Nighttime media use in adolescents with ADHD: links to sleep problems and internalizing symptoms.

This study examined nighttime media use in relation to sleep problems and anxiety/depression symptoms in adolescents with attention-deficit/hyperactivity disorder (ADHD). Participants were 81 adolescents (69% male) ages 13-17 with ADHD. Adolescents completed measures assessing pubertal development, nighttime media use, circadian preference, and daytime sleepiness. Both adolescents and parents completed measures of sleep duration, sleep problems, and internalizing symptoms. When summing across media uses (eg, social networking, playing video games, watching television), the average nighttime media use (after 9:00PM) was 5.31 h. Overall, 63% of adolescents reported obtaining less than 8 h of sleep on school nights, and this percentage rose to 77% for parent-reported sleep duration. Moreover, adolescents obtaining less sleep than recommended had more nighttime media use than those obtaining ≥8 h of nightly sleep. Controlling for age, sex, pubertal development, stimulant medication use, and ADHD symptom severity; nighttime media use was associated with shorter sleep duration and increased sleep problems across both adolescent and parent report. Media use was also associated with greater adolescent-reported anxiety and depression, and marginally associated with eveningness circadian preference and greater daytime sleepiness. In considering specific anxiety dimensions, media use was associated with greater adolescent-reported panic symptoms and parent-reported generalized anxiety disorder symptoms. Our findings suggest that nighttime media use may contribute to sleep problems and comorbid internalizing symptoms in adolescents with ADHD, although additional studies are needed to determine causality, potential bidirectional associations, and underlying mechanisms such as using media to (mis)manage negative emotions. Media use is important to assess and monitor and may be a significant intervention target when addressing sleep and internalizing problems, and possible underlying cognitive-emotional processes in adolescents with ADHD.

Becker SP ，Lienesch JA 《-》

Featured Article: Technology Use and Sleep in Adolescents With and Without Attention-Deficit/Hyperactivity Disorder.

This study used a multi-informant approach to examine differences in types and rates of technology used by adolescents with and without attention-deficit/hyperactivity disorder (ADHD), associations between technology use and sleep/daytime sleepiness, and whether technology use was differentially related to sleep/daytime sleepiness in adolescents with and without ADHD. Eighth graders with (n = 162) and without (n = 140) ADHD were recruited. Adolescents completed questionnaires assessing time spent using technology, sleep-wake problems, school-night time in bed, and daytime sleepiness. Parents and teachers reported on adolescents' technology use and daytime sleepiness, respectively. Adolescents with ADHD had significantly greater total technology, television/movie viewing, video game, and phone/video chatting use than adolescents without ADHD. Adolescents with ADHD engaged in twice as much daily video game use compared to those without ADHD (61 vs. 31 min). Controlling for medication use, ADHD status, pubertal development, sex, and internalizing symptoms, greater parent- and adolescent-reported technology use was associated with more sleep-wake problems and less time in bed. ADHD status did not moderate the relations between technology use and these sleep parameters. In contrast, ADHD status moderated the association between parent-reported technology use and teacher-reported daytime sleepiness, such that this association was significant only for adolescents with ADHD. Technology use, although more prevalent in adolescents with ADHD, is linked with more sleep problems and reduced school-night sleep duration regardless of ADHD status. Technology use is associated with teacher-rated daytime sleepiness only in adolescents with ADHD. Clinicians should consider technology usage when assessing and treating sleep problems.

Bourchtein E ，Langberg JM ，Cusick CN ，Breaux RP ，Smith ZR ，Becker SP ... -  《-》

Evening circadian preference is associated with sleep problems and daytime sleepiness in adolescents with ADHD.

Adolescence is a developmental period characterized by disruptions in sleep and changes in circadian preferences. Although adolescents with attention-deficit/hyperactivity disorder (ADHD) are at even higher risk of sleep disruption than their peers, no study has examined whether circadian preference is associated with sleep problems and daytime sleepiness in adolescents with ADHD. This study provides an initial test of the hypothesis that greater evening preference would be associated with more sleep problems and daytime sleepiness in adolescents diagnosed with ADHD. Participants were 80 adolescents (69% male), aged 13-17 years, with ADHD. Adolescents completed measures assessing circadian preference, pubertal development, anxiety/depressive symptoms and weeknight sleep duration. Both adolescents and parents completed measures of sleep problems and daytime sleepiness. In regression analyses controlling for a number of other variables (i.e., age, sex, pubertal development, ADHD medication use, and ADHD, oppositional defiant disorder and internalizing symptom severity), greater evening preference was associated with both adolescent- and parent-reported sleep problems and daytime sleepiness. Greater evening preference remained significantly associated with each of these sleep problems and daytime sleepiness when also controlling for weeknight sleep duration. This is the first study to demonstrate that evening circadian preference is associated with both sleep problems and daytime sleepiness in adolescents with ADHD. The results indicate that it is important to consider circadian function as research examining sleep in adolescents with ADHD continues to advance.

Becker SP ，Kapadia DK ，Fershtman CEM ，Sciberras E ... -  《-》

Sleep and daytime sleepiness in adolescents with and without ADHD: differences across ratings, daily diary, and actigraphy.

Children with attention-deficit/hyperactivity disorder (ADHD) experience greater sleep problems than their peers. Although adolescence is generally a developmental period characterized by insufficient sleep, few studies have used a multi-informant, multi-method design, to examine whether sleep differs in adolescents with and without ADHD. Targeted recruitment was used to enroll an approximately equal number of eighth-grade adolescents (mean age = 13 years) with (n = 162) and without ADHD (n = 140). Adolescents and parents completed global ratings of sleep problems; adolescents, parents, and teachers completed ratings of daytime sleepiness. Adolescents wore actigraphs and completed a daily sleep diary for approximately 2 weeks. Adolescents with ADHD were more likely than adolescents without ADHD to obtain insufficient sleep on school days (per diary) and weekends (per diary and actigraphy). Adolescents with ADHD were also more likely to report falling asleep in class and to have stayed up all night at least twice in the previous 2 weeks (14% and 5% reported all-nighters for ADHD and comparison, respectively). In regression analyses controlling for a number of variables known to impact sleep (e.g. pubertal development, sex, medication use, having an externalizing, anxiety, or depression diagnosis), ADHD remained associated with shorter diary and actigraphy school night sleep duration, adolescent- and parent-reported daytime sleepiness, and parent-reported difficulties initiating and maintaining sleep and total sleep disturbance. Controlling for other variables, the odds of being classified with clinically elevated parent-reported sleep disturbance were 6.20 times greater for adolescents with ADHD. Findings provide some of the clearest evidence yet that adolescents with ADHD experience more sleep problems and sleepiness than their peers without ADHD. It may be especially important to assess for sleep problems in adolescents with ADHD and to evaluate whether existing sleep interventions are effective, or can be optimized, for use in adolescents with ADHD who also have sleep problems.

Becker SP ，Langberg JM ，Eadeh HM ，Isaacson PA ，Bourchtein E ... -  《-》

A multi-method examination of sluggish cognitive tempo in relation to adolescent sleep, daytime sleepiness, and circadian preference.

The field's understanding of the association between sluggish cognitive tempo (SCT) and sleep is severely limited by the lack of multi-method and multi-informant research designs that move beyond global ratings, often focused on a limited number of sleep-related domains, such as daytime sleepiness. The current study begins to address these limitations by using actigraphy, daily sleep diary, and self- and parent-report global ratings of sleep in adolescents, a developmental period marked by changes in SCT, sleep, and circadian function. As SCT and sleep are also associated with ADHD symptoms, we tested these associations in a sample of adolescents with and without ADHD. Adolescents (N = 302; M age = 13.17 years, 44.7% female) with (n = 162) and without ADHD (n = 140) and parents completed global ratings of sleep and daytime sleepiness, and adolescents completed a measure of circadian preference. Adolescents also wore actigraphs for approximately two weeks, during which daily diaries were completed. Above and beyond demographic characteristics (i.e., sex, race, and family income), pubertal development, medication use, and ADHD group status, adolescents' self-reported SCT symptoms were uniquely associated with shorter sleep duration and later sleep onset per both actigraphy and daily diary. SCT symptoms were also uniquely associated with longer sleep onset latency and poorer overall sleep (per daily diary), more sleep/wake problems and daytime sleepiness (per adolescent rating), more difficulties initiating and maintaining sleep (per parent rating), and later eveningness preference (per adolescent rating). Nearly all significant effects remained in sensitivity analyses controlling for adolescent- or parent-reported ADHD symptom dimensions. Findings provide the strongest evidence to date for SCT being uniquely linked to poorer sleep, greater daytime sleepiness, and a later evening circadian preference across subjective and objective measures. Longitudinal studies are needed to evaluate predictive and bidirectional associations.

Fredrick JW ，Yeaman KM ，Yu X ，Langberg JM ，Becker SP ... -  《-》