Parental rating of sleep in children with attention deficit/hyperactivity disorder

Abstract

Objective: Sleep problems have often been associated with attention deficit/hyperactivity disorder (ADHD). Parents of those with ADHD and children with ADHD report sleep difficulties more frequently than healthy children and their parents. The primary objective of this paper is to describe sleep patterns and problems of 5 to 11-year-old children suffering from ADHD as described by parental reports and sleep questionnaires. Method: The study included 321 children aged 5–11 years (average age 8.4 years); 45 were diagnosed with ADHD, 64 had other psychiatric diagnoses, and 212 were healthy. One hundred and ninety-six of the test subjects were boys and 125 were girls. A semi-structured interview (Kiddie-SADS-PL) was used to DSM-IV diagnose ADHD and comorbidity in the clinical group. Sleep difficulties were rated using a structured sleep questionnaire (Children Sleep Behaviour Scale). Results: Children diagnosed with ADHD had a significantly increased occurrence of sleep problems. Difficulties relating to bedtime and unsettled sleep were significantly more frequent in the ADHD group than in the other groups. Children with ADHD showed prolonged sleep onset latency, but no difference was shown regarding numbers of awakenings per night and total sleep time per night. Comorbid oppositional defiant disorder appeared not to have an added effect on problematic behaviour around bedtime. Conclusion: Parents of children with ADHD report that their children do not sleep properly more often than other parents. The ADHD group report problems with bedtime resistance, problems with sleep onset latency, unsettled sleep and nightmares more often than the control groups. It may therefore be relevant for clinicians to initiate a closer examination of those cases reporting sleep difficulties

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

“…(Hvolby et al, 2009;O'Brien et al, 2003a;O'Brien et al, 2003b;Owens et al, 2000), whereas other studies report sleep onset problems to be associated with ODD comorbidity and stimulant medication rather than ADHD itself (Corkum et al, 1999;Mick et al, 2000). Higher bedtime resistance in an ADHD population with ODD may exacerbate sleep complaints.…”

“…With respect to total sleep duration, some authors reported no differences in sleep duration considering clinical samples of children with ADHD and normal controls (Hvolby et al, 2009;Marcotte et al, 1998;Mick et al, 2000), in contrast to other authors who reported both longer (Corkum et al, 2001) and shorter (Owens et al, 2000) sleep duration in ADHD. Several recent studies in larger population samples confirmed that short sleep duration is associated with problems related to attentional control and hyperactivity/impulsivity (Paavonen et al, 2009;Pesonen et al, 2010;Touchette et al, 2009).…”

“…Higher bedtime resistance in an ADHD population with ODD may exacerbate sleep complaints. However, an added effect of comorbid ODD on problematic behavior scores around bedtime was not confirmed by the study of Hvolby et al (2009). As Owens et al (2000) included unmedicated children with ADHD, stimulant medication could not be responsible for sleep onset latency problems reported in their study.…”

“…Several recent studies in larger population samples confirmed that short sleep duration is associated with problems related to attentional control and hyperactivity/impulsivity (Paavonen et al, 2009;Pesonen et al, 2010;Touchette et al, 2009). In terms of sleep efficiency, some studies reported more nighttime awakenings in children with ADHD compared to normal controls (O'Brien et al, 2003a), whereas others found no differences (Hvolby et al, 2009;Mick et al, 2000). Although some authors described more difficulties with morning awakenings (Chiang et al, 2010;Corkum et al, 2001;Owens et al, 2009), others found no support for this (Corkum et al, 1999;Mick et al, 2000;O'Brien et al, 2003a).…”

Safety, Tolerability and Efficacy of Drugs for Treating Behavioural Insomnia in Children with Attention-Deficit/Hyperactivity Disorder: A Systematic Review with Methodological Quality Assessment

“…Using the subjective parameters, most of the studies have reported sleep disturbances such as early and middle insomnia, nocturnal awakening, short sleep time, restless sleep and daytime sleepiness in children with ADHD [14][15][16] . Even though there is poor understanding of the relationship between sleep and ADHD symptoms, from a clinical standpoint, sleep disturbances associated with ADHD are very relevant since they can cause worsening of ADHD symptoms, leading to an increase in disruptive behaviour 17 .…”