
Mayes, SD, Calhoun, SL, Bixler, EO, Vgontzas, AN, Mahr, F, Hillwig-Garcia, J, Elamir, B, Edhere-Ekezie, L, Parvin, M (2009). ADHD subtypes and comorbid anxiety, depression, and oppositional-defiant disorder: differences in sleep problems. Journal of Paediatric Psychology 34, 328–337.CrossRefGoogle ScholarPubMed
McGrath, J (2020). ADHD and Covid-19: current roadblocks and future opportunities. Irish Journal of Psychological Medicine 37, 204–211.CrossRefGoogle ScholarPubMed
Mesarwi, O, Polak, J, Jun, J, Polotsky, VY (2013). Sleep disorders and the development of insulin resistance and obesity. Endocrinology and Metabolism Clinics of North America 42, 617–634.CrossRefGoogle ScholarPubMed
Minde, K, Popeil, K, Leos, N, Falkner, S, Parker, K, Handley-Derry, M (1993). The evaluation and treatment of sleep disturbances in young children. Journal of Child Psychology and Psychiatry 34, 521–533.CrossRefGoogle ScholarPubMed
Mindell, J, Owens, J (2009). Sleep Hygiene: Healthy Sleep Habits for Children and Adolescents. In A Clinical Guide to Paediatric Sleep. 2nd edition. Lippincott Williams & Wilkins: Philadelphia.Google Scholar
Mulraney, M, Giallo, R, Lycett, K, Mensah, F, Sciberras, E (2016). The bidirectional relationship between sleep problems and internalizing and externalizing problems in children with ADHD: a prospective cohort study. Sleep Medicine 17, 45–51.CrossRefGoogle ScholarPubMed
Nikles, J, Mitchell, GK, de Miranda Araújo, R, Harris, T, Heussler, HS, Punja, S, Vohra, S, Senior, HEJ (2020). A systematic review of the effectiveness of sleep hygiene in children with ADHD. Psychology, Health and Medicine 25, 497–518.CrossRefGoogle ScholarPubMed
Posner, J, Polanczyk, GV, Sonuga-Barke, E (2020). Attention deficit hyperactivity disorder. Seminarm 395, 450–462.Google ScholarPubMed
Okada, M, Kitamura, S, Iwadare, Y, Tachimori, H, Kamei, Y, Higuchi, S, Mishima, K (2017). Reliability and validity of a brief sleep questionnaire for children in Japan. Journal of Physiological Anthropology 36, 35.CrossRefGoogle ScholarPubMed
Owens, JA, Spirito, A, McGuinn, M (2000). The Children’s Sleep Habits Questionnaire (CSHQ): psychometric properties of a survey instrument for school-aged children. Sleep 23, 1043–9.CrossRefGoogle ScholarPubMed
Raman, S, Coogan, AN (2019). Closing the loop between circadian rhythms, sleep, and attention deficit hyperactivity disorder. Handbook of Behavioural Neuroscience 30, 707–716.CrossRefGoogle Scholar
Ramos Platon, MJ, Vela Bueno, A, Espinar Sierra, J, Kales, S (1990). Hypnopolygraphic alterations in attention deficit disorder (ADD) children. International Journal of Neuroscience 53, 87–101.CrossRefGoogle ScholarPubMed
Rong, Y, Yang, C-J, Jin, Y, Wang, Y (2021). Prevalence of attention-deficit/hyperactivity disorder in individuals with autism spectrum disorder: a meta-analysis. Research in Autism Spectrum Disorder 83, 101759.CrossRefGoogle Scholar
Salvi, V, Migliarese, G, Venturi, V, Rossi, F, Torriero, S, Vigano, V, Cerveri, G, Mencacci, C (2019). ADHD in adults: clinical subtypes and associated characteristics. Rivisa di psichiatria 54, 84–89.Google ScholarPubMed
Schans, JV, Çiçek, R, de Vries, TW, Hak, E, Hoekstra, PJ (2017). Association of atopic diseases and attention-deficit/hyperactivity disorder: a systematic review and meta-analyses. Neuroscience and Biobehavioural Reviews 74, 139–148.CrossRefGoogle ScholarPubMed
Schneider, HE, Lam, JC, Mahone, EM (2016). Sleep disturbance and neuropsychological function in young children with ADHD. Child Neuropsychology 22, 493–506.CrossRefGoogle ScholarPubMed
Shochat, T, Cohen-Zion, M, Tzischinsky, O (2014). Functional consequences of inadequate sleep in adolescents: a systematic review. Sleep Medicine Reviews 18, 75–87.CrossRefGoogle ScholarPubMed
Srinivasan, V, Pandi-Perumal, SR, Trahkt, I, Spence, DW, Poeggeler, B, Hardeland, R, Cardinali, DP (2009). Melatonin and melatonergic drugs on sleep: possible mechanisms of action. International Journal of Neuroscience 119, 821–846.CrossRefGoogle ScholarPubMed
Sung, V, Hiscock, H, Sciberras, E, Efron, D (2008). Sleep problems in children with attention-deficit/hyperactivity disorder: prevalence and the effect on the child and family. Archives of Paediatric Adolescent Medicine 162, 336–342.CrossRefGoogle ScholarPubMed
Sutton, EL (2014). Psychiatric disorders and sleep issues. Medical Clinics of North America 98, 1123–1143.CrossRefGoogle ScholarPubMed
Swanson, JM (1992). School-Based Assessment and Interventions for ADD Students. KC Publications: CA, Irvine.Google Scholar
Swanson, JM, Sandman, CA, Deutsch, C, Baren, M (1983). Methylphenidate hydrochloride given with or before breakfast: I. Behavioural, cognitive, and electrophysiologic effects. Paediatrics 72, 49–55.CrossRefGoogle ScholarPubMed
Swanson, JM, Schuck, S, Porter, MM, Carlson, C, Hartman, CA, Sergeant, JA, Clevenger, W, Wasdell, M, McCleary, R, Lakes, K, Wigal, T (2012). Categorical and dimensional definitions and evaluations of symptoms of ADHD: history of the SNAP and the SWAN rating scales. The International Journal of Educational and Psychological Assessment 10, 51–70.Google ScholarPubMed
Turan, S, Akay, AP (2020). The effects of atomoxetine on weight, height, and body mass index in Turkish children and adolescents with attention deficit hyperactivity disorder. Psychiatry and Clinical Psychopharmacology 29, 781–786.CrossRefGoogle Scholar
Van der Heijden, KB, Smits, MG, Van Someren, EJ, Gunning, WB (2005). Idiopathic chronic sleep onset insomnia in attention-deficit/hyperactivity disorder: a circadian rhythm sleep disorder. Chronobiology International 22, 559–570.CrossRefGoogle ScholarPubMed
Van der Heijden, KB, Smits, MG, Van Someren, EJ, Ridderinkhof, KR, Gunning, WB (2007). Effect of melatonin on sleep, behaviour, and cognition in ADHD and chronic sleep-onset insomnia. Journal of the American Academy of Child and Adolescent Psychiatry 46, 233–241.CrossRefGoogle ScholarPubMed
Wajszilber, D, Santiseban, JA, Gruber, R (2018). Sleep disorders in patients with ADHD: impact and management challenges. Nature and Science of Sleep 10, 453–480.CrossRefGoogle ScholarPubMed
Weiss, MD, Wasdell, MB, Bomben, MM, Rea, KJ, Freeman, RD (2006). Sleep hygiene and melatonin treatment for children and adolescents with ADHD and initial insomnia. Journal of the American Academy of Child and Adolescent Psychiatry 45, 512–519.CrossRefGoogle ScholarPubMed
Wolraich, M L, Hagan, JF Jr, Allan, C, Chan, E, Davison, D, Earls, M, Evans, SW, Flinn, SK, Froehlich, T, Frost, J, Holbrook, JR, Lehmann, CU, Lessin, HR, Okechukwu, K, Pierce, KL, Winner, JD, Zurhellen, W (2019). Clinical practice guideline for the diagnosis, evaluation, and treatment of attention-deficit/hyperactivity disorder in children and adolescents. Paediatrics 144, e20192528.CrossRefGoogle ScholarPubMed
Word Health Organization. (1993). The ICD-10 Classification of Mental and Behavioural Disorders: Diagnostic Criteria for Research. World Health Organization: Geneva.Google Scholar
Wynchank, D, Ten, Have, Bijlenga, M, Penninx, D, Beekman, BW, Lamers, AT, de Graaf, F, R, Kooij, J (2018). The association between insomnia and sleep duration in adults with attention-deficit hyperactivity disorder: results from a general population study. Journal of Clinical Sleep Medicine: JCSM: Official Publication of the American Academy of Sleep Medicine 14, 349–357.Google ScholarPubMed
Xu, YC, Wang, JP, Zhu, WJ, Li, P (2020). Childhood atopic dermatitis as a precursor for developing attention deficit/hyperactivity disorder. International Journal of Immunopathology and Pharmacology 34, 2058738420962902.CrossRefGoogle ScholarPubMed
Yürümez, E, Kılıç, BG (2016). Relationship between sleep problems and quality of life in children with ADHD. Journal of Attentional Disorders 20, 34–40.CrossRefGoogle ScholarPubMed
Zielinski, MR, McKenna, JT, McCarley, RW (2016). Functions and mechanisms of sleep. AIMS Neuroscience 3, 67–104.CrossRefGoogle ScholarPubMed
Zhao, T, Xuan, K, Liu, H, Chen, X, Qu, G, Wu, Y, Zhang, J, Sun, Y (2020). Sleep disturbances and related factors among preschool children in rural areas of China: a cross-sectional study. Psychology, Health & Medicine 3, e1919954. doi: 10.1001/jamanetworkopen.2019.19954.Google Scholar
Zwart, TC, Smits, MG, Egberts, TCG, Rademaker, CMA, van Geijlswijk, IM (2018). Long-term melatonin therapy for adolescents and young adults with chronic sleep onset insomnia and late melatonin onset: evaluation of sleep quality, chronotype, and lifestyle factors compared to age-related randomly selected population cohorts. Healthcare (Basel) 6, 23.CrossRefGoogle Scholar