Sleep and sleepiness in children with attention deficit / hyperactivity disorder and controls

The present study assessed the association between habitual sleep patterns and one night of PSG measured sleep with daytime sleepiness in children with ADHD and typically developing children. Eighty‐two children (26 ADHD, 56 typically developing children), between 7 and 11 years, had nighttime sleep recorded using actigraphy over five nights (habitual sleep patterns) and polysomnography during one night (immediate sleep patterns), both within their home environments. Daytime sleepiness was examined using the multiple sleep latency test within a controlled laboratory setting the following day. Using Spearman correlations, the relationships between mean sleep latencies on the multiple sleep latency test and scores on a modified Epworth Sleepiness Scale with polysomnographic measures of sleep quality and architecture and with actigraphic sleep quality measures were examined. Longer sleep latency, measured using polysomnography and actigraphy, was related to longer mean sleep latencies on the multiple sleep latency test in typically developing participants, whereas actigraphic measures of sleep restlessness (time awake and activity during the night), as well as time in slow‐wave sleep, were positively related to mean sleep latency on the multiple sleep latency test in children with ADHD. These results show a differential relationship for children with ADHD and typically developing children between habitual and immediate sleep patterns with daytime sleepiness and suggest that problems initiating and maintaining sleep may be present both in nighttime and daytime sleep.     

Association between symptoms and subtypes of attention‐deficit hyperactivity disorder and sleep problems/disorders

This study aimed to investigate the association between attention‐deficit hyperactivity disorder (ADHD) symptoms and subtypes, and sleep schedules, daytime inadvertent napping, and sleep problems/disorders in children and adolescents with and without ADHD. The sample included 325 patients with ADHD, aged 10–17 years [male: 81.5%; combined type (ADHD‐C): 174; predominantly inattentive type (ADHD‐I): 130; predominantly hyperactive‐impulsive type (ADHD‐HI): 21], and 257 children and adolescents without lifetime ADHD (non‐ADHD). We conducted psychiatric interviews with the participants and their mothers before 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 symptoms. Multi‐level models were used for data analyses controlling for sex, age, psychiatric comorbidities, and treatment with methylphenidate. The ADHD‐C and ADHD‐I groups had more daytime inadvertent napping. In general, the three subtypes were associated with increased rates of sleep problems/disorders. Specifically, ADHD‐C rather than ADHD‐I was associated with circadian rhythm problems, sleep‐talking, nightmares (also ADHD‐HI), and ADHD‐I was associated with hypersomnia. The most‐related sleep schedules and problems for inattention and hyperactivity‐impulsivity were earlier bedtime, later rise time, longer nocturnal sleep, more frequent daytime napping, insomnia, sleep terrors, sleep‐talking, snoring, and bruxism across informants. The findings imply that in addition to the dichotomous approach of ADHD and considering the psychiatric comorbid conditions, ADHD subtypes and symptom dimensions need to be considered in clinical practice and in the research regarding the association between ADHD and sleep problems/disorders.     

注意缺陷多动障碍儿童的工作记忆损害特征

目的:探讨注意缺陷多动障碍(ADHD)儿童工作记忆功能特征。方法:本研究为横断面研究。根据美国精神疾病诊断和统计手册第4版(DSM-IV),对符合ADHD诊断标准的未经治疗的100名门诊患儿及年龄、性别相匹配的100名正常儿童分别采用韦氏儿童智力测验量表中国修订本(C-WISC)及其中的顺背数字(反映言语存贮、加工)、倒背数字(反映言语存贮、加工、中央执行)、Corsi木块和空间n-Back任务(反映视空间存贮和中央执行)进行言语及空间工作记忆测试。结果:ADHD组儿童在顺背数字最高位数及总得分、倒背数字最高位数及总得分、Corsi木块最多木块数及总得分均低于对照组儿童,空间2-Back任务反应时短于对照组儿童(均P0.05)。结论:ADHD儿童存在工作记忆功能缺陷,此缺陷涉及言语环路、视空间存贮系统及中央执行。     

Oxidative imbalance in adult attention deficit/hyperactivity disorder

OBJECTIVE: There are few studies evaluating the biochemical basis of adult attention deficit/hyperactivity disorder (A-ADHD). In the present study, we evaluated whether nitric oxide (NO), an oxidant, level and superoxide dismutase (SOD), an antioxidant, activity are associated with A-ADHD or not. METHODS: Twenty A-ADHD patients from Gaziantep University Sahinbey Research Hospital, Psychiatry Clinic, diagnosed according to The Turkish version of Adult ADD/ADHD DSM IV-Based Diagnostic Screening and Rating Scale by two psychiatrists (H.A.S. and S.S.), and twenty-one healthy volunteer controls were included. Blood samples were collected; NO levels and SOD activities were measured. RESULTS: The mean NO levels in patients were significantly higher than those of controls and SOD activity of patients was significantly lower than controls. CONCLUSIONS: Remarkable high levels of oxidant NO, and low SOD activities suggest an oxidative imbalance in A-ADHD. This is the first study evaluating the oxidative metabolism in A-ADHD.     

注意缺陷多动障碍儿童的眼动抑制缺陷对照研究

目的:探讨注意缺陷多动障碍(Attention Deficit Hyperactivity Disorder,ADHD)儿童在抑制性眼动任务中的反应特征。方法:采用注视、主动眼动及反向眼动任务对21例ADHD儿童和21例正常对照儿童进行评估。结果:(1)注视任务中,ADHD组侵入性眼跳数目高于对照组[无分心条件:(12.67±12.28)vs.(6.38±6.95),P=0.040;分心条件:(16.91±10.00)vs.(11.29±5.99),P=0.030];(2)主动眼动任务中,两组儿童眼跳参数差异无统计学意义;(3)反向眼动任务中,ADHD组眼跳方向错误率高于对照组[间隔条件:(68.14±17.85)%vs.(54.10±20.22)%,P=0.020;重叠条件:(62.49±17.54)%vs.(49.27±17.21)%,P=0.020]。结论:注意缺陷多动障碍儿童眼动抑制能力存在缺陷,推测可能是由于注意缺陷多动障碍儿童具有异常的额叶-纹状体结构和/或功能所致。     

Genome-wide linkage analysis in a Dutch multigenerational family with attention deficit hyperactivity disorder

Attention deficit hyperactivity disorder (ADHD) is a common neuropsychiatric disorder. Genetics has an important role in the aetiology of this disease. In this study, we describe the clinical findings in a Dutch family with eight patients suffering from ADHD, in whom five had at least one other psychiatric disorder. We performed a genome-wide (parametric and nonparametric) affected-only linkage analysis. Two genomic regions on chromosomes 7 and 14 showed an excess of allele sharing among the definitely affected members of the family with suggestive LOD scores (2.1 and 2.08). Nonparametric linkage analyses (NPL) yielded a maxNPL of 2.92 (P=0.001) for marker D7S502 and a maxNPL score of 2.56 (P=0.003) for marker D14S275. We confirmed that all patients share the same haplotype in each region of 7p15.1–q31.33 and 14q11.2–q22.3. Interestingly, both loci have been reported before in Dutch (affected sib pairs) and German (extended families) ADHD linkage studies. Hopefully, the genome-wide association studies in ADHD will help to highlight specific polymorphisms and genes within the broad areas detected by our, as well as other, linkage studies.     

Early childhood temperament in pediatric bipolar disorder and attention deficit hyperactivity disorder

Recent theories suggest that children with pediatric bipolar disorder (PBD) may exhibit more difficult temperaments premorbidly, including traits such as behavioral disinhibition and difficulty with emotion regulation. We investigated temperament characteristics retrospectively during infancy and toddlerhood in subjects with PBD (n=25), attention-deficit/hyperactivity disorder (ADHD; n=25), and healthy controls (n=25). Children with PBD were reported to experience increased difficult temperament in both infancy and toddlerhood compared to children with ADHD. Several characteristics of difficult temperament were associated with residual symptoms of mania and depression. Difficult premorbid temperament characteristics may be a specific indicator of a bipolar diathesis, or might signal underlying dysfunction in affective processes that significantly increase risk for a mood disorder.     

Spatial orienting and focused attention in attention deficit hyperactivity disorder

Seventeen children with attention deficit disorder (ADHD) and 10 normal controls performed two tasks while event-related potentials were recorded. ADHD subjects took part in two more sessions under methylphenidate (MP) or placebo. In the spatial orienting task, invalidly cued targets elicited a longer reaction time (RT) and a P₃ that was longer in latency and greater in amplitude than did validly cued targets. Performance was similar for both groups, but the early portion of P₃ (300–400 ms) was lower in amplitude for invalidly cued targets in ADHD subjects. MP increased accuracy without affecting RT and shortened P₃ peak latency and increased the amplitude of its early portion. In the focused attention task, accuracy was greater for controls and MP, but there were no RT differenees. Attended stimuli elicited greater amplitude P₁, N₁, and P₃ than did nonattended stimuli, but these measures were unaffected by diagnosis or medication.     

单一和双重干扰源对混合型注意缺陷多动障碍儿童干扰控制的影响

目的:探讨单一干扰源和双重干扰源对混合型注意缺陷多动障碍(ADHD)儿童的干扰控制的影响。方法:对25例符合美国精神障碍诊断与统计手册第4版(DSM-IV)诊断标准的门诊混合型ADHD儿童和25名性别、年龄和智力相匹配的对照组儿童,进行图形Stroop测验,通过操纵图片的颜色和形状特征,设置了单一干扰和双重干扰两种条件,比较两组被试的冲突效应量。结果:在单一干扰条件下,ADHD组的冲突效应量显著大于对照组(P0.05),而在双重干扰条件下,两组的冲突效应量差异无统计学意义(P0.05)。结论:本研究提示,在单一干扰源条件下,混合型ADHD儿童表现出干扰控制缺陷,但在双重干扰源条件下,混合型ADHD儿童的干扰控制表现与正常儿童差异不显著。     

Circadian motor activity affected by stimulant medication in children with attention‐deficit/hyperactivity disorder

Attention‐deficit/hyperactivity disorder (ADHD) is a highly prevalent disorder occurring in approximately 3–5% of school‐aged children. The core symptoms of ADHD are effectively treated with stimulant medications such as methylphenidate; however, there are also negative side effects, including insomnia. It has been suggested that administration of stimulant medication may alter the timing or regularity of circadian motor activity levels. This study aimed to investigate the impact of stimulant medication on the strength and timing of circadian rhythms in 16 stimulant medication‐naïve children with ADHD. Participants were monitored for changes in motor activity during a 3‐week blinded placebo‐controlled medication trial to examine the impact of immediate‐release methylphenidate hydrochloride. Motor activity was measured by actigraphy, and 24‐h activity profiles were analysed using cosinor analyses to identify measurable changes in circadian rhythms. The children in this sample demonstrated significant increases in motor activity during the sleep‐onset latency period. They also showed a significant reduction in relative circadian amplitude and a phase‐delay in the timing of the daily rhythm. Clinicians and parents of children being treated with stimulant medication for ADHD should be aware that stimulant medication may cause disruption of sleep/circadian rhythms. Behavioural strategies to improve sleep may be useful for children experiencing these negative effects from medication.     

Sleep in adults with attention deficit hyperactivity disorder (ADHD) before and during treatment with methylphenidate: a controlled polysomnographic study

STUDY OBJECTIVES: Sleep problems are frequently associated with childhood ADHD, as indicated by numerous polysomnographic investigations showing increased nocturnal movements, reduced sleep efficiency, and decreased percentage of REM sleep (although findings are not consistent over all studies). Data on objective and subjective sleep parameters in adults with ADHD are sparse, and to date the impact of stimulants, the most widely used pharmacological treatment for ADHD, on sleep in adults with ADHD has not been examined. Thus the objectives of our study were to assess objective and subjective sleep parameters in adults with ADHD and the impact of stimulant medication on sleep. DESIGN: Two-group comparison and open-label therapy study. PARTICIPANTS: We enrolled 34 nonmedicated patients with ADHD, of whom 24 were without current comorbid psychiatric disorders, and 34 sex- and gender-matched control subjects without current psychiatric disorders or psychotropic medication. INTERVENTIONS: Ten patients were treated with methylphenidate over > or =26 days with a mean daily dose of 36.7 +/- 11.2 mg. MEASUREMENTS: Polysomnographic recording over 2 consecutive nights as well as assessments of subjective sleep parameters were performed in all patients and controls before treatment and reassessed in those patients receiving methylphenidate. RESULTS: Compared to controls untreated patients showed increased nocturnal activity, reduced sleep efficiency, more nocturnal awakenings and reduced percentage of REM sleep. Treatment with methylphenidate resulted in increased sleep efficiency as well as a subjective feeling of improved restorative value of sleep. CONCLUSIONS: Sleep problems in patients with ADHD continue from childhood to adulthood, with similar objective sleep characteristics in adults and children with ADHD. Medication with methylphenidate appears to have beneficial effects on sleep parameters in adults with ADHD.     

哌甲酯控释剂治疗对注意缺陷多动障碍儿童父母压力的影响

目的:探讨哌甲酯控释剂(OROS-MPH)治疗对注意缺陷多动障碍(attention deficit hyper-activity disorder,ADHD)患者临床症状和父母压力的影响。方法:采用自身对照研究设计,对符合美国精神障碍诊断与统计手册第四版(Diagnostic and Statistical Manual of Mental Disorders-Fourth Edition,DSM-IV)诊断标准的73名ADHD患者(年龄6~15岁),使用哌甲酯控释剂(18~54mg/d)治疗8周。以父母填写的IOWA Conners量表及研究者填写的ADHD症状评定问卷评估患者的临床症状,并作为主要临床疗效评价指标,以父母填写的父母压力指数量表(Parenting Stress Index,PSI)来评估父母的压力,分别在基线、治疗4周末和8周末用以上问卷进行评估。结果:66名ADHD患儿完成了8周的治疗。经哌甲酯控释剂治疗后,ADHD患者IOWA Conners量表中的注意缺陷/多动因子分、对立/违抗因子分和总分随治疗时间下降(均P<0.001);ADHD症状评定问卷的注意缺陷因子分、多动冲动因子分和总分较服药前下降(均P<0.001);PSI量表的压力总分随时间明显下降(P<0.01),PSI量表中儿童方面分量表中,适应性、父母的接受度、要求、心境、注意不能/多动、父母的强制性6个因子得分均随着时间下降(均P<0.01);在父母方面分量表中,抑郁、角色的限制、配偶关系、孤独、健康状况5个因子得分均随着时间显著下降(均P<0.01)。基线时PSI总分与IOWA Conners量表总分、ADHD症状评定问卷总分呈正相关(r=0.346~0.902,均P<0.01)。结论:哌甲酯控释剂治疗能有效改善ADHD患者的临床症状和改善患者及其父母的压力,提高社会功能。     

注意缺陷多动障碍儿童父母的执行功能生态学特征

目的:探讨注意缺陷多动障碍(ADHD)儿童父母执行功能生态学特征。方法:选取147名符合美国精神障碍诊断与统计手册第4版(DSM-Ⅳ)诊断标准的注意缺陷多动障碍儿童的父母亲,130名无注意缺陷多动障碍及其他神经疾患的正常儿童的年龄、受教育年限匹配的父母亲,让其分别填写执行功能行为评定量表成人问卷(自评和他评)(BRIEF-A),比较两组对象执行功能。结果:ADHD组父母BRIEF-A自评、他评量表,在执行总分、行为管理指数和元认知管理指数及其所属的抑制、转换、情绪控制、自我监控、启动、工作记忆、计划和组织因子方面,均明显低于对照组(均P<0.05);而父母自评的任务监控因子两组差异无统计学意义(P>0.05)。结论:注意缺陷多动障碍患儿父母的执行功能存在一定的缺陷。     

The sleep of children with attention deficit hyperactivity disorder on and off methylphenidate: a matched case–control study

In the present study, we assessed the effects of regular use of methylphenidate medication in children diagnosed with attention deficit hyperactivity disorder (ADHD) on sleep timing, duration and sleep architecture. Twenty‐seven children aged 6–12 years meeting diagnostic criteria for Diagnostic and Statistical Manual version IV ADHD and 27 control children matched for age (±3 months) and gender. Two nights of standard polysomnographic (PSG) recordings were conducted. ADHD children were allocated randomly to an on‐ or 48 h off‐methylphenidate protocol for first or second recordings. Control children’s recordings were matched for night, but no medication was used. Mixed modelling was employed in the analyses so that the full data set was used to determine the degree of medication effects. Methylphenidate in ADHD children prolonged sleep onset by an average of 29 min [confidence interval (CI) 11.6, 46.7], reduced sleep efficiency by 6.5% (CI 2.6, 10.3) and shortened sleep by 1.2 h (CI 0.65, 1.9). Arousal indices were preserved. Relative amounts of stages 1, 2 and slow wave sleep were unchanged by medication. Rapid eye movement sleep was reduced (?2.4%) on the medication night, an effect that became non‐significant when control data were incorporated in the analyses. PSG data from ADHD children off‐medication were similar to control data. Our findings suggest that methylphenidate reduces sleep quantity but does not alter sleep architecture in children diagnosed with ADHD. An adequate amount of sleep is integral to good daytime functioning, thus the sleep side effects of methylphenidate may affect adversely the daytime symptoms the drug is targeted to control.     

运动改善注意缺陷多动障碍儿童抑制功能的meta分析

目的:探讨运动对ADHD儿童抑制功能的影响。方法:检索Pubmed、Web of Science、theCochrane Library、EMbase建库至2021年5月有关运动对ADHD儿童抑制功能影响的文献,采用Reviewer Manager 5.3软件进行meta分析。结果:纳入11篇文献,共12项研究,研究对象累计644例。分析显示,运动对改善ADHD儿童抑制功能有积极影响(SMD=0.74,95%CI:0.36～1.11,P<0.001)。亚组分析显示,长期规律进行以开式运动技能为主、中至高强度运动的患儿,抑制功能的改善均优于对照组(SMD=0.84、0.95、0.56,95%CI:0.40～1.28、0.52～1.38、0.13～1.00,均P<0.05);小运动量(SMD=1.04,95%CI:0.35～1.72,P<0.01)和大运动量(SMD=0.57,95%CI:0.04～1.10,P<0.05)对患儿抑制功能的影响均优于对照组。结论:运动可改善ADHD儿童的抑制功能,开式动作技能为主的、中至高强度的长期规律运动可显著提升患儿的抑制功能。     

注意缺陷多动障碍综合征患儿睡眠结构的初探

目的 探讨注意缺陷多动障碍（ADHD）综合征患儿的睡眠结构，睡眠中痢性放电及睡眠周期性肢体运动（PLMS）的情况；比较ADHD各亚型问睡眠结构的差异。方法 利用多导睡眠监护仪对2005年6月至2006年11月在首都儿科研究所神经科门诊就诊的符合DSM-Ⅳ诊断标准的58例ADHD患儿及30名正常儿童进行整夜睡眠结构监测。结果 ADHD组58例，其中4例睡眠监测未完成，实际完成54例。ADHD组中混合型（ADHD—C）31例（57．4％，31／54），注意缺陷型（ADHD-I）15例（27．8％，15／54），多动／冲动型（ADHD．H）8例（14．8％，8／54）。①与对照组比较，ADHD组快速动眼期（REM）潜伏期短、睡眠潜伏期延长和睡眠效率降低，差异有统计学意义（P〈0．05）；②ADHD-C患儿睡眠Ⅱ期百分比较ADHD-I增加，差异有统计学意义（P〈0．05）；③ADHD组PLMS发生率为37．0％（20／54），对照组PLMS发生率为13．3％（4／30），差异有统计学意义（P〈0．05）；④ADHD组和对照组EEG未见痢性放电。结论 ①ADHD患儿存在REM睡眠结构的改变、入睡困难及睡眠效率降低；②睡眠Ⅱ期百分比的增多可使ADHD-C较ADHD-I有更多和更重的症状；③ADHD患儿睡眠过程中PLMS发生率较对照组显著升高，PLMS也是导致ADHD患儿睡眠质量下降的原因之一。     

Overrepresentation of adoptees in children with the attention deficit disorder

In a sample (N-200) from two populations of children diagnosed as having the attention deficit disorder (ADD: DSM-III diagnosis for hyperactivity), a 17% rate of nonrelative adoption was found. This figure represents an approximately eight-fold increase over the base rate of nonrelative adoption estimated in a non-ADD control group and in the general population.This work was supported by a grant from the Ontario Mental Health Foundation.     

重复经颅磁刺激联合认知行为训练治疗注意力缺陷伴多动障碍儿童的疗效

目的:观察重复经颅磁刺激(repetitive transcranial magnetic stimulation,rTMS)联合认知行为训练治疗注意力缺陷伴多动障碍(attention deficit hyperactivity disorder,ADHD)患儿的临床疗效.方法:60例ADHD患儿按随机数字表法分为对照组和实验组,每组30例.对照组常规采用认知行为治疗,实验组在采用认知行为训练基础上加用rTMS,治疗前后采用数字划消测试(Number Cancel Test,NCT)和Conners父母量表(Parents Symptom Questionnaire,PSQ)进行评估.结果:对照组治疗前后数字划消测试及Co n n e r s父母量表评分差异均有统计学意义(P<0.01),实验组治疗前后数字划消测试及Conners父母量表评分差异均有统计学意义(P<0.01).实验组与对照组治疗后数字划消测试划在对数、划漏数和净分三项评分差异亦均有统计学意义(均P<0.01),在Conners父母量表评分中学习问题和多动指数两项评分差异亦均有统计学意义(均P<0.05).结论:认知行为训练、rTMS联合认知行为训练治疗ADHD患者均有显著疗效.rTMS联合认知行为训练在治疗ADHD患者与单纯认知行为训练相比有疗效优势.     

Adult attention deficit hyperactivity disorder and early maladaptive schemas

The purpose of the current study is to present the early maladaptive schemas in adult attention deficit hyperactivity disorder (ADHD). The study sample comprised 107 participants, including 55 adult ADHD and 52 healthy volunteers. The age of the participants ranged between 18 and 32 years. Structured Clinical Interview Form for DSM-IV Axis I (SCID-I) and Structured Clinical Interview Form for DSM-III-R Disorders (SCID-II) were applied to all participants and Diagnostic Interview for ADHD (DIVA) for ADHD group based on DSM-5 criteria. The participants filled the Young Schema Questionnaire (YSQ-S3), Adult ADHD Self-Report Scale (ASRS), Wender Utah RatingScale-25 (WURS), Beck Depression Inventory (BDI) and The Beck Anxiety Inventory (BAI). All maladaptive schemas were found to be statistically significantly higher in the ADHD group. As compatible with ADHD core symptoms, “Failure,” “Emotional Inhibition,” “Insufficient Self-Control” and “Social Isolation” were the most seen maladaptive schemas in the ADHD group. “Approval Seeking,” “Entitlement/Grandiosity” and “Punitiveness” were found the weakest schemas in the ADHD group. This study besides supporting the theory of early maladaptive schemas suggests that identifying and modifying maladaptive schemas interventions based on specific schemas can be an important and useful method for psychotherapy in treatment of ADHD.     

成人注意缺陷多动障碍生态执行功能特点

目的:探讨成人注意缺陷多动障碍(ADHD)生态执行功能特点。方法:对41名符合Con-ners’成人ADHD诊断会谈(Conners’Adult ADHD Diagnostic Interview for DSM-IV,CAADID)中ADHD诊断标准的门诊患者和42名年龄、受教育年限与之匹配的正常对照,进行执行功能行为评定量表成人版(BRIEF-A)自评问卷评定。结果:成人期仍符合CAADID诊断标准的ADHD患者,其BRIEF-A自评问卷,经多重检验校正后行为管理指数和元认知指数两个维度得分均高于对照组(均P<0.01),抑制、感情控制、任务启动、任务监测4个因子得分也高于对照组(均P<0.05)。结论:ADHD成人患者生态执行功能可能存在缺陷。