الفهرس 
AN OVERVIEW ON ADHD IN CHILDREN
THE PATHOPHYSIOLOGY OF ADHD AND SLEEP PROBLEMSOnly 14 pages are availabe for public view
 |  | from | 149 |  |  |
| | | from | 149 | | |
Abstract
Attention deficit hyperactivity disorder (ADHD) is defined
as a persistent pattern of inattention and/or hyperactivityimpulsivity
that interferes with functioning or development. Six
or more of the symptoms have persisted for at least six months
to a degree that is inconsistent with developmental level and
that has direct negative impacts on social and academic/
occupational activities.
According to parental reports a two to three fold higher
anecdotes of sleep problems in children with ADHD compared
to control groups in research studies.
The quality and quantity of sleep is certainly affected in
ADHD, and these children are at risk for non-restorative sleep,
which can undoubtedly impose adverse repercussions on daytime
functioning, which may persist throughout adulthood.
Although it remains uncertain whether the sleep problems
among children with ADHD are directly related to the ADHD,
the psychiatric comorbidity or to treatment, or whether ADHD
children suffer from a primary sleep problem, the ‘sleep issues’
of ADHD clearly deserve extensive and thorough exploration,
which is unfortunately lacking.
Children with attention deficit hyperactivity disorder,
shorter sleep duration and sleep disturbances appear early and
predate the usual age of clinical diagnosis. The rate of change of sleep duration relative to individual rather than absolute
sleep duration at any stage may prove beneficial in identifying
increased risk of attention deficit hyperactivity disorder.
ADHD is associated with hypo arousal (a state of
increased sleepiness) rather than hyper arousal. This indicates
that hyperactivity could be a coping mechanism to overcome
the daytime sleepiness the children experience.
Sleep disorder symptoms can resemble the ADHD
symptoms, such as inattention and difficult concentration; they
can actually be misdiagnosed as ADHD. Clinicians should be
aware of the co-existence of Sleep Disordered Breathing (SDB)
and Obstructive Sleep Apnea (OSA) for example with the
ADHD when diagnosing and treating symptoms.
Hypothesis of the study:
The study hypothesizes the presence of sleep problems
among children with ADHD with directly proportionate
relation between the severity of ADHD symptoms and sleep
changes. There may also be significant differences between
children with ADHD and controls in the sleep patterns.
Aim of the study
1. To study the sleep problems in children with ADHD
2. To estimate the severity of ADHD symptoms and their
relation with the sleep profile in children 3. To compare the sleep polysomnography in both cases and
control groups.
Methodology:
Study Design:
It is across sectional, case-control comparative study.
Subjects:-
• Sample site:
The sample will be recruited from patients attending the
outpatient clinics in two areas: The Childhood Special Needs
Center clinics a Ain Shams University that work 6 days a week
(from Saturday till Thursday) and from The Institute of
Psychiatry’s child psychiatry clinics, Faculty of medicine, Ain
Shams University Hospitals that work 4 days a week (from 9
am till 2 pm).
• Sample size:
Sixty children will be recruited in this study; divided into
2 groups: patients group and controls group.
I- Case group
Thirty patients will be selected from the patients
attending the outpatient clinics, diagnosed with ADHD
according to the DSM-V criteria (after history taking, general
and psychiatric examination).Inclusion Criteria:
• Patients fulfilling the criteria of ADHD according to the
DSM V criteria.
• Age ranges between 6 - 12 years.
• Both males and females patients.
Exclusion Criteria:
• Patients with co-morbid major psychiatric illnesses (e.g.
Psychosis, Mood disorders –Conduct disorders– mental
retardation) to exclude the effect of these illnesses or their
medications.
• History of non-psychiatric diseases that can affect sleep or
attention or hyperactivity parameters like (cerebrovascular
diseases, epilepsy, endocrinal diseases and learning disorder
etc.).
II- Control group
Thirty apparently healthy volunteer children with no
history of any psychiatric, neurological disorder matched with
patients for age, sex and social standard will be included in the
study.
Patients were subjected to:
After obtaining a full psychiatric history and examination
to patient fulfilling the inclusion criteria, physical and
neurological examination as well as psychiatric examination
using the following tools:A- Structured Clinical Interview based on the diagnostic
criteria of DSM-V (American Psychiatric Association,
2013)
B- Conners’ Rating Scale (Conners et al., 1998) to assess the
severity of ADHD patients and correlate it to sleep profile
results: the Conners’ parent scale. It is an 80 item
questionnaire. It scores the parents’ report of their child’s
behavior during the past month on a 4-point response
scoring.
C-Children’s Sleep Habits Questionnaire (CSHQ) (Owens et
al., 2000), the Arabic translated version is used (Asaad
and Kahla, 2001): It is a 33 item questionnaire. It scores
the sleep habits of school aged children as reported by the
parents during the past week. It assesses 8 parameters about
sleep habits: bed time resistance, sleep latency, total sleep
time, sleep disruption, awakenings, sleep phenomenon,
respiratory disturbance during sleep and day time
sleepiness.
Then after completing the questionnaires the cases and
controls will be given a date for another day for having the
polysomnogram procedure. It will be done in the sleep lab at
The Institute of Psychiatry, Faculty of Medicine, Ain Shams
University Hospitals.The Polysomnography (PSG) also called a sleep study. It is
a test used to diagnose sleep disorders. Polysomnography
records:
The result and scores obtained were then statistically analyzed
Result:-
• There was a high co-occurrence of sleep problems among
children with ADHD constituting of 60% having at least one
sleep disturbance type, while the control group showed no
sleep problems reported by the Children’s Sleep Habits
Questionnaire.
• The pattern of insomnia in cases of children with ADHD,
findings revealed that out of 30 patients, 18 (60%) suffered
from insomnia; among which the majority reported
combined initial and middle insomnia (27.7%), initial
insomnia (22.2%), combined initial, middle and late
insomnia (16.6%), initial and late insomnia (11.1%),
followed by only one case suffering from initial, middle and
hypersomnolence (5.5%) and one case with middle
insomnia and hypersomnolence (5.5%).
• There was an increased instability in sleep duration and
latency in ADHD children.
• The mean of severity of ADHD symptoms according to
Conner’s scale was 73.8, yet without significantly
correlation with any of the sleep profile items.• Longer sleep latency was reported to be longer in cases than
in the control (mean of 26.5 versus 16.5 respectively), with
statistically significant difference (P=0.000).
• There was more sleep insufficiency in cases than in control
with statistically significant difference (P=0.000),
• Cases with ADHD had slightly longer REM duration, and
shorter REM latency than in the control group with
statistically significant difference (P=0.000).
• The study showed increased arousal in cases group
compared to the control (mean of 4.04 versus 0.3
respectively)
• Cases showed higher index of periodic leg movement than
controls did (mean of 0.14 versus 0.4 respectively) with
statistically significant difference (P=0.000).