(Part 2 of 2)
Successfully managing sleep problems in children with attention-deficit/hyperactivity disorder (ADHD) may help improve behavioral and cognitive outcomes, according to authors of a systematic review recently published in the Journal of Attention Disorders.
In part 2 of this Q&A series, study lead author Upasana Bondopadhyay, MPhil, and co-author Andrew Coogan, PhD, from the University of Ireland, Maynooth, discuss the clinical relevance of their findings, gaps in research that they found, and a related upcoming project. See Part 1 of the Q&A to learn about how the study was designed and their most significant findings.
Q: How can clinicians use your findings to improve care of children with ADHD?
A: Our review presents a couple of important perspectives for clinicians working with children with ADHD. Firstly is an appreciation that sleep problems in ADHD are common and warrant careful assessment and management. There is a tendency sometimes to view sleep problems as ancillary to classical core symptoms; rather, we suggest that sleep problems should be viewed as core in ADHD, with the view that successful clinical management of these may result in benefits for cognitive and behavioral domains. A number of studies in our review demonstrated effective functional outcomes of behavioral sleep interventions, such as sleep training and sleep hygiene interventions, which could form an important addition to psychotherapeutic treatment/management of childhood ADHD.
Secondly, clinicians should be aware of the potential for stimulant medications for ADHD to adversely impact sleep. Consideration might be given to the formulation of the drugs used (eg, extended-release vs immediate-release methylphenidate) and the timing of the dosing. It is again worthwhile to note that most of the studies have explored sleep as a secondary outcome of medication efficacy studies, and we would suggest that future trials more explicitly examine sleep as a primary outcome.
Q: What gaps do you see in the current research on this topic?
A: We found that a majority of the studies have assessed sleep in children diagnosed with ADHD through subjective measures such as parental/caregiver reports, as compared with objective measures such as actigraphy and polysomnography, and few studies assessed sleep through combined subjective and objective tools. Furthermore, we pointed to the abundance of cross-sectional exploration of sleep in children with ADHD rather than long-term assessment of sleep difficulties in these children through longitudinal studies. We underline a strong need for well-powered, multisite, longitudinal studies employing a range of objective—in addition to caregiver/child-reported—sleep functions.
There is a sizable literature consistently examining the effect of sleep difficulties on different behavioral and neuropsychological functions in children with ADHD, although there is a lack of high-quality randomized control trials examining the effects of sleep-focused interventions on neurobehavioral outcomes in children with ADHD. There is also a gender imbalance in the literature, with a focus on boys. There may be important sex-dependent differences in sleep parameters for children with ADHD, as there are in adults with sleep disorders. We proposed that future work explicitly addresses gender differences.
Q: Are you doing any follow-up research related to this study?
A: In an upcoming project, we will explore parental reports of sleep among children diagnosed with ADHD employing a mixed methodology approach to go beyond the more limited nature of insight that can be derived from questionnaire-based studies. We want to really understand how big a problem sleep is perceived as by the parents of children with ADHD, and the overall quality-of-life impacts sleep problems may have on the household.
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.