Penny Corkum

Developing a Measure of Sluggish Cognitive Tempo for Children: Content Validity, Factor Structure, and Reliability

Sluggish cognitive tempo (SCT) is a construct that some researchers believe may be extremely useful in understanding the inattentive subtype of attention-deficit/hyperactivity disorder, and may even help define a completely new disorder. However, the construct of SCT is as yet inadequately operationally or theoretically defined. The authors took the first steps toward developing an empirically supported measure of SCT in children. In Study 1, potential items to measure SCT were identified from a literature review, content validity of the items was evaluated by a group of experts, and a preliminary set of SCT items were selected. In Study 2, ratings completed by parents and teachers of 335 children (ages 4-13) were used to further develop and evaluate the SCT items by computing factor analyses, item-level analyses, reliability analyses, and preliminary validity analyses. The final SCT scale (14 items) produced a total scale score and 3 subscale scores: Slow, Sleepy, and Daydreamer. These scales were constructed with good content validity and were found to have strong reliability. Future directions include replication, extension into a clinical population, and further examination of validity.

Assessment and Management of Sleep Problems in Youths With Attention-Deficit/Hyperactivity Disorder

OBJECTIVE To provide evidence- or consensus-based recommendations concerning the assessment and management of sleep problems in youths with attention-deficit/hyperactivity disorder (ADHD). METHOD PubMed, Ovid, EMBASE, and Web of Knowledge were searched through October 31, 2012. When no evidence was available, consensus of the authors was achieved. The evidence-level of the recommendations on the management of sleep disturbances was based on the Scottish Intercollegiate Guidelines Network (SIGN) system. RESULTS A total of 139 original articles on sleep and childhood ADHD were retrieved, including 22 on treatment of sleep disturbances. This review focuses on behaviorally based insomnia, circadian rhythm disorder, sleep-disordered breathing, restless legs syndrome/periodic limb movement disorder, and sleep disturbances due to comorbid psychiatric disorders or ADHD medications. Healthy sleep practices are recommended as the foundation of management strategies. Behavioral interventions should be considered as first-line treatment of insomnia, although further evidence from randomized controlled trials (RCTs) is needed to prove their efficacy in ADHD. Among pharmacological treatments, RCTs support the use of melatonin to reduce sleep-onset delay, whereas there is more limited evidence for other medications. CONCLUSION Growing empirical evidence is informing assessment/management strategies of sleep problems in youths with ADHD. However, further RCTs are warranted to support current recommendations.

Interference control in children with and without ADHD: a systematic review of Flanker and Simon task performance.

The present review systematically summarizes the existing research that has examined two reaction-time-based interference control paradigms, known as the Eriksen Flanker task and the Simon task, in children with and without ADHD. Twelve studies are included, yielding a combined sample size of 272 children with ADHD (M age 9.28 yrs) and 280 typically developing children (M age 9.38 yrs). As predicted, specific disadvantages were found in the ADHD group in terms of reaction time, percentage of errors, and efficiency of performance on incongruent relative to congruent trials, providing evidence for weaker interference control in this group.

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.

Future Research Directions in Sleep and ADHD Report of a Consensus Working Group

Objective: To explore relationships between basic and translational science research regarding sleep and ADHD in children. Method: A multidisciplinary group of experts in pediatric sleep medicine and ADHD convened in November 2010 to summarize the current literature, delineate knowledge gaps, and formulate recommendations regarding future research directions and priorities. Results: Six major research areas of interest were identified: (a) brain centers regulating sleep, arousal, and attention; (b) neurotransmitter systems involved in both sleep and attention regulation; (c) alterations of neural systems regulating sleep in ADHD; (d) phenotypic similarities between behavioral, mood, and cognitive manifestations of insufficient/disrupted sleep and ADHD; (e) hypoarousal and sleepiness in ADHD; and (f) external sleep–wake signals that affect sleep regulation in ADHD. Conclusion: An enhanced understanding of the complex mechanisms regulating sleep promotion, wakefulness, and attention may contribute to new insights regarding the core impairments in ADHD and lead to the development of new therapies.

Behavioral Interventions for Sleep Problems in Children With Autism Spectrum Disorders: Current Findings and Future Directions

OBJECTIVE To examine behavioral interventions for sleep problems in children with autism spectrum disorders (ASD). METHODS A systematic review evaluating all published studies examining the effectiveness of behavioral treatment of sleep problems in children with ASD is presented. RESULTS Based on the Chambless criteria for treatment efficacy, both standard extinction and scheduled awakenings met criteria for possibly efficacious interventions for sleep problems in children with ASD. Some positive outcomes have been reported, but there has not been enough research examining graduated extinction, faded bedtime, stimulus fading and chronotherapy to make any firm conclusions regarding treatment efficacy for children with ASD. CONCLUSIONS Although more rigorous research is required in order for any sleep interventions for children with ASD to be considered probably efficacious or well-established, the current literature should be used to guide clinical decisions and direct research questions.

Alerting, orienting, and executive attention in children with ADHD

Objective: This study evaluated the alerting, orienting, and executive attention abilities of children with ADHD and their typically developing (TD) peers using a modified version of the adult attention network test (ANT-I). Method: A total of 25 children with ADHD, Combined Type (ADHD-C, mean age = 9.20 years), 20 children with ADHD, Predominantly Inattentive Type (ADHD-I, mean age = 9.58 years), and 45 TD children (mean age = 9.41 years) matched on age and intelligence to the ADHD group completed the ANT-I. Results: As hypothesized, children with ADHD (n = 45) displayed significantly weaker alerting and executive attention than TD children (n = 45) but did not differ from TD children in orienting ability. Children with ADHD-C (n = 25) did not differ from children with ADHD-I (n = 20) on any of the three networks. Conclusions: Results supported the growing body of evidence that has found alerting and executive attention deficits in children with ADHD. (J. of Att. Dis. 2011; 15(4) 310-320)

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.

Case Study: A Case-Series Evaluation of a Behavioral Sleep Intervention for Three Children with Autism and Primary Insomnia

OBJECTIVE To assess the effectiveness of a manualized multi-component behavioral sleep intervention for children with autism spectrum disorder (ASD) and primary insomnia. METHODS Three children (2 males and 1 female, aged 8-9 years) participated. The intervention consisted of a treatment handbook for parents; a distance treatment approach was used in which parents had weekly telephone contact with a therapist. The main behavioral strategies employed were Faded Bedtime with Response Cost and positive reinforcement. Within a case-series design, both subjective (parent-report questionnaires and sleep diaries) and objective (actigraphy) measures were used to record changes in childrens sleep and daytime behavior. RESULTS For all 3 children, mean sleep onset latency was reduced following the intervention. These improvements were generally maintained at follow-up 12 weeks later. CONCLUSIONS The current study provides preliminary evidence for the effectiveness of a manualized behavioral sleep intervention program for improving insomnia in children with ASD.

Case series: evaluation of a behavioral sleep intervention for three children with attention-deficit/hyperactivity disorder and dyssomnia.

Objective: The authors conducted a preliminary evaluation of a behavioral sleep intervention for children with attention-deficit/hyperactivity disorder (ADHD) and dyssomnia delivered via distance treatment. Method: Three children (1 male, 2 females; aged 6-10 years) with ADHD and dyssomnia participated in a 5-week manualized intervention. Using a non-concurrent multiple baseline design, the children were randomly assigned to a 1-, 2-, or 3-week baseline and then received the 5-week intervention. Sleep problems were assessed daily by both objective and subjective measures. Measures of problematic nighttime behaviors and daytime ADHD symptoms were also obtained weekly. Results: After 5 weeks, a clinically significant decrease was found in the severity of the children’s dyssomnia. No changes in ADHD symptoms were noted. Gains were generally maintained at the 3-month follow-up. Parents perceived the intervention as being “helpful” to “very helpful.” Conclusion: Based on the initial data, this intervention shows promise as an effective and feasible treatment.