Subjective and objective measures of sleep in children with attention-deficit/hyperactivity disorder

To compare objective and subjective measures of sleep in children with attention-deficit/hyperactivity disorder (ADHD) and healthy control subjects.

Included were 107 unmedicated children with ADHD and 46 healthy control subjects, all aged 6-14. Sleep-wake patterns were monitored with actigraphy for at least five consecutive days. Subjects and parents completed daily electronic diaries assessing sleep and daytime behavior.

Actigraphy data from 80 ADHD patients and 45 control subjects showed that, compared to the healthy control group, the ADHD group experienced shorter actual sleep time (defined as time in minutes [from sleep onset to final morning awakening] of all epochs scored as sleep [i.e., excluding total duration of all epochs scored as "wake"]) (489.39 vs. 460.30min, p=.001), significantly fewer sleep interruptions (44.45 vs. 35.33, p<.001), but more total interrupted sleep time (44.49 vs. 56.70min, p=.002). Child diaries indicated children with ADHD had significantly more daytime sleepiness and difficulty getting up and less refreshing sleep. Parent diaries indicated children with ADHD had significantly more behavioral difficulties than the control group.

Results suggest children with ADHD have reduced sleep quantity and more disturbed sleep on actigraphic measures, reduced sleep quality on the self report, and more problematic behaviors on the parent report. Clinical interventions for children with ADHD who present with sleep problems should include screening for etiologic and exacerbating factors, institution of behavioral-management strategies, and consideration of pharmacologic treatment targeted toward evening ADHD symptoms.