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

Denise Bijlenga, Madelon A. Vollebregt, J. J. Sandra Kooij, Martijn Arns

Research output: Contribution to journalReview articleAcademicpeer-review

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.
LanguageEnglish
Pages5-19
JournalADHD Attention Deficit and Hyperactivity Disorders
Volume11
Issue number1
DOIs
Publication statusPublished - 2019

Cite this

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title = "The role of the circadian system in the etiology and pathophysiology of ADHD: time to redefine ADHD?",
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.",
author = "Denise Bijlenga and Vollebregt, {Madelon A.} and Kooij, {J. J. Sandra} and Martijn Arns",
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The role of the circadian system in the etiology and pathophysiology of ADHD: time to redefine ADHD? / Bijlenga, Denise; Vollebregt, Madelon A.; Kooij, J. J. Sandra; Arns, Martijn.

In: ADHD Attention Deficit and Hyperactivity Disorders, Vol. 11, No. 1, 2019, p. 5-19.

Research output: Contribution to journalReview articleAcademicpeer-review

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