Sleep disturbance in children with attention-deficit hyperactivity disorder: relationship with melatonin and behavior

ABSTRACT

Aim

To evaluate the prevalence and types of sleep problems and their correlations with melatonin content and behavior in Attention-Deficit Hyperactivity Disorder (ADHD) children.

Method

Sleep in ADHD children and typically developing children (TD) aged 6–14 was assessed by the Sleep Disorders Scale for Children (SDSC) and actigraphy, salivary melatonin quantified by ELISA, and behavior was analyzed using the Strengths and Difficulties Questionnaire.

Results

ADHD children showed a higher frequency of sleep disturbances, higher sleep latency, and lower sleep efficiency than in the TD group. The ADHD group presented lower melatonin nocturnal content compared to the TD group. Disorders of Initiating and Maintaining Sleep (DIMS) was moderately associated with nocturnal melatonin. The total behavior difficulties were correlated with Disorders of Initiating and Maintaining Sleep (DIMS), Sleep/Wake Transition Disorders (SWTD), Disorders of Excessive Somnolence (DES), Sleep Hyperhidrosis (SHY) and Total SDSC Score. The behavior was the only determinant of the total SDSC score (R² = 0.499; p < 0.002).

Conclusion

This study provides, for the first time, evidence that among the frequent sleep disturbances in ADHD, the disorders in initiating and maintaining sleep are associated with the low levels of melatonin found in this population. Additionally, these, along with other sleep disturbances, are linked to behavioral problems in ADHD.

KEYWORDS:

• Attention deficit hyperactivity disorder
• circadian rhythm
• development
• melatonin
• pediatric insomnia

Acknowledgments

This study received financial support from the Coordenação de Aperfeiçoamento de Pessoal de Nível Superior - Brasil (CAPES-Finance Code 001). LP and CMG were also recipients of fellowships from the National Council for Scientific and Technological Development (CNPq) (LP - process number 312322/2022-4). The funding sources played no role in the design or execution of the study.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Author contributions

ALDMS: Conceptualization, Methodology, Investigation, Writing – Original Draft; MCHC: Methodology, Investigation, statistical analysis. CSGS: Writing – Original Draft, Formal analysis; NCS: Methodology, Investigation, Writing – Original Draft. MP: Writing – Original Draft, Formal analysis; CMG: Conceptualization, Methodology, Investigation, Writing – Original Draft; LP: Conceptualization, Methodology, Investigation, Writing – Original Draft, Formal analysis.

Data availability statement

All data underlying this article will be shared on reasonable request to the corresponding author.

Statement of significance

Attention deficit hyperactivity disorder (ADHD) is a continuously evolving concept refined and developed over the past few decades through extensive research into its nature and clinical manifestations. While the clinical presentation and trajectory of the disorder have been well-documented, there remains a need for comprehensive data on the presence, potential causes, and repercussions of sleep disorders in individuals with ADHD. Most previous investigations into sleep disorders in ADHD have relied on subjective instruments, such as questionnaires, which offer insights into sleep issues but have limitations. In our current study, we adopted a multifaceted approach to assess sleep quality in individuals with ADHD. We employed both subjective measures, through questionnaires, and objective measures, using actigraphy, to obtain a more complete and reliable understanding of their sleep patterns. Additionally, we analyzed melatonin hormone levels in children diagnosed with ADHD to explore potential associations. The findings from our study revealed a significant connection between sleep disorders, melatonin levels, and behavioral challenges in children with ADHD. These scientific results hold promise to inform the development of more effective clinical strategies and interventions for individuals living with ADHD. By shedding light on the intricate relationship between sleep, melatonin, and behavior in this population, our research contributes to a deeper understanding of ADHD and its associated challenges.

Additional information

Funding

The work was supported by the Coordenação de Aperfeiçoamento de Pessoal de Nível Superior [financial code 001]; National Council for Scientific and Technological Development [CNPq n. 312322/2022-4]; National Council for Scientific and Technological Development [CNPq n.316762/2021-0].