The role of the circadian system in the etiology and pathophysiology of ADHD: time to redefine ADHD?
Abstract
Attention-deficit/hyperactivity disorder (ADHD) is highly associated with the delayed sleep phase disorder, a circadian rhythm sleep-wake disorder, which is prevalent in 73-78% of children and adults with ADHD. Besides the delayed sleep phase disorder, various other sleep disorders accompany ADHD, both in children and in adults. ADHD is either the cause or the consequence of sleep disturbances, or they may have a shared etiological and genetic background. In this review, we present an overview of the current knowledge on the relationship between the circadian rhythm, sleep disorders, and ADHD. We also discuss the various pathways explaining the connection between ADHD symptoms and delayed sleep, ranging from genetics, behavioral aspects, daylight exposure, to the functioning of the eye. The treatment options discussed are focused on improvement of sleep quality, quantity, and phase-resetting, by means of improving sleep hygiene, chronotherapy, treatment of specific sleep disorders, and by strengthening certain neuronal networks involved in sleep, e.g., by sensorimotor rhythm neurofeedback. Ultimately, the main question is addressed: whether ADHD needs to be redefined. We propose a novel view on ADHD, where a part of the ADHD symptoms are the result of chronic sleep disorders, with most evidence for the delayed circadian rhythm as the underlying mechanism. This substantial subgroup should receive treatment of the sleep disorder in addition to ADHD symptom treatment.
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ADHD-associated mutations have been reported to include a wide range of different physiological processes including circadian rhythm mechanisms.
“However, ADHD-associated mutations have been reported to include a wide range of different physiological processes including circadian rhythm mechanisms [63].”
From Molecular Characterisation of the Mechanism of Action of Stimulant Drugs Lisdexamfetamine and Methylphenidate on ADHD Neurobiology: A Review (2022) · cites this paper as [63]
Although delayed sleep-phase is not enough to develop ADHD symptoms, treatments for sleep problems have promoted a reduction of ADHD symptoms.
“Although delayed sleep-phase is not enough to developed ADHD symptoms, it has been reported that treatments for sleep problems have promoted a reduction of ADHD symptoms [63].”
From Molecular Characterisation of the Mechanism of Action of Stimulant Drugs Lisdexamfetamine and Methylphenidate on ADHD Neurobiology: A Review (2022) · cites this paper as [63]
The DRD4 gene is strongly involved in translating light into electrical signals in the retina, and there is a strong circadian pattern in its transcription.
“In this sense, the dopaminergic DA receptor 4 (DRD4) gene is strongly involved in translating light into electrical signals in the retina, and there is a strong circadian pattern in its transcription [63].”
From Molecular Characterisation of the Mechanism of Action of Stimulant Drugs Lisdexamfetamine and Methylphenidate on ADHD Neurobiology: A Review (2022) · cites this paper as [63]
ADHD involves a delayed sleep-phase symptom typical of sleep onset insomnia and other behavioural symptoms related to ADHD.
“ADHD also involves a delayed sleep-phase symptom (sleep disturbances) typical of sleep onset insomnia [116] and other behavioural symptoms related to ADHD [63].”
From Molecular Characterisation of the Mechanism of Action of Stimulant Drugs Lisdexamfetamine and Methylphenidate on ADHD Neurobiology: A Review (2022) · cites this paper as [63]
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“ADHD also involves a delayed sleep-phase symptom (sleep disturbances) typical of sleep onset insomnia [116] and other behavioural symptoms related to ADHD [63].”
BackgroundInfluential
- Authors
- Bijlenga, D., Vollebregt, M. A., Kooij, J. J. S., & Arns, M.
- Affiliations
- PsyQ (NL)
- Radboud University Medical Center (NL)
- Utrecht University (NL)
- Corresponding author
- Bijlenga, Denise
- Venue
- ADHD Attention Deficit and Hyperactivity Disorders
- Published
- 2019-03
- Volume
- 11
- Issue
- 1
- Pages
- 5-19
- ISSN
- 1866-6116 (ISSN-L)
- 1866-6647
- OpenAlex
- W2927777372
- Cited by
- 137
- References
- 23
- Citations by year
- 2026: 16 · 2025: 19 · 2024: 16 · 2023: 16 · 2022: 20 · 2021: 26 · 2020: 19 · 2019: 5
- FWCI
- 2.96
- Type
- journal article
- Language
- en
- Open access
- closed
- Licence
- www.springer.com/tdm (tdm)
- Locations
- ADHD Attention Deficit and Hyperactivity Disorders (publishedVersion)
- PubMed (publishedVersion)
- Research Publications (Maastricht University) (publishedVersion)
- Amsterdam UMC (VU Amsterdam) - Institutional Repository (submittedVersion)
- Radboud Repository (Radboud University) (submittedVersion)
- Research Publications (Maastricht University) (submittedVersion)
- Data Archiving and Networked Services (DANS) (submittedVersion)
- Topics
- Health Sciences › Medicine › Psychiatry and Mental health › Attention Deficit Hyperactivity Disorder
- Life Sciences › Neuroscience › Endocrine and Autonomic Systems › Circadian rhythm and melatonin
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Sleep and related disorders
- Keywords
- attention deficit hyperactivity disorder, circadian rhythm, delayed sleep phase syndrome, circadian rhythm disruption, sleep disorders, sleep quality, chronotherapy, phase resetting, sleep hygiene, daylight exposure, eye function
- MeSH terms
- Sleep Hygiene, Attention Deficit Disorder with Hyperactivity, Humans, Sleep Initiation and Maintenance Disorders, Chronotherapy, Sleep Disorders, Circadian Rhythm
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