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A systematic review of circadian function, chronotype and chronotherapy in attention deficit hyperactivity disorder

Abstract

Reports of sleep disturbances in attention deficit hyperactivity disorder (ADHD) are common in both children and adults; however, the aetiology of such disturbances is poorly understood. One potentially important mechanism which may be implicated in disrupted sleep in ADHD is the circadian clock, a known key regulator of the sleep/wake cycle. In this systematic review, we analyse the evidence for circadian rhythm changes associated with ADHD, as well as assessing evidence for therapeutic approaches involving the circadian clock in ADHD. We identify 62 relevant studies involving a total of 4462 ADHD patients. We find consistent evidence indicating that ADHD is associated with more eveningness/later chronotype and with phase delay of circadian phase markers such as dim light melatonin onset and delayed sleep onset. We find that there is evidence that melatonin treatment may be efficacious in addressing ADHD-related sleep problems, although there are few studies to date addressing other chronotherapeutic approaches in ADHD. There are only a small number of genetic association studies which report linkages between polymorphisms in circadian clock genes and ADHD symptoms. In conclusion, we find that there is consistent evidence for circadian rhythm disruption in ADHD and that such disruption may present a therapeutic target that future ADHD research might concentrate explicitly on.

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Fig. 1

Abbreviations

ADHD:

Attention deficit hyperactivity disorder

BD:

Bipolar disorder

CSM:

Composite scale of morningness

DLMO:

Dim light melatonin onset

DSPD:

Delayed sleep phase disorder

IS:

Interdaily stability

IV:

Intradaily variability

MEQ:

Morningness–eveningness questionnaire

MCTQ:

Munich chronotype questionnaire

MPH:

Methylphenidate

PER:

PERIOD

SOI:

Sleep-onset insomnia

RCT:

Randomised control trial

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Correspondence to Andrew N. Coogan.

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Coogan, A.N., McGowan, N.M. A systematic review of circadian function, chronotype and chronotherapy in attention deficit hyperactivity disorder. ADHD Atten Def Hyp Disord 9, 129–147 (2017). https://doi.org/10.1007/s12402-016-0214-5

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  • DOI: https://doi.org/10.1007/s12402-016-0214-5

Keywords

  • ADHD
  • Circadian
  • Sleep
  • Melatonin
  • clock gene