Dissecting the Role of Sleep Disturbances in Children With ADHD

(Part 1 of 2)

A systematic review recently published in the Journal of Attention Disorders examined the presence and impact of sleep disturbances in children with attention-deficit/hyperactivity disorder (ADHD). Below, lead author Upasana Bondopadhyay, MPhil, and co-author Andrew Coogan, PhD, from the University of Ireland, Maynooth, explain how the study was designed, their most significant findings, and a surprising gap in existing research that they found.

In Part 2 of this Q&A, the authors will discuss how clinicians can use the findings to improve care of children with ADHD and a related upcoming project.

Q: What led you and your colleagues to review sleep changes and circadian rhythms in children with ADHD?

A: As previous literature has consistently demonstrated the presence of sleep problems in children diagnosed with ADHD, we wanted to present a comprehensive picture of how sleep difficulties have been studied, what the consequences are of these difficulties, and what role ADHD interventions have on the sleep of the child.

Q: Please briefly describe your study method and your most significant finding(s).

A: We conducted a systematic review of 148 studies (published between 2009 and 2019) assessing sleep and circadian (body clock) functions in children aged 5-13 years who had been diagnosed with ADHD. We designed the discussion of these studies based on 5 broad areas including studies exploring parental perceptions of sleep problems in ADHD, sleep characteristics in children with ADHD, the daytime consequences of sleep problems, and the effects of pharmacological and nonpharmacological treatments for ADHD on sleep. Our review not only reiterated a thorough picture of the presence and effect of sleep difficulties in all spheres of the child’s life, but also revealed a definite manifesto for future research in this area—carefully arrived at based on limitations in the present literature.

Q: Were any of the outcomes surprising or different than you expected?

A: We were not necessarily surprised with the findings, as the presence of sleep problems in individuals diagnosed with ADHD has been demonstrated previously by a sizable literature. Further, we have previously showed significant sleep and circadian rhythm changes to be associated with ADHD in adults.

What we found however was a surprising gap in the style of research which generally has been conducted in this area. Many of the studies we reviewed were small and poorly statistically powered, with a majority employing cross-sectional/case-control design and relying on subjective reports. Further, there was a male participant dominance in studies which have continued to explore sleep parameters among children diagnosed with various subtypes of ADHD, building up a repertoire of articles showing inconsistent findings with regard to specific sleep areas.

Our review revealed both the importance of studying developmental trajectories of sleep problems in children with ADHD and how sleep problems may impact on development in other areas, and how their growing environments (such as their family, socio-economic, cultural factors) might be inevitably influencing the evolution of these problems and in turn affecting the core clinical features of ADHD.

Reference
Bondopadhyay U, Diaz-Orueta U, Coogan AN. A systematic review of sleep and circadian rhythms in children with attention deficit hyperactivity disorder. Journal of Attention Disorders. 2021 January 5;[Epub ahead of print].

Upasana Bondopadhyay, MPhil, is a clinical psychologist by training registered with the Health and Care Professions Council, United Kingdom, and the Rehabilitation Council of India. She is currently pursuing her PhD in psychology from the National University of Ireland, Maynooth. Her research interests include childhood neurodevelopmental disorders, child and adolescent psychotherapeutic interventions, and psychodiagnostic testing. She completed her bachelor’s degree in psychology at the University of Delhi, New Delhi, India, and MPhil in clinical psychology at Amity University, Noida, India.

Andrew Coogan, PhD, is a Professor and former Head of the Department of Psychology at the National University of Ireland, Maynooth. He works in the area of sleep and circadian research from a multidisciplinary and translational perspective. His background is in behavioral neuroscience, and he has been researching circadian rhythms for more than 20 years, examining both fundamental and applied aspects. He has conducted work previously on sleep and circadian rhythms in adults with ADHD, and is currently excited to be moving into examining similar questions in children and their parents.