ADHD and Sleep-Related Disturbances: A General Introduction

Sleep-related disturbances are common among children diagnosed with Attention-Deficit/Hyperactivity Disorder (ADHD; Mick, Biederman, Jetton, & Faraone, 2000).  Recent estimates suggest that approximately one-third of children diagnosed with ADHD experience moderate to severe sleep problems (Sung, Hiscock, Sciberras, & Efron, 2008).  These problems include difficulties initiating sleep, delayed sleep onset, bedtime resistance, maintaining sleep, restlessness during sleep, and chronic tiredness upon awakening from sleep (Corkum, 2001; Lecendreux & Córtese, 2007; Owens, et al., 2009). The causes of sleep-related disturbances range from environmental (e.g., family, neighborhood, school) to psychological (e.g., depression and anxiety) to biological (e.g., obesity and diabetes).  They also frequently result in co-morbidities such as Restless Leg Syndrome, Sleep Disordered Breathing, and/or Periodic Limb Movement Disorder (Chervin, et al., 2002; Córtese, et al., 2005; Konofal, 2008).

Although there appears to be a fairly clear connection between sleep-related disturbances and ADHD, the reasons for this co-morbidity is largely unknown. Research has shown that even subtle changes in the sleep patterns of children diagnosed with ADHD potentially impacts cognitive and psychological development in children (Kirov et al., 2012). Hence, understanding the nature of the co-morbidity between sleep problems and ADHD and the adoption of interventions based on this understanding may improve these children’s quality of life. For example, when it is possible to create a connection between disordered sleep and the effects of stimulant medication used to treat ADHD, medical professionals, educators, and family members may be able to intervene more quickly and more effectively (Cortese et al., 2012).

Adverse outcomes associated with sleep problems can become pronounced when a child enters school. Students who are chronically deprived of sleep commonly experience problems pertaining to focus and the ability to stay awake in academic settings (Quine, 1992). Such sleep deprivation may also result in behavior problems, lack of motivation to complete schoolwork, and decreased ambition (Todd, et al., 2002; Gozal, & Pope, 2001).  Since individuals diagnosed with ADHD may also exhibit deficits pertaining to executive functioning (e.g., difficulties with attention, planning, and organization), behaviors and reactions due to these issues may become particular impactful for the affected child (Biederman, et al., 2004). Deficits in executive functioning may also result in problems with developing a sleep preparation pattern, which in turn could result in difficulties initiating and maintaining sleep in an age appropriate and adequate manner.

Though problems of sleeping may result in adverse outcomes for children diagnosed with ADHD, when normal sleep patterns are restored, functioning can dramatically improve in all areas of daily life. In order to aid in preventive and intervention efforts, more research is needed that investigates the biopsychosocial causes and effects of sleep-related disturbances in children and adults diagnosed with ADHD. Such research may aid in the reduction of problems pertaining to falling and staying asleep, and could help with impaired academic performance across the lifespan. Integrating knowledge about developmental processes into this discussion may be particularly beneficial in identifying factors that can contribute to sleep related complaints at different cognitive and physical stages. 

About the Author:

Jerrod Brown, MA, MS, MS, MS, is the Treatment Director for Pathways Counseling Center, Inc. Pathways’ focus is to provide programs and services that benefit individuals impacted by mental illness and addictions. Mr. Brown is also the founder and CEO of the American Institute for the Advancement of Forensic Studies (AIAFS).  Email: [email protected]

Contributors:

Pamela Oberoi is currently the manager of the refugee mental health program at Pathways Counseling Center.

Ellie Biglow is a Mental Health Practitioner with Pathways Counseling Center, Inc.

Dana Blair is a volunteer with the American Institute for the Advancement of Forensic Studies (AIAFS).

References

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