Sleep disturbances in children and adolescents with attention-deficit/hyperactivity disorder: A narrative review

Sleep disturbances and disorders are commonly associated with attention-deficit/hyperactivity disorder (ADHD), with affected children frequently experiencing delayed sleep onset, frequent nighttime awakenings, morning fatigue, and excessive daytime sleepiness. A bidirectional relationship exists between ADHD and sleep disturbances: Sleep deprivation is linked to increased inattention and emotional dysregulation, while evening hyperactivity and impulsivity may contribute to difficulty falling asleep. Central nervous system stimulants remain the first-line treatment for managing ADHD symptoms; however, insomnia can be a common side effect. Notably, newer and long-acting stimulants formulations have demonstrated extended benefit into evening with limited impact on sleep in recent studies. This narrative review summarizes the various sleep disorders associated with ADHD, outlines clinical approaches for sleep assessment, and evaluates the impact of ADHD treatments on sleep. It also highlights both non-pharmacological and pharmacological interventions for managing sleep problems in children with ADHD. Finally, the review offers practical recommendations to help clinicians optimize both sleep and daytime functioning in patients with ADHD. ADHD should be conceptualized as a 24-hour disorder, requiring integrated treatment strategies that address both daytime symptoms and nighttime sleep challenges.