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Subtypes of ADHD and their association with sleep disturbances in children

ADHS-Subtypen und ihr Zusammenhang mit Schlafstörungen bei Kindern

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Abstract

Objective

So far, little is known about potential links between subtypes of attention deficit hyperactivity disorder (ADHD) and sleep disturbances in childhood. Therefore, this study examined the association between sleep disorders and all three subtypes of ADHD.

Methods

A total of 60 children showing attention deficit symptoms (aged 6–13 years; 88.3% boys) were diagnosed with regard to ADHD according to the DSM-IV-TR. The subtypes of ADHD diagnosed were then related to potential sleep disturbances as measured using a standardized parent-rated questionnaire (Children’s Sleep Habits Questionnaire, CSHQ-DE).

Results

Clinically significant elevated scores in the CSHQ-DE’s Sleep Disturbance Scale were exhibited in all 60 children. Parents of the children with primarily hyperactive–impulsive subtype reported the highest scores. Children with this subtype displayed the highest rate of specific sleep disorders, e.g., increased daytime sleepiness and higher bedtime resistance.

Conclusion

The assumption that children with ADHD show elevated scores of sleep disturbances was verified. In addition, it was possible to identify a unique pattern of sleep disturbances corresponding to the respective ADHD subtypes.

Zusammenfassung

Ziel

Bisher gibt es wenig gesichertes Wissen über den Zusammenhang der Subtypen der Aufmerksamkeitsdefizit-Hyperaktivitäts-Störung (ADHS) und Schlafstörungen in der Kindheit. Daher wird in dieser Studie der Zusammenhang von Schlafstörungen und allen 3 Subtypen der ADHS untersucht.

Methode

Bei insgesamt 60 Kindern (6–13 Jahre; 88,3% Jungen) wurde entsprechend DSM-IV-TR die Diagnose einer ADHS gestellt. Die diagnostizierten Subtypen der ADHS wurden in Verbindung gesetzt mit potenziellen Schlafstörungen im Kindesalter – gemessen mit einem standardisierten Elternfragebogen (Children’s Sleep Habits Questionnaire, CSHQ-DE).

Ergebnisse

In der Gesamtstichprobe aller Kinder zeigten sich klinisch signifikant erhöhte Werte in der Gesamtskala des CSHQ-DE. Eltern von Kindern mit ADHS vom hyperaktiv-impulsiven Subtyp berichteten über die höchsten Werte. Diese Kinder zeigten auch die höchste Rate an spezifischen Schlafstörungen, wie z. B. erhöhte Tagesschläfrigkeit sowie stärkere Widerstände, zu Bett zu gehen.

Schlussfolgerung

Die Annahme, dass Kinder mit ADHS verstärkt Schlafstörungen aufweisen, wurde bestätigt. Darüber hinaus war es möglich, ein spezifisches Muster an Schlafschwierigkeiten entsprechend dem jeweiligen ADHS-Subtyp zu identifizieren.

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References

  1. American Academy of Child and Adolescent Psychiatry (2007) Practice parameter for the assessment and treatment of children and adolescents with attention-deficit/hyperactivity disorder. J Am Acad Child Adolesc Psychiatry 46:894–921

    Article  Google Scholar 

  2. American Psychiatric Association (2000) Diagnostic and statistical manual of mental disorders. American Psychiatric Association, Washington, DC

  3. Aronen ET, Paavonen EJ, Fjällberg M et al (2000) Sleep and psychiatric symptoms in school-aged children. J Am Acad Child Adolesc Psychiatry 39:502–508

    Article  PubMed  CAS  Google Scholar 

  4. Barkley RA, Murphy KR, O’connell T et al (2005) Effects of two doses of methylphenidate on simulator driving performance in adults with attention deficit hyperactivity disorder. J Safety Res 36:121–131

    Article  PubMed  Google Scholar 

  5. Biederman J, Faraone SV, Milberger S et al (1996) Predictors of persistance and remission of ADHD: results from a four-year prospective follow-up study of ADHD children. J Am Acad Child Adolesc Psychiatry 35:343–351

    Article  PubMed  CAS  Google Scholar 

  6. Breuer D, Döpfner M (2006) Aufmerksamkeitsdefizit-/Hyperaktivitätsstörungen bei drei- bis sechsjährigen in der ärztlichen Praxis – eine bundesweite Befragung. Z Kinder Jugendpsychiatr Psychother 34:357–365

    Article  PubMed  Google Scholar 

  7. Chervin R, Archbold K, Dillon J et al (2002) Inattention, hyperactivity, and symptoms of sleep-disordered breathing. Pediatrics 109:449–456

    Article  PubMed  Google Scholar 

  8. Connor D, Edwards G, Fletcher K et al (2003) Correlates of comorbid psychopathology in children with ADHD. J Am Acad Child Adolesc Psychiatry 42:193–2002

    Article  PubMed  Google Scholar 

  9. Corkum P, Tannock R, Moldofsky H et al (2001) Actigraphy and parental ratings of sleep in children with attention-deficit/hyperactivity disorder (ADHD). Sleep 24:303–312

    PubMed  CAS  Google Scholar 

  10. Cortese S (2012) The neurobiology and genetics of attention-deficit/hyperacitivity disorder (ADHD): what every clinician should know. Eur J Paediatr Neurol (in press)

  11. Cortese S, Faraone SV, Konofal E et al (2009) Sleep in children with attention-deficit/hyperactivity disorder: meta-analysis of subjective and objective studies. J Am Acad Child Adolesc Psychiatry 48:894–908

    PubMed  Google Scholar 

  12. Döpfner M, Görtz-Dorten A (2008) Diagnostik-System für Psychische Störungen im Kindes- und Jugendalter nach ICD-10 und DSM-IV, DISYPS-II. Verlag Hans Huber, Bern

  13. Elliot H (2002) Attention deficit hyperactivity disorder in adults: a guide for the primary care physician. South Med J 95:736–742

    Google Scholar 

  14. Gillberg C, Gillberg IC, Rasmussen P et al (2004) Co-existing disorders in ADHD—implications for diagnosis and intervention. Eur Child Adolesc Psychiatry 13:I80–I92

    Article  PubMed  Google Scholar 

  15. Gruber R, Sadeh A, Raviv A (2000) Instability of sleep patterns in children with attention-deficit/hyperactivity disorder. J Am Acad Child Adolesc Psychiatry 39:495–501

    Article  PubMed  CAS  Google Scholar 

  16. Guilleminault C, Korobkin R, Winkle R (1981) A review of 50 children with obstructive sleep apnea syndrome. Lung 159:275–187

    Article  PubMed  CAS  Google Scholar 

  17. Hagenah U (2002) Schlafstörungen bei kinder- und jugendpsychiatrischen Erkrankungen. Z Kinder Jugendpsychiatr Psychother 30:185–198

    Article  PubMed  CAS  Google Scholar 

  18. Jan Y-W, Yang C-M, Huang Y-S (2011) Comorbidity and confounding factors in attention-deficit/hyperactivity disorder and sleep disorders in children. Psychol Res Behav Manag 4:139–150

    PubMed  Google Scholar 

  19. Jensen PS, Martin D, Cantwell DP (1997) Comorbidity in ADHD: implications for research, practice, and DSM-IV. J Am Acad Child Adolesc Psychiatry 36:1065–1079

    Article  PubMed  CAS  Google Scholar 

  20. Kraenz S, Fricke L, Wiater A et al (2004) Häufigkeit und Belastungsfaktoren bei Schlafstörungen im Einschulalter. Prax Kinderpsychol Kinderpsychiatr 53:3–18

    PubMed  Google Scholar 

  21. Lebourgeois MK, Avis K, Mixon M et al (2004) Snoring, sleep quality, and sleepiness across attention-deficit/hyperactivity disorder subtypes. Sleep 27:520–525

    PubMed  Google Scholar 

  22. Lecendreux M, Konofal E, Bouvard M et al (2000) Sleep and altertness in children with ADHD. J Child Psychol Psychiatry 41:803–812

    Article  PubMed  CAS  Google Scholar 

  23. Lehmkuhl G, Wiater A, Mitschke A et al (2008) Schlafstörungen im Einschulalter – Ursachen und Auswirkungen. Dtsch Arztebl 105:809–814

    Google Scholar 

  24. Nadeau KG (2005) Career choices and workplace challenges for individuals with ADHD. J Clin Psychol 61:607–619

    Article  Google Scholar 

  25. Ohayon M, Roberts R, Zulley J et al (2000) Prevalence and patterns of problematic sleep among older adolescents. J Am Acad Child Adolesc Psychiatry 39:1549–1556

    Article  PubMed  CAS  Google Scholar 

  26. Owens JA, Maxim R, Nobile C et al (2000) Parental and self-report of sleep in children with attention-deficit/hyperactivity disorder. Arch Pediatr Adolesc Med 154:549–555

    PubMed  CAS  Google Scholar 

  27. Owens JA, Spirito A, Mcguinn M (2000) The Children’s Sleep Habits Questionnaire (CSHQ): psychometric properties of a survey instrument for school-aged children. Sleep 23:1043–1051

    PubMed  CAS  Google Scholar 

  28. Paavonen EJ, Aronen ET, Moilanen I et al (2000) Sleep problems in school-aged children: a complimentary view. Acta Paediatr 89:223–228

    Article  PubMed  CAS  Google Scholar 

  29. Petermann F, Petermann UH (2007) Hamburg-Wechsler-Intelligenztest für Kinder – IV (HAWIK-IV). Hogrefe, Göttingen

  30. Polanczyk G, Silva De Lima M, Horta B et al (2007) The worldwide prevalence of ADHD: a systematic review and metaregression analysis. Am J Psychiatry 164:942–948

    Article  PubMed  Google Scholar 

  31. Rickel A, Brown R (2007) Attention deficit/hyperactivity disorder in children and adults. Hogrefe & Huber, Göttingen

  32. Schlarb AA, Schwerdtle B, Hautzinger M (2010) Validation and psychometric properties of the German version of the Children’s Sleep Habits Questionnaire (CSHQ-DE). Somnologie 14:260–266

    Article  Google Scholar 

  33. Schmidt S, Petermann F (2008) Entwicklungspsychopathologie der ADHS. Z Psychiatr Psychol Psychother 56:265–274

    Google Scholar 

  34. Schwerdtle B, Roeser K, Kübler A et al (2010) Validierung und psychometrische Eigenschaften der deutschen Version des Sleep Self Report (SSR-DE). Ein Selbstbeurteilungsinstrument zur Erfassung von Schlafstörungen für Kinder von 7–12 Jahren. Somnologie 14:267–274

    Article  Google Scholar 

  35. Stein MA, Mendelsohn J, Obermeyer WH et al (2001) Sleep and behavior problems in school-aged children. Pediatrics 197:e60

    Article  Google Scholar 

  36. Wiegand MH (2006) Fremdbeobachtung. In: Schulz H (ed) Kompendium Schlafmedizin für Ausbildung, Klinik und Praxis. Deutsche Gesellschaft für Schlafmedizin. ecomed Medizin, Landsberg

  37. Willoughby MT, Angold A, Egger HL (2008) Parent-reported attention-deficit/hyperactivity disorder symptomatology and sleep problems in a preschool-age pediatric clinic sample. J Am Acad Child Adolesc Psychiatry 47:1086–1094

    Article  PubMed  Google Scholar 

Download references

Acknowledgment

The authors would like to thank the children and parents for their participation and cooperation.

Conflict of interest

On behalf of all authors, the corresponding author states that there are no conflicts of interest.

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Authors and Affiliations

  1. Faculty of Science, Department of Psychology, University of Tübingen, Schleichstr. 4, 72076, Tübingen, Germany

    J. Wagner PhD & A.A. Schlarb

  2. Department of Psychology, University of Koblenz-Landau, Landau, Germany

    A.A. Schlarb

Authors
  1. J. Wagner PhD
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  2. A.A. Schlarb
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Correspondence to A.A. Schlarb.

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Both authors contributed equally to this work.

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Wagner, J., Schlarb, A. Subtypes of ADHD and their association with sleep disturbances in children. Somnologie 16, 118–124 (2012). https://doi.org/10.1007/s11818-012-0569-6

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