Sleep and Stroop Performance with Adjunctive Melatonin in Pharmacotherapy-stable Pediatric ADHD: A Prospective
Ritwick Tripathi1, Shweta Singh1, Amit Arya1
1Dept. of Psychiatry, King George's Medical University, Lucknow, Uttar Pradesh, India.
Insights
Melatonin supplementation improved sleep quality and cognitive performance in children with ADHD and sleep disturbances. Further research is needed to confirm these findings due to the study
Area of Science:
- Neuroscience
- Pediatrics
- Sleep Medicine
Background:
- Attention-deficit/hyperactivity disorder (ADHD) frequently co-occurs with sleep disturbances.
- Limited evidence exists on melatonin's impact on neurocognitive outcomes in pediatric ADHD.
- This study investigates melatonin's association with sleep and cognitive function in children with ADHD.
Purpose of the Study:
- To assess the effect of melatonin on parent-reported sleep disturbance scores in children and adolescents with ADHD.
- To evaluate the impact of melatonin on Stroop Color-Word Test performance in this population.
- To examine the relationship between sleep improvements and cognitive changes with melatonin use.
Main Methods:
- A 6-week, prospective, open-label, single-arm study.
- Participants (N=33) with ADHD and sleep disturbances (CSHQ score ≥41) on stable medication received melatonin (3-5 mg/day).
- Outcomes included Children's Sleep Habits Questionnaire (CSHQ) and Stroop Color-Word Test performance.
Main Results:
- Significant improvements were observed in CSHQ total scores and six subscales after 6 weeks of melatonin use.
- Stroop Color-Word Test performance showed large improvements, although practice effects cannot be ruled out.
- Correlations between sleep improvements and cognitive changes were small and not statistically significant.
Conclusions:
- Melatonin use was associated with improved parent-reported sleep and enhanced Stroop performance in children with ADHD.
- The single-arm design limits causal inference; further randomized controlled trials are warranted.
- Future studies should incorporate objective sleep measures and parallel cognitive assessments.
Background:
Attention-deficit/hyperactivity disorder (ADHD) is frequently comorbid with sleep disturbances; evidence linking melatonin to objective neurocognitive outcomes in this population is lacking. The present study assessed the association of melatonin with parent-reported sleep disturbance scores and Stroop Color-Word Test performance in children and adolescents with ADHD and comorbid sleep disturbances on stable pharmacotherapy.
Methods:
Prospective, open-label, single-arm, 6-week study. Thirty-three participants (ADHD; Children's Sleep Habits Questionnaire [CSHQ] score ≥41) on stable methylphenidate or atomoxetine were enrolled; 32 completed follow-up. Melatonin (3 mg/day <40 kg; 5 mg/day ≥40 kg) was administered 1 hour before bedtime. Primary outcome: CSHQ total score (baseline, weeks 2, 4, 6). Secondary outcome: Psychology Experiment Building Language Stroop Color-Word Test (baseline and week 6). Analysis involved repeated-measures analysis of variance and paired t tests.
Results:
Total CSHQ scores declined from 50.25 ± 3.60 to 34.31 ± 2.69 at 6 weeks (F=506.238, p < .001, partial η²=0.942), with significant improvement in six of eight subscales after Bonferroni correction. Pre- and post-Stroop scores showed large observed changes (d=1.12-1.19; all p < .001), though practice effects cannot be excluded without a control group. Sleep-cognition correlations were small and non-significant (r=0.19-0.29; p > .10). Adverse effects were mild and transient.
Conclusions:
Pre- and post-improvements in parent-reported sleep scores and Stroop performance were observed over 6 weeks of melatonin use; given the single-arm design, causal attribution is not possible. Randomized controlled trials with objective sleep measures and parallel cognitive assessment forms are warranted.
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