Attention-Deficit/Hyperactivity Disorder

  • Nicole Ali
  • Fiona Davidson
  • Marilyn MacPherson
  • Penny CorkumEmail author


Sleep problems are a common occurrence in children with attention-deficit/hyperactivity disorder (ADHD). The most common sleep problem is insomnia (difficulties falling asleep and staying asleep and early morning awakenings). Children with ADHD also have increased rates of restless legs syndrome, periodic limb movement disorder, and circadian rhythm disorder. Increased rates of obstructive sleep apnea have also been found but are within the non-pathological range. Because these sleep disorders all negatively impact the quality and quantity of sleep, they have a detrimental impact on cognitive abilities, in particular some of those abilities already compromised by ADHD symptoms such as attention, concentration, and memory.

When a child is assessed for ADHD, it is extremely important to evaluate sleep because in some cases what appear to be symptoms of ADHD may be outcomes related to a sleeping disorder. Even if ADHD is truly present, sleep problems may make ADHD symptoms worse and treatment may not work as effectively as possible if comorbid sleeping problems are not being addressed. Treating sleep disorders in children with ADHD can help improve or even eliminate symptoms and better prepare the child for the ADHD-based treatments, if needed.

Behavioral interventions used with typically developing kids such as graduated extinction for children who require parental assistance to fall asleep and token systems with response cost for children who have difficulty remaining in bed can be very successful even in the ADHD population, when properly modified to meet the child’s needs.


ADHD Attention-deficit/hyperactivity disorder Behavioral intervention Children Insomnia Sleep Obstructive sleep apnea Periodic limb movement Restless legs syndrome 



This work has been supported (in part) by a network program grant from Kids Brain Health Network (formerly NeuroDevNet), a Canadian Networks of Centres of Excellence.


  1. 1.
    American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 5th ed. Washington, DC: American Psychiatric Association; 2013.CrossRefGoogle Scholar
  2. 2.
    American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 3rd ed. revised. Washington, DC: American Psychiatric Association; 1987.Google Scholar
  3. 3.
    American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 4th ed. Washington, DC: American Psychiatric Association; 1994.Google Scholar
  4. 4.
    Haney T, Kott KM. Sleep problems in children: an overlooked factor in evaluating behavior. J Psychosoc Nurs Ment Health Serv. 2014;52(10):27–32.PubMedCrossRefGoogle Scholar
  5. 5.
    Noble GS, O'Laughlin L, Brubaker B. Attention deficit hyperactivity disorder and sleep disturbances: consideration of parental influence. Behav Sleep Med. 2011;10(1):41–53.PubMedCrossRefGoogle Scholar
  6. 6.
    Sung V, Hiscock H, Sciberras E, Efron D. Sleep problems in children with attention-deficit/hyperactivity disorder: prevalence and the effect on the child and family. Arch Pediatr Adolesc Med. 2008;162(4):336–42.PubMedCrossRefGoogle Scholar
  7. 7.
    Gruber R, Wiebe S, Montecalvo L, Brunetti B, Amsel R, Carrier J. Impact of sleep restriction on neurobehavioral functioning of children with attention deficit hyperactivity disorder. Sleep. 2011;34(3):315–23.PubMedPubMedCentralCrossRefGoogle Scholar
  8. 8.
    Bessey MJ, Coulombe A, Corkum P. Sleep hygiene in children with ADHD: findings and recommendations. ADHD Rep. 2013;21(3):1–7.CrossRefGoogle Scholar
  9. 9.
    Ganelin-Cohen E, Ashkenasi A. Disordered sleep in pediatric patients with attention deficit hyperactivity disorder: an overview. Isr Med Assoc J. 2013;15(11):705–9.PubMedGoogle Scholar
  10. 10.
    Owens JA. The ADHD and sleep conundrum: a review. J Dev Behav Pediatr. 2005;26(4):312–22.PubMedCrossRefGoogle Scholar
  11. 11.
    Ivanov I, Bansal R, Hao X, Zhu H, Kellendonk C, et al. Morphological abnormalities of the thalamus in youths with attention deficit hyperactivity disorder. Am J Psychiatry. 2010;167(4):397–408.PubMedPubMedCentralCrossRefGoogle Scholar
  12. 12.
    Monti JM, Jantos H. The roles of dopamine and serotonin, and of their receptors, in regulating sleep and waking. Prog Brain Res. 2008;172:624–46.Google Scholar
  13. 13.
    Mash EJ, Wolfe DA. Abnormal child psychology. 5th ed. Belmont: Cengage Learning; 2013.Google Scholar
  14. 14.
    Oades RD. Dopamine-serotonin interactions in attention-deficit hyperactivity disorder (ADHD). Prog Brain Res. 2008;172:543–65.PubMedCrossRefGoogle Scholar
  15. 15.
    Corkum P, Moldofsky H, Hogg-Johnson S, Humphries T, Tannock R. Sleep problems in children with attention-deficit/hyperactivity disorder: impact of subtype, comorbidity, and stimulant medication. J Am Acad Child Asolesc Psychiatry. 1999;38(10):1285–93.CrossRefGoogle Scholar
  16. 16.
    Cortese S, Faraone SV, Konofal E, Lecendreux M. Sleep in children with attention-deficit/hyperactivity disorder: meta-analysis of subjective and objective studies. J Am Acad Child Adolesc Psychiatry. 2009;48(9):894–908.PubMedGoogle Scholar
  17. 17.
    Efron D, Lycett K, Sciberras E. Use of sleep medication in children with ADHD. Sleep Med. 2014;15(4):472–5.PubMedCrossRefGoogle Scholar
  18. 18.
    Owens JA, Moturi S. Pharmacologic treatment of pediatric insomnia. Child Adolesc Psychiatr Clin N Am. 2009;18(4):1001–16.CrossRefGoogle Scholar
  19. 19.
    Cortese S, Brown TE, Corkum P, Gruber R, O'Brien LM, Stein M, et al. Assessment and management of sleep problems in youths with attention-deficit/hyperactivity disorder. J Am Acad Child Adolesc Psychiatry. 2013;52(8):784–96.PubMedPubMedCentralCrossRefGoogle Scholar
  20. 20.
    Jan YW, Yang CM, Huang YS. Comorbidity and confounding factors in attention-deficit/hyperactivity disorder and sleep disorders in children. Pschol Res Behav Manag. 2011;4:139–50.Google Scholar
  21. 21.
    Corkum P, Davidson F, Macpherson M. A framework for the assessment and treatment of sleep problems in children with attention-deficit/hyperactivity disorder. Pediatr Clin N Am. 2011;58(3):667–83.CrossRefGoogle Scholar
  22. 22.
    Babcock DA. Evaluating sleep and sleep disorders in the pediatric primary care setting. Pediatr Clin N Am. 2011;58(3):543–54.CrossRefGoogle Scholar
  23. 23.
    Konofal E, Cortese S, Marchand M, Mouren MC, Arnulf I, Lecendreux M. Impact of restless legs syndrome and iron deficiency on attention-deficit/hyperactivity disorder in children. Sleep Med. 2007;8(7–8):711–5.PubMedCrossRefGoogle Scholar
  24. 24.
    Picchietti D, Allen RP, Walters AS, Davidson JE, Myers A, Ferini-Strambi L. Restless legs syndrome: prevalence and impact in children and adolescents – the Peds REST study. Pediatrics. 2007;120(2):253–66.PubMedPubMedCentralCrossRefGoogle Scholar
  25. 25.
    Cortese S, Konofal E, Lecendreux M, Arnulf I, Mouren MC, Darra F, et al. Restless legs syndrome and attention-deficit/hyperactivity disorder: a review of the literature. Sleep. 2005;28(8):1007–13.PubMedCrossRefGoogle Scholar
  26. 26.
    Owens JA. A clinical overview of sleep and attention-deficit/hyperactivity disorder in children and adolescents. J Can Acad Child Adolesc Psychiatry. 2009;18(2):92–102.PubMedPubMedCentralGoogle Scholar
  27. 27.
    Silvestri R, Gagliano A, Aricó I, Calarese T, Cedro C, Bruni O, et al. Sleep disorders in children with attention-deficit/hyperactivity disorder (ADHD) recorded overnight by video-polysomnography. Sleep Med. 2009;10(10):1132–8.PubMedPubMedCentralCrossRefGoogle Scholar
  28. 28.
    Kirk VG, Bohn S. Periodic limb movements in children prevalence in a referred population. Sleep. 2004;27:313–5.PubMedCrossRefGoogle Scholar
  29. 29.
    Corkum P, Coulombe JA. Sleep in the context of ADHD: a review of reviews to determine implications for research and clinical practice. In: Montgomery-Downs H, Wolfson AR, editors. The Oxford handbook of infant, child, and adolescent sleep: development and problems. 1st ed. New York: Oxford University Press; 2013.Google Scholar
  30. 30.
    Chervin RD, Ruzicka DL, Giordani BJ, Weatherly RA, Dillon JE, Hodges EK, et al. Sleep-disordered breathing, behavior, and cognition in children before and after adenotonsillectomy. Pediatrics. 2006;117(4):e769–78.PubMedPubMedCentralCrossRefGoogle Scholar
  31. 31.
    Heijden KB, Smits MG, Someren EJ, Ridderinkhof KR, Gunning WB. Effect of melatonin on sleep, behavior, and cognition in ADHD and chronic sleep-onset insomnia. J Am Acad Child Adolesc. 2007;46(2):233–41.CrossRefGoogle Scholar
  32. 32.
    Pelayo R, Dubik M. Pediatric sleep pharmacology. Semin Pediatr Neurol. 2008;15(2):79–90.PubMedCrossRefGoogle Scholar
  33. 33.
    Kidwell KM, Van Dyk TR, Lundahl A, Nelson TD. Stimulant medications and sleep for youth with ADHD: a meta-analysis. Pediatrics. 2015;136(6)PubMedCrossRefGoogle Scholar
  34. 34.
    Corkum P, Panton R, Ironside S, Macpherson M, Williams T. Acute impact of immediate release methylphenidate administered three times a day on sleep in children with attention-deficit/hyperactivity disorder. J Pediatr Psychol. 2008;33(4):368–79.PubMedCrossRefGoogle Scholar
  35. 35.
    Galland BC, Tripp EG, Taylor BJ. The sleep of children with attention deficit hyperactivity disorder on and off methylphenidate: a matched case-control study. J Sleep Res. 2010;19(2):366–73.PubMedCrossRefGoogle Scholar
  36. 36.
    National Sleep Foundation. How much sleep do we really need? [Internet]. [place unknown]: [publisher unknown]; [date unknown]. Available from:
  37. 37.
    Becker SP, Froehlich TE, Epstein JN. Effects of methylphenidate on sleep functioning in children with attention-deficit/hyperactivity disorder. J Dev Behav. 2016;37(5):395–404.CrossRefGoogle Scholar
  38. 38.
    Moreau V, Rouleau N, Morin CM. Sleep, attention, and executive functioning in children with attention-deficit/hyperactivity disorder. Arch Clin Neuropsychol. 2013;28(7):692–9.PubMedCrossRefGoogle Scholar
  39. 39.
    Corkum P, Weiss SK, Tan-McNeill K, Davidson F. Pediatric behavioral insomnia in children with neurodevelopmental disabilities – strategies to improve sleep. Insomnia Rounds. 2014;2(6):1–6.Google Scholar
  40. 40.
    Mindell JA, Meltzer LJ. Behavioural sleep disorders in children and adolescents. Ann Acad Med Singap. 2008;37(8):722–8.PubMedGoogle Scholar
  41. 41.
    Papadopoulous N, Sciberras E, Hiscock H, Mulraney M, McGillivray J, Rinehart N. The efficacy of a brief behavioral sleep intervention in school-aged children with ADHD and comorbid autism spectrum disorder. J Atten Disord. 2015.Google Scholar
  42. 42.
    Owens JA, Rosen CL, Mindell JA, Kirchner HL. Use of pharmacotherapy for insomnia in child psychiatry practice: a national survey. Sleep Med. 2010;11(7):692–700.PubMedCrossRefGoogle Scholar
  43. 43.
    Chevereuil C, Polard E, Gicquel G, Frémaux T, Bentué-Ferrer D. Le traitement pharmacologique de l’insomnie en pédopsychiatrie. Therapie. 2010;65(1):1–12.CrossRefGoogle Scholar
  44. 44.
    Barrett JR, Tracy DK, Giaroli G. To sleep or not to sleep: a systematic review of the literature of pharmacological treatments of insomnia in children and adolescents with attention-deficit/hyperactivity disorder. J Child Adolesc Psychopharmacol. 2013;23(10):640–7.PubMedPubMedCentralCrossRefGoogle Scholar
  45. 45.
    Weiss MD, Wasdell MB, Bomben MM, Rea KJ, Freeman RD. Sleep hygiene and melatonin treatment for children and adolescents with ADHD and initial insomnia. J Am Acad Child Adolesc Psychiatry. 2006;45(5):512–9.CrossRefGoogle Scholar
  46. 46.
    Kledzik AM, Thorne MC. The role of melatonin in psychiatric disorders. Psychopharm Rev. 2011;46(7):49–56.CrossRefGoogle Scholar
  47. 47.
    Talk About Sleep. How to use melatonin correctly [Internet]. [Place unknown]: [publisher unknown]; [cited 2013]. Available from:
  48. 48.
    Mullane J, Corkum P. Case series: evaluation of a behavioral sleep intervention for three children with attention-deficit/hyperactivity disorder and dyssomnia. J Atten Disord. 2006;10(2):217–27.PubMedPubMedCentralCrossRefGoogle Scholar
  49. 49.
    Acevedo-Polakovich I, Lorch EP, Milich R. Comparing television use and reading in children with ADHD and non-referred children across two age groups. Media Psychol. 2007;9(2):447–72.CrossRefGoogle Scholar
  50. 50.
    Allen S, Howlet M, Corkum P. ABCs of SLEEPING: a review of evidence behind pediatric sleep practice recommendations. Sleep Med Rev. 2016;29:1–14.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  • Nicole Ali
    • 1
  • Fiona Davidson
    • 1
  • Marilyn MacPherson
    • 2
  • Penny Corkum
    • 1
    Email author
  1. 1.Department of Psychology and NeuroscienceDalhousie UniversityHalifaxCanada
  2. 2.Pediatrics, Colchester East Hants Health CenterTruroCanada

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