Sleep Regularity, Timing Could Influence ADHD Symptoms in Teens


New research expands on the understood link between sleep and ADHD-related behavior, and gives clinicians new therapeutic targets.

Jessica Lunsford-Avery, PhD (Duke)

Jessica Lunsford-Avery, PhD (Duke)

Timing and regularity of sleep could be a crucial factor in symptoms and social functioning associated with ADHD, according to new research presented at The American Professional Society of ADHD and Related Disorders (APSARD) 2021 Annual Conference this weekend.

The new data from research conducted by investigators at the Duke University Medical Center—and presented by Jessica Lunsford-Avery, PhD, a child development and behavioral health specialist—supports the long-held notion of sleep as a vital element in adolescent behavioral health relevant to ADHD.

In fact, it is the “complexity of sleep,” Lunsford-Avery and colleagues wrote, which has made it previously difficult to determine the aspects of sleep which influence adolescent ADHD outcomes, beyond just duration.

“Sleep supports adolescent behavioral health and functioning, particularly among teens with ADHD,” they wrote. “This study examined associations between two sleep indices (regularity, timing) and (1) ADHD symptoms and (2) academic/social functioning over and above the impact of shortened/fragmented sleep.”

In the study, funded by the Duke Institute for Brain Sciences and National Institute of Mental Health, investigators recruited 90 adolescents from the research institution’s community for their assessment. Mean patient age was 14.08 years old, with 46% reported as female.

Patients underwent 7 days and nights of actigraphy, and reported on ADHD symptom severity, as well as academic and social functioning, with additional comment from their parent/guardian.

The team controlled for sex, age, and race factors using stepwise linear regressions, and examined for associations between sleep timing and regulatory with ADHD and functional outcomes—after accounting for shortened/fragmented sleep.

Lunsford-Avery and colleagues observed that delayed sleep timing as linked to greater self-reported ADHD symptoms (P <.05) and lowered social functioning (P = .02) after accounting for shortened or fragmented sleep.

What’s more, irregular sleep was linked to greater patient- and parent-reported symptoms of ADHD (P = .01; P <.001, respectively), as well as lower social function (P = .003; P = .02, respectively). Lower academic functioning was also associated with irregular sleep, as per both patient and parent reports.

Investigators concluded that both sleep regularity and timing may be crucial to adolescent patients with ADHD achieving ideal attention and daytime functioning. In fact, both outcomes could inform potential intervention and interventional studies.

“Future work should focus on developing and evaluating convenient, low-cost, and effective methods for addressing delayed and/or irregular sleep patterns in ADHD populations,” they wrote.

The study, “Sleep Regularity and Timing Associated With ADHD Severity and Academic/Social Performance in Adolescents,” was presented at APSARD 2021.

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