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Examining daily stimulant medication use and sleep in adolescents with ADHD

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Abstract

Research has been inconclusive as to whether stimulant treatment causes or exacerbates sleep problems in adolescents with ADHD. This study examined sleep differences in adolescents with ADHD as a function of stimulant use. Participants were adolescents with ADHD (N = 159, ages 12–14). Parents reported on receipt of stimulant treatment (n = 92, 57.86%; n = 47 amphetamines, n = 45 methylphenidate). Adolescents wore actigraphs and completed daily diaries assessing sleep and daily use of stimulants for 2 weeks. Sleep parameters included daily-reported bedtime, sleep onset latency (SOL), sleep duration, daytime sleepiness, and difficulty waking the following morning; and actigraphy-measured sleep onset time, total time in bed, and sleep efficiency. We estimated between- and within-individual associations between stimulant medication use and sleep indices with all stimulants, after removing adolescents using sleep aids and weekend days, and as a function of stimulant type. Adolescent sleep did not differ between those receiving and not receiving stimulant treatment. Within individuals using stimulants, we largely observed no significant differences between medicated and unmedicated days, though findings were most often significant for school days only. Small effects were found indicating longer SOL, later sleep onset time, and more daytime sleepiness related to medication use. In contrast, there were slight improvements to sleep duration and sleep efficiency related to methylphenidate use, though methylphenidate was also associated with later sleep onset time and more daytime sleepiness. Given the inconsistent and small effects, findings suggest that stimulant medication may impact sleep, but does not appear to be a primary contributor to sleep problems in adolescents with ADHD.

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Data availability

Data preparation and descriptive statistics were done in SPSS 28 and SAS 9.4. MPlus 8.8 was used for all modeling. Data and code are available from the corresponding author upon reasonable request and execution of a data use agreement.

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Funding

This research was supported by award number R305A160126 from the Institute of Education Sciences (IES), U.S. Department of Education. When data reported in this study were collected, Stephen Becker was supported by Award Number K23MH108603 from the National Institute of Mental Health (NIMH). Dr. Wiggs's effort on this project was supported by the National Research Service Award in Primary Medical Care, T32HP10027, through the Health Resources and Services Administration (HRSA). The content is solely the responsibility of the authors and does not necessarily represent the official views of the IES, NIMH, or HRSA.

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Authors and Affiliations

  1. Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children’s Hospital Medical Center, 3333 Burnet Avenue MLC 10006, Cincinnati, OH, 45206, USA

    Kelsey K. Wiggs, James L. Peugh & Stephen P. Becker

  2. Department of Psychology, Virginia Tech, Blacksburg, VA, USA

    Rosanna Breaux

  3. Department of Clinical Psychology, Rutgers University, Piscataway, NJ, USA

    Joshua M. Langberg

  4. Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA

    James L. Peugh & Stephen P. Becker

Authors
  1. Kelsey K. Wiggs
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  2. Rosanna Breaux
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  4. James L. Peugh
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  5. Stephen P. Becker
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Contributions

Author 1 was responsible for project idea, data cleaning and analysis, interpretation of results, and writing and editing the manuscript. Author 2 helped in data collection and editing of the manuscript. Authors 3 and 5 secured funding for the project, oversaw overall project design and data collection, and helped with editing of the manuscript. Author 4 helped with data analytic plan and editing of the manuscript.

Corresponding author

Correspondence to Kelsey K. Wiggs.

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Conflicts of interest

Dr. Wiggs discloses grant funding (F31) from the National Institute of Neurological Disorders and Stroke (NINDS). Dr. Breaux discloses research support from the American Psychological Association, 4-VA, Society for a Science of Clinical Psychology, Children and Adults with Attention-Deficit/Hyperactivity Disorder (CHADD) Young Scientist Research Fund Award, the Center for Emotional Health (CEH) Emotional Health Research Excellence Award, Virginia Tech Center for Peace Studies and Violence Prevention, and Virginia Tech Institute for Society, Culture, and Environment. Dr. Langberg discloses grant funding from the National Institute on Drug Abuse (NIDA) and the Institute of Education Sciences (IES), and has received book royalties from the National Association for School Psychologists (NASP) and editorial honoraria as Associate Editor and Editor of Research on Child and Adolescent Psychopathology. Dr. Becker discloses grant funding from the Institute of Education Sciences (IES), U.S. Department of Education; National Institute of Mental Health (NIMH); and Cincinnati Children’s Research Foundation (CCRF), and has received book honoraria from Guilford Press, editorial honoraria as Joint Editor of JCPP Advances, grant review panel honoraria from the IES, and educational seminar speaking fees and CE course royalties from J&K Seminars. Dr. Peugh has no disclosures to report.

Ethical approval

The study was approved by the Virginia Commonwealth University and the Cincinnati Children’s Hospital Medical Center Institutional Review Boards.

Informed consent/consent to publish

We obtained written informed consent and assent from participants to participate in this study and use their de-identified data in analysis and publications.

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Wiggs, K.K., Breaux, R., Langberg, J.M. et al. Examining daily stimulant medication use and sleep in adolescents with ADHD. Eur Child Adolesc Psychiatry 33, 821–832 (2024). https://doi.org/10.1007/s00787-023-02204-w

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