Fiona Davidson

Manipulating Sleep Duration Alters Emotional Functioning and Cognitive Performance in Children

OBJECTIVE To examine the impact of sleep duration on emotional functioning and cognitive performance in children. METHODS 32 children (8-12 years) wore actigraphs for 3 weeks. Following a week of typical sleep, each child was randomly assigned to go to bed 1 hr earlier for 4 nights (Long Sleep) or 1 hr later for 4 nights (Short Sleep) relative to their typical bedtime. Each child then completed the opposite condition. After each week, emotional and cognitive functioning were assessed using objective and subjective measures. RESULTS Results revealed impaired functioning in the Short- relative to the Long-Sleep condition on measures of positive affective response, emotion regulation, short-term memory, working memory, and aspects of attention. CONCLUSIONS Results suggest that even modest differences in sleep duration over just a few nights can have significant consequences for childrens daytime functioning. These findings demonstrate the important impact of sleep duration on childrens daytime functioning.

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.

A Framework for the Assessment and Treatment of Sleep Problems in Children with Attention- Deficit/Hyperactivity Disorder

Children with attention-deficit/hyperactivity disorder (ADHD) have high rates of sleep problems and sleep disorders. It is critical that pediatricians assess for sleep problems during the course of ADHD assessment and when treating children with stimulant medication. Sleep must be considered in the differential diagnosis and in terms of comorbidity with ADHD. The most common sleep problem in children with ADHD is insomnia, and the first line of treatment should be the implementation of behavioral interventions rather than medication. More research is needed to determine if children with ADHD respond to behavioral interventions in a similar manner as typically developing children.

Sleep Quantity and Quality in Relation to Daytime Functioning in Children

This study examined sleep in relation to daytime functioning in 32 typically developing children (8–12 y). Participants wore actigraphs for one week and then completed tasks designed to measure emotional functioning, short-term memory, working memory, and attention. Results revealed that children slept approximately 1 h less per night than recommended. Older children had shorter sleep durations, higher sleep efficiencies, and later sleep onset times. Examination of the relationships between sleep and daytime functioning revealed that small variations in sleep were significantly associated with differences in emotional functioning and attention. Results highlight the need to increase awareness about the importance of sleep in children.

Better Nights/Better Days—Distance Intervention for Insomnia in School-Aged Children With/Without ADHD: A Randomized Controlled Trial

OBJECTIVE Better Nights/Better Days, a distance intervention for insomnia in school-aged children (with and without attention-deficit/hyperactivity disorder [ADHD]), was evaluated to determine its effectiveness on childrens sleep and psychosocial functioning. METHODS A single center, parallel group design randomized controlled trial (stratified on ADHD diagnosis) was conducted. Parents were randomized to intervention (n = 31) or waitlist control (n = 30), and completed questionnaires administered over the phone at baseline, postintervention (2 months), and follow-up (6 months). Actigraphy was also collected. The intervention consisted of a five-session manual and weekly telephone coach support. RESULTS The intervention group demonstrated a significant reduction in sleep problems and improved psychosocial functioning at postintervention and follow-up. Actigraphy results indicated improved sleep onset, but not sleep duration. Children with and without ADHD responded in a similar manner to this intervention. Parents provided high satisfaction ratings. CONCLUSIONS This intervention holds promise as an accessible, sustainable, and effective program to address insomnia in school-aged children.

Validating the Behavior Rating Inventory of Executive Functioning for Children With ADHD and Their Typically Developing Peers

The Behavior Rating Inventory of Executive Functioning (BRIEF) has been widely used both clinically and in research for measuring executive functioning (EF) in children with attention-deficit hyperactivity disorder (ADHD). This study examined the concurrent validity of the BRIEF (both parent and teacher ratings) compared to performance-based measures of EF in children with ADHD compared to typically developing (TD) children. The authors assessed 20 children with ADHD and 20 TD controls on 4 EF domains—working memory, planning, inhibition, and set shifting—using the BRIEF and performance-based measures of EF. Children (aged 8–12 years old) with ADHD demonstrated more EF impairment than their TD peers on both questionnaire- and performance-based measures. Ratings on questionnaire- and performance-based measures did not uniquely correlate with each other. Questionnaire-based measures were better at discriminating between children with ADHD and TD children, specifically BRIEF parent ratings, and discrimination depended mostly on the Working Memory, Plan/Organize, and Inhibit subscales. The BRIEF has clinical utility for discriminating between children with ADHD and their TD peers; however, some limitations exist for interpretation of the BRIEF, and it should be used with caution in the assessment and diagnosis of ADHD.

Emotional and Cognitive Impact of Sleep Restriction in Children

Several observational, cross-sectional, and longitudinal studies as well as a few well-controlled experimental studies have examined the impact of sleep loss on childrens daytime functioning. The emerging results indicate that sleep plays a critical role in various aspects of daytime functioning in children, including cognitive and emotional functioning. Furthermore, studies indicate that daytime functioning may be impaired by even small amounts of sleep restriction in children.

Sleep and Attention in Children With ADHD and Typically Developing Peers

Objective: The objective of this study was to examine the relationships between sleep and attention in both typically developing (TD) children and children with ADHD. Method: The current study examined sleep and attention in 50 children, from 6 to 12 years of age (25 ADHD, 25 TD). Attention was measured using the Conners’ Parent Rating Scale–Revised: Long Version and the Attention Network Test–Interaction (ANT-I), which provided an objective measure of alerting, orienting, and executive attention. Sleep was objectively measured using actigraphy. Results: Children with ADHD had poorer alerting and executive attention on the ANT-I, as well as poorer parent-reported attention. In addition, poor sleep predicted performance on alerting attention for children with ADHD and TD children, whereas the interaction between poor sleep and ADHD diagnosis predicted executive attention scores. Conclusion: The findings of the current study highlight the importance of ensuring children are getting good quality sleep to optimize attention, particularly for children with ADHD.

The Impact of Sleep Restriction on Daytime Functioning in School-Age Children With and Without ADHD: A Narrative Review of the Literature

The purpose of this narrative review was to synthesize the existing literature on the impact of sleep on daytime functioning in both typically developing (TD) children and children with attention-deficit/hyperactivity disorder (ADHD). Correlational studies in children suggest that insufficient sleep and impaired daytime functioning are significantly associated; however, this does not address the causal relationships between sleep and daytime functioning. The review results indicated that there is limited experimental sleep manipulation research in children. In the eight studies that employed experimental methods to examine sleep restriction, the consequences of insufficient sleep were greatest for attention and inconsistent for other domains, such as cognition and emotion regulation. Despite the significant co-occurrence of ADHD and sleep problems, the experimental sleep research focused on the daytime impact of shorter sleep in children with ADHD is extremely limited and as such more research is needed.