Format

Send to

Choose Destination
Atten Defic Hyperact Disord. 2019 Mar;11(1):5-19. doi: 10.1007/s12402-018-0271-z. Epub 2019 Mar 29.

The role of the circadian system in the etiology and pathophysiology of ADHD: time to redefine ADHD?

Author information

1
PsyQ Expertise Center Adult ADHD, Carel Reinierszkade 197, 2593 HR, The Hague, The Netherlands. d.bijlenga@psyq.nl.
2
Research Institute Brainclinics, Nijmegen, The Netherlands.
3
Department of Cognitive Neuroscience, Radboud University Medical Centre, Donders Institute for Brain, Cognition and Behaviour, Nijmegen, The Netherlands.
4
PsyQ Expertise Center Adult ADHD, Carel Reinierszkade 197, 2593 HR, The Hague, The Netherlands.
5
Department of Psychiatry, VU University Medical Center, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands.
6
Department of Experimental Psychology, Utrecht University, Utrecht, The Netherlands.
7
neuroCare Group, Munich, Germany.

Abstract

Attention-deficit/hyperactivity disorder (ADHD) is highly associated with the delayed sleep phase disorder, a circadian rhythm sleep-wake disorder, which is prevalent in 73-78% of children and adults with ADHD. Besides the delayed sleep phase disorder, various other sleep disorders accompany ADHD, both in children and in adults. ADHD is either the cause or the consequence of sleep disturbances, or they may have a shared etiological and genetic background. In this review, we present an overview of the current knowledge on the relationship between the circadian rhythm, sleep disorders, and ADHD. We also discuss the various pathways explaining the connection between ADHD symptoms and delayed sleep, ranging from genetics, behavioral aspects, daylight exposure, to the functioning of the eye. The treatment options discussed are focused on improvement of sleep quality, quantity, and phase-resetting, by means of improving sleep hygiene, chronotherapy, treatment of specific sleep disorders, and by strengthening certain neuronal networks involved in sleep, e.g., by sensorimotor rhythm neurofeedback. Ultimately, the main question is addressed: whether ADHD needs to be redefined. We propose a novel view on ADHD, where a part of the ADHD symptoms are the result of chronic sleep disorders, with most evidence for the delayed circadian rhythm as the underlying mechanism. This substantial subgroup should receive treatment of the sleep disorder in addition to ADHD symptom treatment.

KEYWORDS:

ADHD; Circadian rhythm; Delayed sleep; Sleep disorders; Sleep-onset insomnia

PMID:
30927228
DOI:
10.1007/s12402-018-0271-z
[Indexed for MEDLINE]

Supplemental Content

Full text links

Icon for Springer
Loading ...
Support Center