Sleep problems and disorders among adolescents with persistent and subthreshold attention-deficit/hyperactivity disorders

Abstract

Study Objectives: To investigate the sleep schedules, problems, and disorders among adolescents with persistent attention-deficit/hyperactivity disorder (ADHD) and those with partially remitted ADHD symptoms. Design: A case-control study. Setting: National Taiwan University and schools in Taipei Patients or Participants: The sample included 281 adolescents (male, 85.4%; 145 with persistent ADHD, 136 with subthreshold ADHD), aged 11 to 17, who were diagnosed with ADHD, according to DSM-IV criteria, at the mean age of 6.7 years (SD = 3.0) and 185 unaffected control subjects. Interventions: N/A. Measurements and Results: We conducted psychiatric interviews of participants and their mothers using the Chinese Kiddie-Schedule for Affective Disorders and Schizophrenia-Epidemiology version for making the diagnoses of ADHD, other psychiatric disorders, and sleep problems or disorders. We also collected the medication treatment data and parent and teacher reports of ADHD-related symptoms. Our results showed that adolescents with a childhood diagnosis of ADHD according to DSM-IV criteria, regardless of persistent ADHD, were more likely to have current and lifetime sleep problems and sleep disorders according to DSM-IV (insomnia, sleep terrors, nightmares, bruxism, and snoring). The presence of at least 1 psychiatric comorbid condition increased the risks for insom- insomnia and nightmares. The use of methylphenidate was not associated with further increased risk of sleep problems, except bruxism. Conclusions: Our findings support a relationship between ADHD and sleep problems, which can be partially explained by the psychiatric comorbidities, but did not support a disturbed sleep schedule. Our study suggests that mental health professionals should screen for sleep problems and psychiatric comorbidities among adolescents with a childhood diagnosis of ADHD regardless of the severity of current ADHD symptoms.