Sleep and Alertness in Children with ADHD
Abstract
Objective: To evaluate sleep and alertness and to investigate the presence of possible underlying sleep/wake disorders in children with attention‐deficit/hyperactivity disorder (ADHD). Method: After 3 nights of adaptation in a room reserved for sleep studies in the department of child psychiatry, children underwent polysomnography (PSG) followed by the Multiple Sleep Latency Test (MSLT) and reaction time tests (RT) during the daytime. Thirty boys diagnosed as having ADHD (DSM‐IV), aged between 5 and 10 years, and 22 ageand sex‐matched controls participated in the study. All children were medication‐free and showed no clinical signs of sleep and alertness problems. Results: No significant differences in sleep variables were found between boys with ADHD and controls. The mean latency period was shorter in children with ADHD. Significant differences were found for MSLT 1, 2 and 3 ( p < .05). Mean reaction time was longer in children with ADHD, with significant differences in all tests ( p < .05). Number and duration of sleep onsets measured by the MSLT correlated significantly with the hyperactivity‐impulsivity and inattentive‐passivity ndices of the CTRS and CPRS. Conclusion: Children with ADHD were more sleepy during the day, as shown by the MSLT, and they had longer reaction times. These differences are not due to alteration in the quality of nocturnal sleep. The number of daytime sleep onsets and the rapidity of sleep‐onsets measured as MSLT were found to be pertinent physiological indices to discriminate between ADHD subtypes. These results suggest that children with ADHD have a deficit in alertness. Whether this deficit is primary or not requires further studies.
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An additional dose of a short-acting stimulant, or the use of a formulation with an increased duration of action, may prevent sleep disturbances resulting from worsening of hyperactivity or behavioral difficulties at bedtime.
“an additional dose of a short-acting stimulant, or the use of a formulation with an increased duration of action, may prevent sleep disturbances resulting from worsening of hyperactivity or behavioral difficulties at bedtime (Cortese et al. 2013a, b; Lecendreux et al. 2000).”
From Associations of sleep disturbance with ADHD: implications for treatment (2015) · cites this paper as Lecendreux et al. 2000
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“Third, there are now several studies that have also examined the issue of arousal level and daytime sleepiness in children with ADHD in an attempt to further delineate the relationships among attention, activity, and arousal.(60,61) Somewhat counterintuitively, the results of these studies consistently suggest that ch…”
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Hvolby, A. (2015) · ADHD Attention Deficit and Hyperactivity Disorders · doi:10.1007/s12402-014-0151-0 · Cited by 339 · see citing works
“nificantly shorter in patients with ADHD than in controls, based on two included studies (Golan et al. 2004; Lecendreux et al. 2000).”
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“, 2004) or to objective polysomnograph measures of sleep problems (Lecendreux et al., 2000).”
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“Hyperactive children tend to be sleepier than other children (Chervin et al., 2002a; Lecendreux et al., 2000), and some electrophysiological evidence suggests that aggressive individuals have decreased arousal levels at rest (Houston and Stanford, 2001).”
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“, 2001) and alertness (Lecendreux et al., 2000) in ADHD children, resulting in increased omission error rates and reaction times.”
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“…(e.g., obstructive sleep apnea), are objectively “sleepier” (i.e., they are more likely to fall asleep, to fall asleep very quickly and on a greater percentage of naps on the MSLT) compared with typically developing controls (Golan et al., 2004; Lecendreux et al., 2000; Prihodova et al., 2010).”
BackgroundInfluentialSubjective symptoms in idiopathic hypersomnia: beyond excessive sleepiness
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“while decreased attention could be the consequence of the hypoarousal (Lecendreux et al., 2000).”
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“In a recent meta-analysis (Cortese et al. 2009), we concluded that preliminary evidence from two studies (Lecendreux et al. 2000; Golan et al. 2004) performed by means of the Multiple Sleep Latency Test indicates that children with ADHD have signifi cantly lower mean times to fall asleep during the…”
MethodSelf-citationSleep disturbances in adolescents with ADHD: A systematic review and framework for future research
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“Children and adolescents with ADHD have been reported with significantly more daytime sleepiness than controls during daytime (Golan et al., 2004; Lecendreux et al., 2000).”
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“Furthermore, stronger daytime sleepiness has been found in ADHD using the MSLT in two studies (Golan et al. 2004; Lecendreux et al. 2000) and a third small study (Palm et al.”
MethodSleep phenotypes in attention deficit hyperactivity disorder
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“Conversely, MSLT studies have demonstrated deficits in daytime arousal in children with ADHD compared to controls, despite normal nighttime sleep (Golan et al., 2004; Lecendreux et al., 2000).”
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“It has been proposed that children with ADHD are sleepier during the day than normal children due to a general deficit in alertness, which consequently produces secondary nighttime sleep problems (Lecendreux et al., 2000).”
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“It is likewise possible that a systemic, chronic underarousal contributes to a range of inattentive, underactive, and sleepy behaviors which are captured across the various rating scales assessing SCT, inattentive, and daytime sleepiness behaviors (Lecendreux et al., 2000; Miano et al., 2006).”
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“Dysregulation of arousal systems along with the HPA axis has been proposed in the pathophysiology of depression [104], autism [105] and ADHD [106].”
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“Controlling for SDB, Lecendreux et al. (2000) found that, following one night, no relationship existed between nocturnal sleep and mean sleep latency on the MSLT. Consistent with Golan et al. (2004), however, children with ADHD had greater daytime sleepiness, suggesting further need to investigate…”
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Rothenberger, A. (2008) · Journal of Child Psychology and Psychiatry · doi:10.1111/j.1469-7610.2008.01994.x · Cited by 53 · see citing works
Parent reports of sleep/alertness problems and ADHD symptoms in a sample of obese adolescents
Cortese, S., Maffeis, C., Konofal, É., Lecendreux, M., Comencini, E., Angriman, M., Vincenzi, B., Pajno-Ferrara, F., Mouren, M., & Bernardina, B. D. (2007) · Journal of Psychosomatic Research · doi:10.1016/j.jpsychores.2007.08.005 · Cited by 52 · see citing works
“According to this theory, children with ADHD/ADHD symptoms (or at least a subgroup of them) may actually be sleepier than controls and may use motor hyperactivity as a strategy to stay awake and alert in order to counteract the tendency to fall asleep [21].”
Self-citationCortese, S., Konofal, É., Bernardina, B. D., Mouren, M., & Lecendreux, M. (2007) · Medical Hypotheses · doi:10.1016/j.mehy.2007.04.036 · Cited by 51 · see citing works
“Two objective studies [17,18] indicated than children and adolescents with ADHD are significantly sleepier than controls during the daytime.”
BackgroundSelf-citationMayes, S. D., Calhoun, S. L., Bixler, E. O., & Vgontzas, A. N. (2009) · Sleep Medicine Clinics · doi:10.1016/j.jsmc.2008.12.004 · Cited by 52 · see citing works
Abuse-Deterrent and Tamper-Resistant Opioid Formulations
Schneider, J. P., Matthews, M. L., & Jamison, R. N. (2010) · CNS Drugs · doi:10.2165/11584260-000000000-00000 · Cited by 51 · see citing works
Goril, S., Zalai, D. M., Scott, L., & Shapiro, C. M. (2016) · Sleep Medicine · doi:10.1016/j.sleep.2016.06.002 · Cited by 51 · see citing works
Parental rating of sleep in children with attention deficit/hyperactivity disorder
Hvolby, A., Jørgensen, J. I., & Bilenberg, N. (2009) · European Child & Adolescent Psychiatry · doi:10.1007/s00787-009-0750-z · Cited by 49 · see citing works
“Studies have documented a discrepancy between parental reports on sleep difficulties and objective measurements, raising the question that parents may tend to overestimate the problem [8, 20, 26, 32, 33, 39].”
BackgroundSleep Study Abnormalities in Children With Attention Deficit Hyperactivity Disorder
Goraya, J. S., Cruz, M., Valencia, I., Kaleyias, J., Khurana, D. S., Hardison, H. H., Marks, H. G., Legido, A., & Kothare, S. V. (2008) · Pediatric Neurology · doi:10.1016/j.pediatrneurol.2008.09.007 · Cited by 49 · see citing works
Miano, S., Esposito, M., Foderaro, G., Ramelli, G. P., Pezzoli, V., & Manconi, M. (2016) · CNS Neuroscience & Therapeutics · doi:10.1111/cns.12573 · Cited by 48 · see citing works
“According to this theory, the motor hyperactivity observed in children with ADHD, who are significantly sleepier than healthy subjects during the day, may be considered an attempt to counteract a primary form of hypersomnolence, as happens in children with narcolepsy [14,15].”
BackgroundWilloughby, M. T., Angold, A. C., & EGGER, H. L. (2008) · Journal of the American Academy of Child & Adolescent Psychiatry · doi:10.1097/chi.0b013e31817eed1b · Cited by 47 · see citing works
“This is an important limitation, given clinical and empirical evidence indicating that daytime sleepiness is primarily related to IN symptomatology, whereas sleep-disordered breathing and movement during sleep are primarily related to HI symptomatology.(5,12,13) Therefore, study differences in subtype distributions (a…”
BackgroundSleep 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
Self-citationBlunden, S. L., Hoban, T. F., & Chervin, R. D. (2006) · Sleep Medicine Clinics · doi:10.1016/j.jsmc.2005.11.006 · Cited by 48 · see citing works
The multiple sleep latency test
Arand, D. L., & Bonnet, M. H. (2019) · Handbook of clinical neurology · doi:10.1016/b978-0-444-64032-1.00026-6 · Cited by 52 · see citing works
Dyssomnia in Children Diagnosed with Attention Deficit Hyperactivity Disorder: A Critical Review
Bullock, G. L., & Schall, U. (2005) · Australian & New Zealand Journal of Psychiatry · doi:10.1080/j.1440-1614.2005.01584.x · Cited by 47 · see citing works
“In the 10 studies reviewed here, only two studies [20,23] showed no differences between sleep variables in ADHD children and controls.”
BackgroundGaultney, J. F., Terrell, D. F., & Gingras, J. L. (2005) · Behavioral Sleep Medicine · doi:10.1207/s15402010bsm0301_5 · Cited by 43 · see citing works
Dobler, V., Anker, S., Gilmore, J., Robertson, I. H., Atkinson, J., & Manly, T. (2005) · Journal of Child Psychology and Psychiatry · doi:10.1111/j.1469-7610.2005.00421.x · Cited by 43 · see citing works
Virring, A., Lambek, R., Thomsen, P. H., Møller, L. R., & Jennum, P. (2016) · Journal of Sleep Research · doi:10.1111/jsr.12377 · Cited by 42 · see citing works
“…in the group of children with ADHD were shorter than in the control group, which corresponds well with previous findings (Golan et al., 2004; Lecendreux et al., 2000; Palm et al., 1992), suggesting that children with ADHD are sleepier during the day despite a symptomatology characterized by…”
BackgroundResultInfluentialSangal, R. B., & Sangal, J. M. (2014) · Clinical EEG and Neuroscience · doi:10.1177/1550059414527284 · Cited by 39 · see citing works
“It has been reported that children with ADHD fall asleep faster in a soporific situation than normal subjects.(28,29) A cognitive task requiring selective attention would require alertness and postpone drowsiness, which may be why this report did not find a difference in theta power.”
Background
- Authors
- Lecendreux, M., Konofal, E., Bouvard, M., Falissard, B., & Mouren‐Siméoni, M.
- Affiliations
- Hôpital Robert-Debré (FR)
- Centre Hospitalier Charles Perrens (FR)
- Hôpital Paul-Brousse (FR)
- Venue
- Journal of Child Psychology and Psychiatry
- Publisher
- Wiley
- Published
- 2000-09
- Volume
- 41
- Issue
- 6
- Pages
- 803-812
- ISSN
- 0021-9630 (ISSN-L)
- 1469-7610
- OpenAlex
- W2115025001
- Cited by
- 269
- References
- 0
- Citations by year
- 2026: 5 · 2025: 5 · 2024: 8 · 2023: 4 · 2022: 6 · 2021: 8 · 2020: 7 · 2019: 14 · 2018: 9 · 2017: 6 · 2016: 14 · 2015: 9 · 2014: 16 · 2013: 6 · 2012: 20
- FWCI
- 4.65
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Journal of Child Psychology and Psychiatry (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Psychiatry and Mental health › Attention Deficit Hyperactivity Disorder
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Sleep and related disorders
- Life Sciences › Neuroscience › Cognitive Neuroscience › Sleep and Wakefulness Research
- Keywords
- attention deficit hyperactivity disorder, sleep, daytime alertness, multiple sleep latency test, reaction time, sleep latency, daytime sleepiness, ADHD subtypes, hyperactivity/impulsivity, children
- MeSH terms
- Adult, Central Nervous System Stimulants, Attention Deficit Disorder with Hyperactivity, Child, Child, Preschool, Humans, Methylphenidate, Psychiatric Status Rating Scales, Reaction Time, Severity of Illness Index, Sleep, REM, Wakefulness
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