Sleep and Neurobehavioral Functioning in Boys with Attention-Deficit/ Hyperactivity Disorder and No Reported Breathing Problems
Abstract
STUDY OBJECTIVE: To investigate by objective measures the neurobehavioral correlates of sleep patterns in boys with attention-deficit/hyperactivity disorder (ADHD) and no reported breathing problems and in control children. DESIGN: Sleep assessment was conducted for 5 consecutive days and neurobehavioral assessment was conducted in the morning of the third day of measurement in children with ADHD and no breathing problems and control children. SETTING: The neurobehavioral assessment was conducted in the school; sleep was assessed in the home. PARTICIPANTS: 25 controls and 24 boys diagnosed with ADHD between 7 and 11 years of age. MEASUREMENTS: Sleep was monitored using actigraphy for 5 consecutive nights. A computerized neurobehavioral evaluation system was used to assess children's neurobehavioral functioning. RESULTS: Canonical correlation analyses revealed different patterns of associations between sleep and neurobehavioral functioning for the 2 groups. Significant relationships were found between measures of sleep and performance on complicated neurobehavioral tasks in the control group but not in the ADHD group. In addition, children with ADHD had increased instability of sleep parameters compared to the controls. CONCLUSIONS: The findings highlighted the distinct nature of associations between sleep and neurobehavioral functioning in boys with ADHD children and no reported breathing problems compared to controls. Despite the similarity between symptoms caused by sleep fragmentation and symptoms of ADHD, these appear to be different clinical conditions. The source of inattentiveness in children should be identified for best planning of clinical intervention.
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A similar picture of volatility and unpredictability is observed in sleep patterns in children with ADHD.
“and a similar picture of volatility and unpredictability is observed in sleep patterns in children with ADHD (Gruber and Sadeh 2004; Gruber et al. 2000; Lecendreux and Cortese 2007; Tsai and Huang 2010).”
From Associations of sleep disturbance with ADHD: implications for treatment (2015) · cites this paper as Gruber and Sadeh 2004
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Sleep in Children With Attention-Deficit/Hyperactivity Disorder
Cortese, S., Faraone, S. V., Konofal, É., & Lecendreux, M. (2009) · Journal of the American Academy of Child & Adolescent Psychiatry · doi:10.1097/chi.0b013e3181ae09c9 · Cited by 47 · see citing works
The impact of lockdown on sleep patterns of children and adolescents with ADHD
Bruni, O., Giallonardo, M. T., Sacco, R., Ferri, R., & Melegari, M. G. (2021) · Journal of Clinical Sleep Medicine · doi:10.5664/jcsm.9296 · Cited by 42 · see citing works
Sleep and COMT Polymorphism in ADHD Children: Preliminary Actigraphic Data
Gruber, R., Grizenko, N., Schwartz, G. J., Amor, L. B., Gauthier, J., de Guzman, R., & Joober, R. (2006) · Journal of the American Academy of Child & Adolescent Psychiatry · doi:10.1097/01.chi.0000220848.48650.10 · Cited by 42 · see citing works
Self-citationSeneff, S., Swanson, N., & Li, C. (2015) · Agricultural Sciences · doi:10.4236/as.2015.61005 · Cited by 41 · see citing works
“Sleep disorders are associated with a large number of neurological diseases and conditions, including autism [1], attention deficit hyperactivity disorder (ADHD) [2]-[4], depression [5], Parkinson’s disease [6]-[8], schizophrenia [9]-[11], anxiety disorder [12], amyotrophic lateral sclerosis (ALS) [13], and Alzheimer’…”
BackgroundExcessive Daytime Sleepiness in Patients With ADHD—Diagnostic and Management Strategies
Bioulac, S., Micoulaud-Franchi, J., & Philip, P. (2015) · Current Psychiatry Reports · doi:10.1007/s11920-015-0608-7 · Cited by 36 · see citing works
Association between sleep and working memory in children with ADHD: a cross-sectional study
Sciberras, E., DePetro, A., Mensah, F. K., & Hiscock, H. (2015) · Sleep Medicine · doi:10.1016/j.sleep.2015.06.006 · Cited by 38 · see citing works
“Gruber and Sadeh found no relationship between sleep measured using actigraphy and neurobehavioural functioning (including working memory) in children with ADHD (n = 24) [15].”
BackgroundAttention-deficit/Hyperactivity Disorder and Sleep Disorders in Children
Tsai, M.-H., & Huang, Y. (2010) · Medical Clinics of North America · doi:10.1016/j.mcna.2010.03.008 · Cited by 38 · see citing works
Poor Sleep Has Negative Implications for Children With and Without ADHD, but in Different Ways
Knight, F. L. C., & Dimitriou, D. (2017) · Behavioral Sleep Medicine · doi:10.1080/15402002.2017.1395335 · Cited by 38 · see citing works
“As such, deficits in this system may underlie difficulties in attentional, behavioral, and movement regulation, as well as sleep–wake regulation (Gruber & Sadeh, 2004).”
BackgroundSleep Disorders and ADHD: Shared and Common Phenotypes
Lewin, D. S., & Pinto, M. D. (2004) · SLEEP · doi:10.1093/sleep/27.2.188 · Cited by 36 · see citing works
Actigraphic Sleep Pattern of Preschoolers With ADHD
Melegari, M. G., Vittori, E., Mallia, L., Devoto, A., Lucidi, F., Ferri, R., & Bruni, O. (2016) · Journal of Attention Disorders · doi:10.1177/1087054716672336 · Cited by 34 · see citing works
“Similar to previous studies, intra-individual variability was estimated for each of the above parameters by calculating the within-subjects standard deviation of each variable (Gruber et al., 2000, Gruber & Sadeh, 2004; Moreau et al., 2014).”
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“The vast majority of studies conducted to date on the sleep functioning of children with ADHD have used samples of which all [7–9] or themajority [10–14] of childrenwere diagnosedwith ADHD combined type (ADHD-C).”
BackgroundTininenko, J. R., Fisher, P. A., Bruce, J., & Pears, K. C. (2010) · Journal of Developmental & Behavioral Pediatrics · doi:10.1097/dbp.0b013e3181f1773b · Cited by 32 · see citing works
Liang, X., Qiu, H. J., & Li, S. X. (2023) · Psychiatry Research · doi:10.1016/j.psychres.2023.115447 · Cited by 33 · see citing works
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Goodlin‐Jones, B. L., Waters, S. F., & Anders, T. F. (2009) · Child Psychiatry & Human Development · doi:10.1007/s10578-009-0124-2 · Cited by 29 · see citing works
“The extant literature suggests that disturbances in sleep, either difficulty in initiating or in maintaining sleep, when reported by parents, are present in approximately 20–25% of typically developing children [10] and approximately 50% of children with neurodevelopmental disorders, including children with ADHD [17,…”
BackgroundAdolescents’ sleep and adjustment: Reciprocal effects
Kelly, R. J., Zeringue, M. M., & El‐Sheikh, M. (2021) · Child Development · doi:10.1111/cdev.13703 · Cited by 29 · see citing works
O’Sullivan, R., Bissell, S., Hamilton, A., Bagshaw, A. P., & Richards, C. (2023) · Sleep Medicine Reviews · doi:10.1016/j.smrv.2023.101814 · Cited by 26 · see citing works
Barclay, N. L., & Gregory, A. M. (2013) · Current topics in behavioral neurosciences · doi:10.1007/7854_2013_239 · Cited by 22 · see citing works
van Kooten, J. A. M. C., Jacobse, S. T. W., Heymans, M. W., de Vries, R., Kaspers, G. J. L., & van Litsenburg, R. R. L. (2020) · SLEEP · doi:10.1093/sleep/zsaa231 · Cited by 21 · see citing works
Um, Y. H., Jeong, J., Hong, S., Kim, T., Lim, H. K., Seo, H., & Han, J. (2015) · Sleep Medicine · doi:10.1016/j.sleep.2015.11.016 · Cited by 21 · see citing works
Sleep Duration Is Associated with Academic Achievement of Adolescent Girls in Mathematics
Lin, L., Somerville, G., Boursier, J., Santisteban, J. A., & Gruber, R. (2020) · Nature and Science of Sleep · doi:10.2147/nss.s237267 · Cited by 23 · see citing works
Self-citationNo objectively measured sleep disturbances in children with attention‐deficit/hyperactivity disorder
Bergwerff, C. E., Luman, M., & Oosterlaan, J. (2016) · Journal of Sleep Research · doi:10.1111/jsr.12399 · Cited by 20 · see citing works
The Triple Threat of Sleep, Adolescence, and ADHD
Becker, S. P. (2019) · Elsevier eBooks · doi:10.1016/b978-0-12-814180-9.00011-9 · Cited by 18 · see citing works
Solleveld, M. M., Schrantee, A., Baek, H. K., Bottelier, M. A., Tamminga, H. G. H., Bouziane, C., Stoffelsen, R., Lucassen, P. J., Someren, E. J. W. V., Rijsman, R. M., et al. (2020) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2020.00082 · Cited by 18 · see citing works
Davidson, F., Rusak, B., Chambers, C. T., & Corkum, P. V. (2018) · Canadian Journal of School Psychology · doi:10.1177/0829573518770593 · Cited by 17 · see citing works
Relations Between Sleep and Temperament in Preschool Children With ADHD
Melegari, M. G., Sette, S., Vittori, E., Mallia, L., Devoto, A., Lucidi, F., Ferri, R., & Bruni, O. (2018) · Journal of Attention Disorders · doi:10.1177/1087054718757645 · Cited by 15 · see citing works
“In agreement with previous studies, intraindividual variability was calculated for each of the above parameters by calculating the within-subjects standard deviation of each variable (Gruber & Sadeh, 2004; Gruber, Sadeh, & Raviv, 2000; Moreau, Rouleau, & Morin, 2014).”
MethodKoa, T. B., Gooley, J. J., Chee, M. W. L., & Lo, J. C.-Y. (2024) · SLEEP · doi:10.1093/sleep/zsae010 · Cited by 13 · see citing works
Sleep patterns of 7‐week‐old infants at familial risk for attention deficit hyperactivity disorder
Landau, R., Sadeh, A., Vassoly, P., Berger, A., Atzaba‐Poria, N., & Auerbach, J. G. (2010) · Infant Mental Health Journal · doi:10.1002/imhj.20275 · Cited by 14 · see citing works
Self-citationA Multimethod, Case-Controlled Study of Sleep–Wake Disturbances in Adolescents With Spina Bifida
Murray, C. B., Palermo, T. M., & Holmbeck, G. N. (2017) · Journal of Pediatric Psychology · doi:10.1093/jpepsy/jsx150 · Cited by 12 · see citing works
Neurobehavioural functions during variable and stable short sleep schedules
Koa, T. B., & Lo, J. C.-Y. (2020) · Journal of Sleep Research · doi:10.1111/jsr.13252 · Cited by 10 · see citing works
“Specifically, increased variability in sleep duration is associated with poorer sustained attention (Gruber & Sadeh, 2004), less positive affect (Taub, 1978), greater negative mood (Bei et al., 2016; Taub, 1978), as well as more depressive (Dillon et al., 2015; Lemola et al., 2013; McHale et al.,…”
BackgroundTrastorno por déficit de atención con hiperactividad y alteraciones del sueño
Domínguez-Ortega, L., & de Vicente-Colomina, A. (2006) · Medicina Clínica · doi:10.1157/13086847 · Cited by 12 · see citing works
Archbold, K. H. (2006) · Journal of the American Psychiatric Nurses Association · doi:10.1177/1078390306295087 · Cited by 10 · see citing works
“In children, these sleep perturbations have been linked to decreased academic performance, hyperkinesis, and impaired cognition (Fallone, Acebo, Seifer, & Carskadon, 2005; Gruber & Sadeh, 2004; Huang et al., 2004; Lecendreux et al., 2000; Sadeh, Raviv, & Gruber, 2000).”
BackgroundServot, S., St-Amand, A., Rousseau, M., Simard, V., & Touchette, É. (2021) · Child Abuse & Neglect · doi:10.1016/j.chiabu.2021.105364 · Cited by 9 · see citing works
Reale, L., Guarnera, M., & Mazzone, L. (2013) · School Psychology International · doi:10.1177/0143034313485850 · Cited by 9 · see citing works
“Attention problems related to difficulties in concentration during the day are symptoms that may be diagnostic of Attention Deficit/Hyperactivity Disorder, which in turn is often associated with poor school performance (Gruber & Sadeh, 2004).”
BackgroundQu, X., Kalb, L. G., Holingue, C., Rojo‐Wissar, D. M., Pritchard, A. E., Spira, A. P., Volk, H. E., & Jacobson, L. A. (2023) · Journal of Attention Disorders · doi:10.1177/10870547231204010 · Cited by 7 · see citing works
“…of sleep disturbances (including parent-reported sleep problems and actigraphy-assessed sleep duration) with neuro-cognitive outcomes, including working memory, motor function, intelligence, and executive function, among young children with ADHD (Gruber & Sadeh, 2004; Schneider et al., 2016).”
BackgroundSleep and Quality of Life in ADHD
Bekker, E. M., Kooij, J. J. S., & Buitelaar, J. K. (2008) · Humana Press eBooks · doi:10.1007/978-1-60327-343-5_28 · Cited by 7 · see citing works
Benoit, T. A. S. A. (2015) · Journal of Sleep Disorders Treatment & Care · doi:10.4172/2325-9639.1000149 · Cited by 6 · see citing works
“, percent of rapid eye movement [REM]/non-rapid eye movement [NREM] sleep) [6,8-12]; however, others have found that when compared to control children, those with ADHD show increased movement during sleep [10,1317], decreased sleep onset latency (SOL) [14,18], decreased slow wave sleep (SWS) [17], decreased REM [17,19…”
BackgroundLi, X., Shea, K. S. C., Chiu, W. V., Lau, F. L. F., Wong, C. K. D., Yu, W. M. M., Li, A. M., Wing, Y. K., Lai, Y. C. K., & Li, S. X. (2022) · Journal of Clinical Sleep Medicine · doi:10.5664/jcsm.10060 · Cited by 6 · see citing works
“For example, previous studies either recruited only boys with ADHD 43 or children with ADHD and comorbid psychiatric disorders.”
ADHD Symptoms and Sleep Problems During Middle Childhood: The Indirect Effect of Peer Victimization
Pagán, A. F., Ricker, B. T., Cooley, J. L., Cummings, C., & Sanchez, C. R. (2024) · Child Psychiatry & Human Development · doi:10.1007/s10578-024-01666-6 · Cited by 6 · see citing works
“Moreover, actigraph studies find that children diagnosed with ADHD experience significant variability of sleep quality at night [15] and a longer sleep-onset latency [16].”
Dan, O., Haimov, I., Asraf, K., Nachum, K., & Cohen, A. (2018) · Journal of Attention Disorders · doi:10.1177/1087054718785473 · Cited by 5 · see citing works
Cardiac Autonomic Modulation and Sleep-Disordered Breathing in Children
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Assessing Sleep Problems in ADHD
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Commentary on Hyper-activity in Children Having Behavior Disorders (Childers, 1935)
Barkley, R. A. (2009) · Journal of Attention Disorders · doi:10.1177/1087054709338857 · Cited by 2 · see citing works
“…was Childers’ recognition that sleep problems were quite common in the clinical histories of these children, just as they are found today in up to 63% or more of children diagnosed with ADHD (Ball & Koloian, 1995; Corkum, Moldofsky, Hogg-Johnson, Humphries, & Tannock, 1999; Gruber & Sadeh, 2004).”
BackgroundSleep Problems and ADHD – An Overview∗
Barkley, R. A. (2014) · The ADHD Report · doi:10.1521/adhd.2014.22.3.6 · Cited by 1 · see citing works
Sleep Problems in Children with Anxiety and Attention Deficit Hyperactivity Disorders
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Indiplon: a single compound in two formulations for the treatment of insomnia
Zammit, G. K. (2006) · Future Neurology · doi:10.2217/14796708.1.3.259
HyPeRKiNeticKá PoRUcHA / ADHD, HyPeRKiNeticKý SyNDRó M A PoRUcHy SPá NKU v DetStve
Adamík, P., Ondrejka, I., & Tonhajzerová, I. (2010)
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28 and Quality of Life in ADHD
Bekker, E. M., Kooij, J. J. S., & Buitelaar, J. K. (2008)
- Authors
- Gruber, R., & Sadeh, A.
- Affiliations
- Tel Aviv University (IL)
- Corresponding author
- Gruber, Reut
- Venue
- Sleep
- Publisher
- Oxford University Press (OUP)
- Published
- 2004-03
- Volume
- 27
- Issue
- 2
- Pages
- 267-273
- ISSN
- 0161-8105 (ISSN-L)
- 1550-9109
- OpenAlex
- W239088791
- Cited by
- 106
- References
- 42
- Citations by year
- 2026: 3 · 2024: 2 · 2023: 3 · 2022: 1 · 2021: 3 · 2020: 4 · 2019: 3 · 2018: 4 · 2017: 4 · 2016: 5 · 2015: 10 · 2014: 5 · 2013: 6 · 2012: 1
- FWCI
- 9.01
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- SLEEP (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Sleep and related disorders
- Health Sciences › Medicine › Psychiatry and Mental health › Attention Deficit Hyperactivity Disorder
- Health Sciences › Medicine › Physiology › Obstructive Sleep Apnea Research
- Keywords
- attention deficit hyperactivity disorder, sleep patterns, neurobehavioral function, sleep fragmentation, sleep instability, actigraphy, children, inattention, sleep-disordered breathing
- MeSH terms
- Attention Deficit Disorder with Hyperactivity, Child, Cognition Disorders, Humans, Male, Neuropsychological Tests, Surveys and Questionnaires, Reaction Time, Respiration, Severity of Illness Index, Prevalence
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