Altered circadian profiles in attention-deficit/hyperactivity disorder: An integrative review and theoretical framework for future studies

Abstract

and (iv) rhythmicity in neuroendocrine and neurophysiological responsiveness. On this basis, we propose a neurobiological framework to guide future study, which sees circadian effects in ADHD, along with other aspects of ADHD arousal-related deficits (e.g., cognitive energetic deficits), as being the result of dysregulated locus coeruleus function. Based on this perspective specific recommendations for future research are presented.

Stability of Sleep Disorders From Preschool to First Grade and Their Bidirectional Relationship with Psychiatric Symptoms

“…ADHD might be related to insomnia through a shared origin of arousal dysfunction. 41 Symptoms of ADHD and ODD, which are categorized as disruptive disorders, might also increase the risk for insomnia through coercive circles of bedtime resistance; problematic behavior at bedtime might trigger more inconsistent parental bedtime rules, and such inconsistency may cause persisting bedtime resistance in the child through intermittent reinforcement, thus contributing to an increased risk for insomnia. This pattern of parent-child interactions might also be evident regarding night awakenings.…”

Variations in the sleep–wake cycle from childhood to adulthood: chronobiological perspectives

“…167,168 Increased daytime sleepiness is also found in ADHD and major depression. 160,169,170 There is a period of increased onset of many of these mental illnesses during adolescence, 171,172 which coincides with the period of increased change in sleep-wake patterns outlined above. An increased incidence of depressive symptoms is also found in children and adults with sleep disordered breathing [173][174][175] which may reflect, among other possible pathophysiological mechanisms, an influence of disruption in the sleep-wake cycle on the development of mental illness.…”

“…[150][151][152][153] Similarly, a delay in timing of the sleep-wake cycle (including delayed sleep onset and offset) has been associated with anxiety disorders, depression, bipolar disorder, seasonal affective disorder, and psychotic disorders. [154][155][156][157][158] Various disturbances in sleep are found in mental disorders: increased sleep latency, awakenings, limb movement disorders, and sleep disordered breathing in ADHD; 159,160 increased sleep latency, awakenings, nightmares, and night time panic attacks in anxiety disorders; [161][162][163] increased sleep latency and awakenings in affective disorders; 162,164,165 irregular and fragmented sleep in psychotic disorders; 166 and increased sleep latency, awakenings, and sleep disordered breathing in alcoholism. 167,168 Increased daytime sleepiness is also found in ADHD and major depression.…”

“…There is also evidence of increased variability and reduced stability of sleep-wake cycles in those at high risk for bipolar disorder, 176 as well as longitudinal evidence that irregularity of sleep-wake patterns in childhood is associated with increased behavioral difficulties, 185 and incidence of depressive and anxious disorders in adolescence and adulthood. 186 Symptoms themselves show time of day variations, including hyperactivity and inattention in ADHD, 160 as well as mood in both healthy and mood disordered patients. [187][188][189] Disruption of endogenous biological rhythms likely contributes to behavioral abnormalities in sleep and activity patterns, and may also play a role in the development of mental illnesses.…”

“…[204][205][206] In ADHD, there is some evidence for a delay of melatonin rhythms in children and adults with comorbid insomnia, and abnormal patterns of cortisol secretion have been reported in children. 160 However, results are mixed on the direction of deviations and roles of comorbid factors, and a specific role of endogenous rhythm disruptions in ADHD remains to be established. 160 Circadian gene polymorphisms and circadian gene expression have been implicated in the development of anxiety disorders, affective disorders, psychotic disorders, ADHD, and alcoholism, [207][208][209][210][211][212][213][214][215][216] …”