View source for Sleep in Children with Attention Deficit Hyperactivity Disorder (ADHD)

==Other poor sleep associated factors==
There are more factors that might contribute to sleep problems in children with ADHD:

* Co-morbidities: mood disorders, [[Generalised Anxiety Disorder|anxiety disorders]] and tic disorders have been linked with significant sleep problems<ref name=":29" /><ref>American Academy of Pediatrics (AAP). Clinical practice guideline: diagnosis and evaluation of the child with attention-deficit/hyperactivity disorder. Pediatrics 2000; 105: 1158-70</ref><ref name=":24">Nikles J, Mitchell GK, de Miranda Araújo R, Harris T, Heussler HS, Punja S, Senior HEJ. A systematic review of the effectiveness of sleep hygiene in children with ADHD. Psychology, Health & Medicine. 2020; 1–23.</ref><ref>Thomas S, Lycett K, Papadopoulos N, Sciberras E, Rinehart N. Exploring behavioral sleep problems in children with ADHD and comorbid autism spectrum disorder. Journal of Attention Disorders. 2018; 22(10): 947–958.</ref>. In children with ADHD, psychiatric comorbidities are very common: up to 87% have a comorbidity and 20% have three or more comorbidities<ref>Hodgkins P, Setyawan J, Mitra D, Davis K, Quintero J, Fridman M, Shaw M, Harpin V. [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3701791/ Management of ADHD in children across Europe: patient demographics, physician characteristics and treatment patterns]. European Journal of Pediatrics. 2013; 172(7): 895-906</ref>. Problems with sleep may also contribute to the development of comorbid anxiety or [[depression]]<ref>Hvolby A, Jorgensen J, Bilenberg N. Actigraphic and parental reports of sleep difficulties in children with attention-deficit/hyperactivity disorder. Archives of Pediatrics & Adolescent Medicine. 2008; 162: 323–329.</ref>. Depression is also associated with increased daytime sleepiness and overall sleep problems<ref name=":38" />.
*[[Obesity]]: there seems to be an association between ADHD and obesity<ref name=":22" /><ref>Cortese S, Angriman M, Maffeis C, Isnard P, Konofal E, Lecendreux M, Purper-Ouakil D, Vincenzi B, Bernardina BD, Mouren MC. Attention-deficit/hyperactivity disorder (ADHD) and obesity: a systematic review of the literature. Critical Reviews in Food Science and Nutrition. 2008; 48(6): 524-37</ref>. Obesity is correlated with sleep-disordered breachting and other sleep disorders<ref>Cortese S, Konofal E, Dalla Bernardina B, Mouren MC, Lecendreux M. Does excessive daytime sleepiness contribute to explaining the association between obesity and ADHD symptoms? Medical Hypotheses. 2008; 70(1): 12–16.</ref>, a short sleep duration<ref name=":15" /> and a shorter time in bed<ref>Hart CN, Larose JG, Fava JL, James BL, Wing RR. [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3644344/ The association between time in bed and obesity risk in young adults.] Behavioural Sleep Medicine. 2013; 11(5): 321–327.</ref>.
*[[Sensory Integration|Sensory difficulties]] are associated with sleep difficulties in children with ADHD<ref>Mimouni-Bloch A, Offek H, Engel-Yeger B, Rosenblum S, Posener E, Silman Z, Tauman R. Association between sensory modulation and sleep difficulties in children with Attention Deficit Hyperactivity Disorder (ADHD). Sleep Medicine. 2021; 84: 107-113</ref>. The challenges in regulation sensory perceptions result in difficulties when trying to initiate and sustain sleep<ref>Shochat T, Tzischinsky O, Engel-Yeger E. Sensory Hypersensitivity as a Contributing Factor in the Relation Between Sleep and Behavioral Disorders in Normal Schoolchildren. Behavioral Sleep Medicine. 2009; 7(1): 53-62</ref>.
*Children with more severe ADHD symptoms and lower motor proficiency may face an elevated risk of encountering sleep problems<ref>Papadopoulos N, Stavropoulos V, McGinley J, Bellgrove M, Tonge B, Murphy A, Cornish K, Rinehart N. [https://www.researchgate.net/publication/323707714_Moderating_Effect_of_Motor_Proficiency_on_the_Relationship_Between_ADHD_Symptoms_and_Sleep_Problems_in_Children_With_Attention_Deficit_Hyperactivity_Disorder-Combined_Type Moderating Effect of Motor Proficiency on the Relationship Between ADHD Symptoms and Sleep Problems in Children With Attention Deficit Hyperactivity Disorder-Combined Type]. Behavioral Sleep Medicine. 2019; 17(5): 646-656</ref>. ADHD severity is associated with greater sleep problems<ref name=":49" />.
*Parents' own sleep behaviour (sleep timing) might be associated with poorer quality sleep<ref>Iwata S, Iwata O, Matsuishi T. [https://www.researchgate.net/publication/235657709_Sleep_patterns_of_Japanese_preschool_children_and_their_parents_Implications_for_co-sleeping Sleep patterns of Japanese preschool children and their parents: implications for co-sleeping]. Acta Peadiatrica. 2013; 102: e257-62</ref>.
*Parents with ADHD themselfs often have troubles fostering healthy sleep habits and limiting screen time<ref name=":45">Peasgood T, Bhardwaj A, Biggs K. [https://link.springer.com/article/10.1007/s00787-016-0841-6 The impact of ADHD on the health and well-being of ADHD children and their siblings]. European Child and Adolescent Psychiatry. 2016; 25: 1217-1231</ref><ref>Chronis AM, Lahey BB, Pelham Jr WE, Kipp HL, Baumann BL, Lee SS. Psychopathology and substance abuse in parents of young children with attention-deficit/hyperactivity disorder. Journal of the American Academy of Child and Adolescent Psychiatry. 2003; 42(12): 1424-32</ref><ref>Gray L, Loring W, Malow BA, Pryor E, Turner-Henson, A, Rice M. Do Parent ADHD Symptoms Influence Sleep and Sleep Habits of Children with ADHD? A Pilot Study. Pediatric Nursing. 2020; 46(1): 18</ref>. Consistent parenting has shown to decrease bedtime resistance and sleep anxiety<ref name=":24" />.
*Poorer parent [[Mental Health|mental health]] is associated with child sleep problems<ref>Martin CA, Papadopoulos N, Chellew T, Rinehart NJ, Sciberras E. Associations between parenting stress, parent mental health and child sleep problems for children with ADHD and ASD: Systematic review. Research in Developmental Disabilities. 2019; 93: 103463.</ref>.
*Parents tend to be less diligent in enforcing their children's bedtime routines on days without school compared to school days<ref name=":46" /><ref name=":47" />. This inconsistency may impact the circadian rhythm and contribute to delayed sleep onset in general.
*Irregular schedules<ref name=":17" /><ref>Noble GS, O’Laughlin L, Brubaker B. [https://www.researchgate.net/publication/221752833_Attention_Deficit_Hyperactivity_Disorder_and_Sleep_Disturbances_Consideration_of_Parental_Influence Attention deficit hyperactivity disorder and sleep disturbances: Consideration of parental influence]. Behavioral Sleep Medicine. 2012; 10(1): 41–53.</ref>.
*Exposure at night to [[Blue Light and the Effect on Sleep|blue light sources]] (LED lights and light-emitting sources like smartphones or tablets<ref>Chaste P, Clement N, Botros HG, Guillaume J-L, Konyukh M, Pagan C, Scheid I, Nygren G, Anckarsäter H, Rastam M, Stahlberg O, Gillberg IC, Melke J, Delorme R, Leblond C, Toro R, Huguet G, Fauchereau F, Durand C, Boudarene L, Serrano E, Lemière N, Launay JM, Leboyer M, Jockers R, Gillberg C, Bourgeron T. [https://www.researchgate.net/publication/229949762_Genetic_variations_of_the_melatonin_pathway_in_patients_with_attention-deficit_and_hyperactivity_disorders Genetic variations of the melatonin pathway in patients with attention-defcit and hyperactivity disorders]. Journal of Pineal Research. 2011; 51(4): 394–399</ref><ref>Bijlenga D, van der Heijden KB, Breuk M, van Someren EJW, Lie MEH, Boonstra AM, Swaab HJT, Kooij JJS. Associations between sleep characteristics, seasonal depressive symptoms, lifestyle, and adhd symptoms in adults. Journal of Attention Disorders. 2013; 17(3): 261–275</ref><ref>Roenneberg T, Merrow M. [https://www.researchgate.net/publication/303502730_The_Circadian_Clock_and_Human_Health The circadian clock and human health.] Current Biology. 2016; 26(10): R432–R443</ref>) and social media activities delay bedtimes and lead to shorter sleep duration<ref>Walch OJ, Cochran A, Forger DB. [https://www.science.org/doi/10.1126/sciadv.1501705 A global quantifcation of “normal” sleep schedules using smartphone data]. Science Advances. 2016; 2(5): e1501705</ref>.
* Children (ages 12-14) are 2.47 times more likely to consume more caffeine (soda, coffee, energy drinks) than their peers during later times of the day. Also, their caffeine use is associated with poorer subjective sleep functioning<ref name=":43">Cusick CN, Langberg JM, Breaux R, Green CD, Becker SP. [https://academic.oup.com/jpepsy/article/45/6/643/5835378?login=false Caffeine Use and Associations With Sleep in Adolescents With and Without ADHD.] Journal of Pediatric Psychology. 2020; 45(6): 643-653</ref>. They may be using caffeine as a form of self-medication to enhance concentration<ref name=":43" /><ref>Bryant Ludden A, Wolfson AR. Understanding adolescent caffeine use: Connecting use patterns with expectancies, reasons, and sleep. Health Education & Behavior. 2010; 37: 330-342</ref>.