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

doi:10.1007/s12402-018-0271-z

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

^*Corresponding author for this work

Research output: Contribution to journal › (Systematic) Review article › peer-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.

Original language	English
Pages (from-to)	5-19
Number of pages	15
Journal	ADHD Attention deficit and hyperactivity disorders
Volume	11
Issue number	1
DOIs	https://doi.org/10.1007/s12402-018-0271-z
Publication status	Published - Mar 2019
Externally published	Yes

Keywords

Attention Deficit Disorder with Hyperactivity/complications
Chronotherapy
Humans
Sleep Disorders, Circadian Rhythm/complications
Sleep Hygiene
Sleep Initiation and Maintenance Disorders/complications
CLOCK GENE
ADHD
DEFICIT HYPERACTIVITY DISORDER
LIGHT THERAPY
Delayed sleep
Circadian rhythm
Sleep disorders
SCHOOL-AGE-CHILDREN
SUBSEQUENT RECOVERY
ATTENTION-DEFICIT/HYPERACTIVITY DISORDER
Sleep-onset insomnia
GEOGRAPHIC-VARIATION
SLEEP RESTRICTION
MORNINGNESS-EVENINGNESS PREFERENCE
CONVERGENCE INSUFFICIENCY

Access to Document

10.1007/s12402-018-0271-z

Cite this

@article{9c7d2e9de6bc465ba1032e1473df8c1e,

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.",

keywords = "Attention Deficit Disorder with Hyperactivity/complications, Chronotherapy, Humans, Sleep Disorders, Circadian Rhythm/complications, Sleep Hygiene, Sleep Initiation and Maintenance Disorders/complications, CLOCK GENE, ADHD, DEFICIT HYPERACTIVITY DISORDER, LIGHT THERAPY, Delayed sleep, Circadian rhythm, Sleep disorders, SCHOOL-AGE-CHILDREN, SUBSEQUENT RECOVERY, ATTENTION-DEFICIT/HYPERACTIVITY DISORDER, Sleep-onset insomnia, GEOGRAPHIC-VARIATION, SLEEP RESTRICTION, MORNINGNESS-EVENINGNESS PREFERENCE, CONVERGENCE INSUFFICIENCY",

author = "Denise Bijlenga and Vollebregt, {Madelon A} and Kooij, {J J Sandra} and Martijn Arns",

note = "Publisher Copyright: {\textcopyright} 2018, Springer-Verlag GmbH Austria, part of Springer Nature.",

year = "2019",

month = mar,

doi = "10.1007/s12402-018-0271-z",

language = "English",

volume = "11",

pages = "5--19",

journal = "ADHD Attention deficit and hyperactivity disorders",

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TY - JOUR

T1 - The role of the circadian system in the etiology and pathophysiology of ADHD

T2 - time to redefine ADHD?

AU - Bijlenga, Denise

AU - Vollebregt, Madelon A

AU - Kooij, J J Sandra

AU - Arns, Martijn

PY - 2019/3

Y1 - 2019/3

N2 - 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.

AB - 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.

KW - Attention Deficit Disorder with Hyperactivity/complications

KW - Chronotherapy

KW - Humans

KW - Sleep Disorders, Circadian Rhythm/complications

KW - Sleep Hygiene

KW - Sleep Initiation and Maintenance Disorders/complications

KW - CLOCK GENE

KW - ADHD

KW - DEFICIT HYPERACTIVITY DISORDER

KW - LIGHT THERAPY

KW - Delayed sleep

KW - Circadian rhythm

KW - Sleep disorders

KW - SCHOOL-AGE-CHILDREN

KW - SUBSEQUENT RECOVERY

KW - ATTENTION-DEFICIT/HYPERACTIVITY DISORDER

KW - Sleep-onset insomnia

KW - GEOGRAPHIC-VARIATION

KW - SLEEP RESTRICTION

KW - MORNINGNESS-EVENINGNESS PREFERENCE

KW - CONVERGENCE INSUFFICIENCY

U2 - 10.1007/s12402-018-0271-z

DO - 10.1007/s12402-018-0271-z

M3 - (Systematic) Review article

C2 - 30927228

SN - 1866-6116

VL - 11

SP - 5

EP - 19

JO - ADHD Attention deficit and hyperactivity disorders

JF - ADHD Attention deficit and hyperactivity disorders

IS - 1

ER -