The Link Between ADHD, Poor Sleep, Attentiveness, and Impulsivity

Does attention deficit hyperactivity disorder (ADD/ADHD) affect your child’s sleeping behavior? And in turn, does poor sleep affect attentiveness and impulsivity? New research points to a connection between sleep problems and ADD/ADHD.

Thursday March 4th - 11:00am

ADHD children often struggle to fall asleep and stay asleep.

Many parents with attention deficit hyperactivity disorder (ADHD) kids are familiar with the problems associated with bedtime: children may start whining and crying before turning in for the night, have difficulty falling asleep, and frequently wake up in fits and starts. Well, according to a recent article published in the September 2009 issue of the Journal of the American Academy of Child and Adolescent Psychiatry, there is a possible link between ADD/ADHD and sleep disorders. Researchers found that children with the condition demonstrate significantly more difficulty sleeping at night than their undiangnosed peers.

In the past, psychiatrists have overlooked sleep disturbances caused by ADD/ADHD because previous studies on the subject provided mixed evidence. The recent finding that children with ADD/ADHD do have more sleep disturbances, however, “lays the groundwork for [future] studies aimed at elucidating if the treatment of sleep disturbances may improve daytime ADHD symptoms,” said Samuele Cortese, M.D., Ph.D., child psychiatrist at the Child and Adolescent Psychiatry Unit in University Hospital Clocheville in Tours, France, and one of the authors of the study.

Researches found that children with ADD/ADHD showed more bedtime resistance, such as refusing to get ready for or remain in bed, difficulty with falling asleep, and restless sleep -- often awakening frequently in the middle of the night compared with children without ADD/ADHD. They also had more symptoms of sleep-disordered breathing -- snoring, pauses in breathing, and sleep apnea -- as well as more difficulties waking up in the morning, and increased daytime sleepiness.

Children with ADD/ADHD were also more likely to take longer to transition from full wakefulness to sleep, as well as experience more shallow breathing and a lower respiratory rate while sleeping.

Researchers used a meta-analysis, or a statistical abstract of many individual studies, comparing sleep in children with ADD/ADHD to children without. Sixteen subjective (based on questionnaires) and objective (using polysomnography or actigraphy) studies were used for this meta-analysis with a total of 722 children with ADD/ADHD and 638 children without.

The authors of the study excluded data from studies that included children with comorbid disorders or were taking stimulant medications. This suggests that children with ADD/ADHD already had sleeping problems before the introduction of other possible causes.

Researchers cautioned that a limited number of studies were included in the meta-analysis and that more studies need to be conducted before any further conclusions can be made about the relationship between ADD/ADHD and sleep disorders. “There are several studies showing that improvements in sleep may lead to improvement of attention and impulsivity, but large and methodologically sound studies assessing this issue in children diagnosed with ADHD are still limited,” Cortese said.

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