Sleep patterns and the risk for ADHD: a review

Figures & data

Table 1 Studies examining the risk of developing ADHD based on sleep restriction, sleep disturbances and sleep disorders

Author	Sample size	Age at first assessment	Sleep measures	Diagnostic measures	Timeframe	Main findings
Gregory and O’Connor^Citation16	490	4 years	Single sleep problem scale	Attention and aggression subscales of the CBCL^Citation66	11 years	Sleep problems at 4 years of age predicted attention and aggression problems at age 15; behavior problems, with the exception of inattention, did not predict sleep problems.
Touchette et al^Citation15	1492	2.5 years	Self-administered questionnaire for the mother	Interviewer completed computerized questionnaire	3.5 years	Risk for HI was 3.2 times higher for short increasing sleepers compared with 11 hour sleepers.
O’Callaghan et al^Citation17	4202	6 months/2–4 years	Maternal report of child sleep problems (ie, quality of sleep, sleeplessness)	Attention subscale of the CBCL^Citation66	13.5 years	Sleep problems occurring ‘sometimes’ in boys predicted attention problems at age 5; irregular sleep habits occurring ‘often’ from the ages of 2 and 4 in both sexes predicted attention problems at 5 years.
Friedman et al^Citation18	568	4 years	CBCL^Citation66	Laboratory assessment of inhibiting, updating, and shifting abilities	12 years	Sleep problems at 4 years did not predict executive functioning in adolescence; individuals with sleep problems that decreased more throughout the study demonstrated greater executive functioning in adolescence.
Thunström et al^Citation62	54	6–12 months	Five open ended questions about child’s sleep pattern according to ICSD classifications^Citation67	DSM-IV criteria^Citation2 assessment by multidisciplinary team	5 years	Family issues, behavior problems at bedtime, and long sleep onset latency during infancy were associated with an ADHD diagnosis at age 5.5 years old.
Chervin et al^Citation20	229	2–13 years	Snoring, restless leg, and sleepiness items of pediatric sleep questionnaire^Citation53	Hyperactivity subscale of the Conner’s parent rating scale^Citation68	Until 4 years after initial assessment	Hyperactivity at follow-up was associated with: baseline habitual snoring, loud snoring, composite score on snoring, sleepiness, or sleep-disordered breathing.
Chervin et al^Citation21	143	2–18 years	Snoring, restless leg, and sleepiness items of pediatric sleep questionnaire^Citation53	Scale for inattention and hyperactivity derived from the DSM-IV^Citation2	Concurrent	Snoring was more frequent among children with ADHD. Snoring scores were associated with increased inattention and hyperactivity.
Gottlieb et al^Citation63	3019	5 years	Parent completed survey regarding symptoms of sleep disordered breathing	Parent reported responses to questions validated with the Conners’ parent rating scale – revised^Citation65	Concurrent	Children with SDB symptoms had more daytime sleepiness, inattention, hyperactivity compared with children without symptoms of SDB.
Paavonen et al^Citation55	280	7–8 years	Actigraphy, parent completed sleep disturbance scale for children^Citation70	Parent completed attention-deficit/hyperactivity disorder rating scale IV^Citation71	Concurrent	Short sleep duration was associated with hyperactivity and impulsivity, while sleep disturbances were associated with hyperactivity, impulsivity, and attention problems.
Pesonen et al^Citation60	470	8 years	Actigraphy assessment for 7 nights	Parent completion of the CBCL^Citation66	Concurrent	Short sleep duration was significantly related to ADHD problems as rated by mothers; short sleep duration was significantly related to more externalizing symptoms as rated by fathers.
Owens et al^Citation64	235	3–18 years	CSHQ^Citation54; pediatric sleep disorder clinic evaluation	CBCL^Citation66	Concurrent	Short sleep was associated with increased externalizing scores. Reporting at least one additional sleep disorder diagnosis was the greatest predictor of adverse outcomes on the CBCL.
O’Brien et al^Citation61	5728	5–7 years	Parent completed sleep survey; Polysomnography	Parent completed questionnaire about hyperactivity; Conner’s Parent Rating Scale^Citation72 and the CBCL^Citation66	Concurrent	SDB symptoms were significantly associated with mild, but not severe, ADHD symptoms as measured by the Conner’s parent rating scale.
Konofal et al^Citation24	32	5–9 years	NIH-specific criteria^Citation73 for restless leg syndrome	Conners’ parent rating scale^Citation72	Concurrent	There was a trend towards higher ADHD symptomology in children with ADHD and restless leg syndrome than in children with ADHD only.
Kass et al^Citation65	148	Mean = 22.7 years	Epworth sleepiness scale^Citation74; Athens insomnia scale^Citation75	Adult behavior checklist^76	Concurrent	Sleep scores were associated with attention deficit and hyperactivity subscales of the adult behavior checklist.

Abbreviations: ADHD, attention-deficit/hyperactivity disorder; CBCL, child behavior checklist; CSHQ, children’s sleep habits questionnaire; DSM, Diagnostic and Statistical Manual of Mental Disorders; HI, hyperactivity-impulsivity; ICSD, International Classification of Sleep Disorders; NIH, National Institutes of Health; SDB, sleep-disordered breathing.

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