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Sleep and ADHD
An Evidence-Based Guide to Assessment and Treatment
Harriet Hiscock,Emma Sciberras
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eBook - ePub
Sleep and ADHD
An Evidence-Based Guide to Assessment and Treatment
Harriet Hiscock,Emma Sciberras
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About This Book
Sleep and ADHD begins with an overview of sleep (normal sleep, sleep cues, developmental phases, etc.) and continues with the epidemiology of ADHD and sleep problems, including medical issues (e.g. sleep apnea), parasomnias, behavioral insomnias (i.e. limit setting, sleep onset association disorders, circadian rhythm disorders and anxiety-related insomnia). It then covers the etiology of sleep problems, including the role of sleep hygiene and habits, the developing child, and the role of stimulants and medications used in the management of ADHD sleep problems. As the first book of its kind, users will find this reference an invaluable addition to the literature on ADHD.
- Covers both the pharmacological and non-pharmacological management of sleep problems
- Addresses sleep issues in younger children, but also addresses adolescents and adults
- Discusses the impact of sleep problems on the family as well as the child with ADHD
- Reviews the evidence around the neurobiology of sleep and systems regulating sleep in ADHD
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Chapter 1
Attention Deficit Hyperactivity Disorder
An Overview
Daryl Efron1,2,3, 1Centre for Community Child Health, Murdoch Childrenâs Research Institute, Melbourne, VIC, Australia, 2Department of Paediatrics, University of Melbourne, Melbourne, VIC, Australia, 3General Medicine, The Royal Childrenâs Hospital, Melbourne, VIC, Australia
Abstract
Attention deficit hyperactivity disorder (ADHD) is the most common neurodevelopmental disorder. It is a polygenic disorder with multifactorial etiology, including genetic and environmental factors. Onset occurs in childhood, but symptoms usually persist across developmental stages into adult life, at least to some extent. A range of cognitive deficits are seen in ADHD, underpinning the substantial functional difficulties experienced by individuals with the condition. Management includes both pharmacological and nonpharmacological interventions. Comorbidities such as sleep problems are common and contribute to the impairments. These need to be identified and addressed alongside ADHD symptoms. ADHD is associated with an increased risk of negative long-term outcomes however, with support many patients thrive and have successful lives.
Keywords
Attention deficit hyperactivity disorder; comorbidities; genetics; psychostimulant medication
Attention deficit hyperactivity disorder (ADHD) is a neurodevelopmental disorder characterized by developmentally inappropriate levels of hyperactivity, impulsivity, and/or inattention. Onset occurs in childhood, but persistence into adolescence and adult life is common. Heterogeneity in symptom profile, comorbidity mix, genetic and environmental risk factors, neurocognitive deficits, and response to treatment is a notable feature of ADHD. Furthermore, the presentation and functional difficulties associated with ADHD evolve across developmental stages as demands change (Cherkasova, Sulla, Dalena, Pondé, & Hechtman, 2013). ADHD is associated with impairments in social, academic, and family functioning and poorer outcomes in childhood (Efron, Sciberras, & Anderson, 2014), adolescence and adulthood (Shaw et al., 2012).
ADHD is classified as a Neurodevelopmental Disorder in the Diagnostic and Statistical Manual of Mental Disorders-Fifth Edition (DSM-5) (American Psychiatric Association, 2013), alongside autism spectrum disorder (ASD), intellectual disability, learning disorders, and communication disorders. This represents an important conceptual shift from the DSM-IV (1994) where it was classified as a disruptive behavior disorder and is appropriate recognition of its strong neurobiological basis.
In the descriptive text, DSM-5 emphasizes the importance of gathering independent information âconfirming substantial symptoms across settingsâ from informants âwho have seen the individual in those settings,â that is, parents and teachers. DSM-5 also explicitly recognizes the fact that comorbidities are the rule rather than the exception in ADHD and need to be identified and addressed.
1.1 Historical Perspective
The disorder we currently call ADHD was first described in the medical literature over 200 years ago (Lange, Reichl, Lange, Tucha, & Tucha, 2010). In 1798, Scottish physician Sir Alexander Crighton published a work entitled âAn inquiry into the nature and origin of mental derangement: comprehending a concise system of the physiology and pathology of the human mind and a history of the passions and their effectsâ in which he described individuals with either congenital or acquired mental restlessness, who were easily distracted by extraneous stimuli and had âan incapacity of attending with a necessary degree of constancy to any one object.â In the mid-19th century, German psychiatrist and author of popular illustrated childrenâs books Dr Heinrich Hoffman created two characters: Fidgety Phil, who drives his parents crazy with his inability to sit still at the dinner table, and Johnny Look-in-the-Air, who watches swallows and clouds as he walks and so falls into a river. These boys would be recognizable today as having the Combined and Inattentive presentations of ADHD, respectively. At the turn of the 20th century, the father of British pediatrics Sir George Still, in his Goulstonian Lectures to the Royal College of Physicians in London, described a series of 43 teenagers with âdefective moral control.â They displayed symptoms such as âpassionatenessâ (impulsivity), and âa quite abnormal capacity for sustained attention,â core symptoms of ADHD. Some of these children also demonstrated âspitefulness,â âlawlessness,â and âwanton mischievousness,â symptoms which today would suggest diagnoses of oppositional defiant disorder (ODD) or conduct disorder, which often co-occur with ADHD. The language used by Still betrays the Victorian periodâs prevailing interpretation of aberrant behavior as symptomatic of character flaws and moral we...