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Abstract
Although sleep problems are common in children with ADHD, their extent, preceding risk factors, and the association between neurocognitive performance and neurobiological processes in sleep and ADHD, are still largely unknown. We examined sleep variables in school-aged children with ADHD, addressing their intra-individual variability (IIV) and considering potential precursor symptoms as well as the chronotype. Additionally, in a subgroup of our sample, we investigated associations with neurobehavioral functioning (n = 44). A total of 57 children (6–12 years) with (n = 24) and without ADHD (n = 33) were recruited in one center of the large ESCAlife study to wear actigraphs for two weeks. Actigraphy-derived dependent variables, including IIV, were analyzed using linear mixed models in order to find differences between the groups. A stepwise regression model was used to investigate neuropsychological function. Overall, children with ADHD showed longer sleep onset latency (SOL), higher IIV in SOL, more movements during sleep, lower sleep efficiency, and a slightly larger sleep deficit on school days compared with free days. No group differences were observed for chronotype or sleep onset time. Sleep problems in infancy predicted later SOL and the total number of movements during sleep in children with and without ADHD. No additional effect of sleep problems, beyond ADHD symptom severity, on neuropsychological functioning was found. This study highlights the importance of screening children with ADHD for current and early childhood sleep disturbances in order to prevent long-term sleep problems and offer individualized treatments. Future studies with larger sample sizes should examine possible biological markers to improve our understanding of the underlying mechanisms.
Highlights
ADHD is a neurodevelopmental disorder characterized by age-inappropriate hyperactivity, inattention, and impulsivity, with a high prevalence of about 5% in childhood and adolescence [1]
Correlational analyses revealed no significant association with ADHD symptom severity or any of the sleep variables when controlled for age (p > 0.05)
The results show that, in our sample, children with ADHD experienced more sleep problems than typically developing controls on school days and on free days, but no significant differences were found in chronotype or sleep onset time
Summary
ADHD is a neurodevelopmental disorder characterized by age-inappropriate hyperactivity, inattention, and impulsivity, with a high prevalence of about 5% in childhood and adolescence [1]. The Diagnostic and Statistical Manual of Mental Disorders 5th edition (DSM-5) [2] distinguishes between the inattentive presentation, the hyperactive/impulsive, and the combined presentation. Estimates assume that up to 50–70% of children, adolescents, and adults with ADHD are affected by sleep disturbances [3–6], which range from sleep onset insomnia through sleep-disordered breathing, and restless legs syndrome to sleep epilepsy [7,8]. The most reliable measure of circadian timing is the onset of melatonin secretion in dim light conditions (dim light melatonin onset (DLMO) [12,13]), resulting in the so-called ‘chronotype’ [14]. Children are earlier chronotypes, become later with the start of the puberty, and are ‘latest’ at around the age of 20. Questionnaires like the Munich ChronoType Questionnaire (MCTQ [14]) have proven to be a good correlate of DLMO, with the advantage of being easy to administer [16]
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