ADHD Treatments, Sleep, and Sleep Problems: Complex Associations

Stein, Mark A.; Weiss, Margaret; Hlavaty, Laura E.

doi:10.1007/s13311-012-0130-0

Cited by 126 publications

(94 citation statements)

References 66 publications

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“…This finding is mostly consistent with a frequently proposed, but rarely tested, argument that youth adjust to medication over time and may have initial sleep problems that will resolve. 9,29 Although sleep problems did not resolve entirely, sleep efficiency was not as poor when children stayed on medications longer. Similarly, the more nights that sleep was assessed during the study, the less negative effects on sleep efficiency were observed.…”

Section: Discussionmentioning

confidence: 99%

“…5,6 Sleep problems are common for youth with ADHD even when they are not taking medications, 7 and some clinicians claim that children with ADHD sleep better when taking medications. 8 Stein et al 9 explained that difficulties falling asleep commonly observed in children with ADHD may be due to a "rebound effect" in which the child experiences withdrawal symptoms as the medication wears off near bedtime, suggesting that there may be benefits to maintaining active stimulants in the child's body even in the hours approaching bedtime. Furthermore, stimulant medications may positively influence sleep indirectly by improving compliance and reducing bedtime resistance (a common problem for children with ADHD), thereby allowing children to fall asleep faster.…”

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confidence: 99%

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Stimulant Medications and Sleep for Youth With ADHD: A Meta-analysis

et al. 2015

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CONTEXT: Mixed findings exist on whether stimulant medications alter youth sleep. OBJECTIVE:To determine the effect of stimulant medications on sleep.DATA STUDIES: Studies published through March 2015 were collected via CINAHL, PsycINFO, and PubMed. References of retrieved articles were reviewed.STUDY SELECTION: Eligibility criteria included studies with children/adolescents who had attention-deficit/hyperactivity disorder (ADHD), random assignment to stimulants, and objective sleep measurement. Studies that did not include information about key variables were excluded. DATA EXTRACTION: Study-level, child-level, and sleep data were extracted by 2 independent coders. Effect sizes were calculated by using random effects models. Potential moderators were examined by using mixed effect models.RESULTS: A total of 9 articles (N = 246) were included. For sleep latency, the adjusted effect size (0.54) was significant, indicating that stimulants produce longer sleep latencies. Frequency of dose per day was a significant moderator. For sleep efficiency, the adjusted effect size (20.32) was significant. Significant moderators included length of time on medication, number of nights of sleep assessed, polysomnography/actigraphy, and gender. Specifically, the effect of medication was less evident when youth were taking medication longer. For total sleep time, the effect size (20.59) was significant, such that stimulants led to shorter sleep duration. LIMITATIONS:Limitations include few studies, limited methodologic variability, and lack of unpublished studies.CONCLUSIONS: Stimulant medication led to longer sleep latency, worse sleep efficiency, and shorter sleep duration. Overall, youth had worse sleep on stimulant medications. It is recommended that pediatricians carefully monitor sleep problems and adjust treatment to promote optimal sleep.Department of Psychology, University of Nebraska-Lincoln, Lincoln, NebraskaMs Kidwell contributed to the conceptualization of the study, organized literature searches, coded the original studies, and drafted the introduction and discussion sections; Ms Van Dyk contributed to the conceptualization of the study, coded the original studies for reliability analyses, and reviewed and revised the manuscript; Ms Lundahl contributed to the conceptualization of the study, conducted the meta-analyses, and drafted the methods and results sections; Dr Nelson contributed to the conceptualization of the study and provided critical editing of the manuscript; and all authors approved the final manuscript as submitted.www.pediatrics.org/cgi

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Section: Discussionmentioning

confidence: 99%

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confidence: 99%

Stimulant Medications and Sleep for Youth With ADHD: A Meta-analysis

et al. 2015

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“…The linkages between sleep and DSM-defined ADHD are complex and are thoroughly considered in several reviews (Gruber 2009;Kirov and Brand 2014;Stein et al 2012;Yoon et al 2012). What is clear is that sleep problems are considerably more common in individuals diagnosed with ADHD in comparison to the general population, with approximately 30 % of children and 60 % of adults with ADHD exhibiting significant sleep problems (Yoon et al 2012).…”

Section: Sleep and Adhdmentioning

confidence: 99%

“…The association between ADHD and sleep problems has been documented for several decades, with restless sleep even included as a symptom of Attention Deficit Disorder in the Third Edition of the DSM (American Psychiatric Association 1980). Importantly, although stimulant medication use may impact sleep onset and sleep duration (Kirov and Brand 2014), some studies find no differences in sleep functioning among medicated versus non-medicated youth with ADHD (e.g., Becker et al 2014;Moreau et al 2014) and other studies show that youth with ADHD who are not taking stimulant medications continue to have significantly higher rates of sleep problems in comparison to their peers (Cohen-Zion and Ancoli-Israel 2004; Stein et al 2012). Accordingly, the high prevalence of sleep problems in youth with ADHD is not solely an artifact of stimulant medication use.…”

Section: Sleep and Adhdmentioning

confidence: 99%

Advancing a Biopsychosocial and Contextual Model of Sleep in Adolescence: A Review and Introduction to the Special Issue

Becker

Langberg

Byars

2015

J Youth Adolescence

157

130

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Sleep problems in adolescence have been identified as an international public health issue. Over the past few decades, notable advances have been made in our understanding of the patterns and consequences of sleep in adolescence. Despite these important gains, there is much about the role of sleep in adolescence that remains to be understood. This Special Issue brings together studies that examine sleep as it specifically pertains to adolescent development and adjustment. In this introductory article, we argue for the importance of grounding the study of sleep and adolescence in developmental science and a developmental psychopathology framework. First, a review of the literature is used to outline a biopsychosocial and contextual model of sleep in adolescence. Second, attention-deficit/hyperactivity disorder (ADHD) is used as an exemplar of the proposed model given the pervasiveness of sleep problems among youth with ADHD and the likelihood that sleep problems and ADHD symptoms are interconnected in complex ways. Finally, a brief introduction to the empirical articles included in the Special Issue is provided, with particular attention given to how these articles fit within the proposed biopsychosocial and contextual model. Along with the framework proposed in this article, the studies included in this Special Issue advance the current literature and point to critical directions for future research.

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“…Stein et al [9], (this issue), review the evidence for the type of sleep problems present in children and adults with ADHD. They also discuss the effects of medication to treat ADHD on sleep.…”

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confidence: 99%

New Directions for Therapeutics in ADHD

Schweitzer

McBurnett

2012

Neurotherapeutics

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The number of publications on attention deficit hyperactivity disorder (ADHD) has increased sharply over the last 10 years, with more than 700 likely for 2012. Consequently, it is difficult to stay apprised of this literature. This issue of Neurotherapeutics includes 12 comprehensive reviews of topics related to ADHD.ADHD is the most common childhood behavioral disorder and one of the more common adult psychiatric disorders. Traditional therapeutics for ADHD include behavioral therapy and pharmacologic intervention. These approaches have been available for decades; however, therapies have evolved and expanded with better understanding of the disorder. This includes a better understanding of the role of dopamine and norepinephrine and how this new knowledge can guide the development of novel pharmacological agents. Better recognition of subpopulations of the disorder, the presence of co-morbidity (e.g., sleep disturbance and autism spectrum disorders), and need to address the disorder throughout the life span have helped refine the diagnostic process. The search for improved treatments for ADHD continues, as a significant portion of the ADHD population does not respond, or responds sub-optimally, to currently available therapy. Concerns about drug side effects have fostered an interest in identifying new and alternative treatment options.The current issue reviews new approaches that range from preventative interventions that minimize the development of the disorder to the potential for treatment based on electrical brain response. Similarly, the role of environmental impact, such as food and food dyes, on behavior associated with ADHD, is addressed. Also critically reviewed are current conceptualizations of the disorder and potential new targets for treatment. The latter articles include discussion of prevalence of the disorder and subtypes, the role of variability in response times in ADHD, cognitive training approaches for targeting reward-related and cognitive impairments, among others.Willcutt [1] (this issue) report the largest meta-analysis to date on the prevalence of ADHD, along with related analyses of a large population-based sample. Prevalence varied according to diagnostic methodology, but using a bestestimate procedure and strict DSM-IV diagnostic criteria, the overall incidence of ADHD was estimated to be 5.9 %, and similar across countries and regions. Tests of changes proposed for diagnosing ADHD in DSM-V found little effect for relaxing the age of onset criterion or allowing co-morbid psychotic or pervasive developmental disorders. In contrast to the wealth of data on children, much less is known about ADHD in adults. Green and Rabiner [2] (this issue) contribute a qualitative discussion of the small volume of literature available on ADHD in college students. Among the difficulties with diagnosing and treating ADHD in college students his group noted are the high rates of malingering in order to obtain prescription medication, and the frequency of diversion and misuse of medication.Children with ...

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ADHD Treatments, Sleep, and Sleep Problems: Complex Associations

Cited by 126 publications

References 66 publications

Stimulant Medications and Sleep for Youth With ADHD: A Meta-analysis

Stimulant Medications and Sleep for Youth With ADHD: A Meta-analysis

Advancing a Biopsychosocial and Contextual Model of Sleep in Adolescence: A Review and Introduction to the Special Issue

New Directions for Therapeutics in ADHD

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