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Event Related Potentials ERPs and other EEG Based Methods for Extracting Biomarkers of Brain Dysfunction: Examples from Pediatric Attention Deficit/Hyperactivity Disorder ADHD

Event Related Potentials ERPs and other EEG Based Methods for Extracting Biomarkers of Brain Dysfunction: Examples from Pediatric Attention Deficit/Hyperactivity Disorder ADHD

Published on: March 12, 2020

Sleep physiology associated with cognitive disengagement syndrome in adolescents with and without ADHD

Jessica R Lunsford-Avery¹, Andrew D Krystal², Melissa C Miller³

¹Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, 2400 Pratt Street, 7th Floor, Durham, NC, 27705, USA.

|February 19, 2026

Abstract

Objective:

Cognitive disengagement syndrome (CDS) is an attentional phenotype characterized by excessive daydreaming and hypoactivity that is distinct from attention-deficit/hyperactivity disorder (ADHD). Emerging research finds poorer sleep functioning to be associated with CDS symptoms, though few studies have used objective sleep methods such as polysomnography (PSG). This multi-informant, multi-method study examines whether PSG-assessed sleep physiology indices and subjective sleep quality/circadian preference are associated with CDS severity in adolescents with and without ADHD.

Methods:

Participants were 62 medication-free adolescents (ages 13-17, 50% female), half with ADHD and half were non-psychiatric controls. Adolescents completed 3 consecutive nights of ambulatory PSG and measures of sleep quality and circadian preference. Parents completed measures of CDS and ADHD severity. Partial Pearson correlations covarying for age, sex, and pubertal status examined sleep physiology, sleep quality, and circadian preference in relation to CDS. Linear regressions explored whether associations differed by group.

Results:

Adolescents with ADHD displayed greater CDS severity than controls. Longer PSG-measured latency to persistent sleep, greater wake after sleep onset and percentage of stage 1 (N1) sleep, and reduced sleep efficiency and total sleep time were associated with greater CDS severity. Poorer subjective sleep quality and greater eveningness were also associated with greater CDS severity. Findings were largely unchanged in sensitivity analyses controlling for ADHD severity. Associations between sleep and CDS did not differ between adolescents with ADHD compared to non-psychiatric controls.

Conclusion:

Although adolescents with ADHD exhibited greater CDS severity than controls, PSG-assessed sleep physiology indices were associated with greater parent-reported CDS symptoms irrespective of diagnostic group. Longitudinal and experimental research is needed to replicate and extend findings.

Keywords:

ADHD Adolescents Cognitive disengagement syndrome Polysomnography Sleep physiology Sluggish cognitive tempo

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