Teens with attention-deficit/hyperactivity disorder (ADHD) obtain less sleep than their peers, with up to 75% of youth with ADHD obtaining insufficient sleep. This is noteworthy since insufficient sleep is associated with a multitude of negative outcomes in typically developing teens, including academic underachievement, emotion dysregulation, and mental health problems - all outcomes that occur at higher rates among teens with ADHD. Our pilot work demonstrates that insufficient sleep is correlated with depression, behavior problems, and academic impairment in teens with ADHD specifically and insufficient sleep is clearly associated with greater attentional problems in typical teens. However, no experimental study has examined whether sleep duration is causally linked to attentional, behavioral, emotional, and academic impairments in teens diagnosed with ADHD. If sleep problems contribute to functional impairments in teens with ADHD, then they represent an overlooked treatment target. Experimental studies provide the strongest test of causality, and studies using at- home sleep restriction protocols in teens without ADHD show a causal link between shortened sleep duration and impairment. However, administering an at-home sleep restriction protocol may be especially challenging for teens with ADHD due to their difficulties with organizing bedtime and wake activities, as well as differences from healthy teens in biological circadian preference. Thus, a critical first step in examining sleep as causally related to impairment in teens with ADHD is documenting the feasibility of using an at-home sleep restriction protocol with this population. We propose to (1) evaluate the feasibility of using an a-home sleep restriction protocol in teens with ADHD, and (2) collect preliminary data examining whether shortened sleep duration is causally linked to attentional, behavioral, emotional, and academic impairment in teens with ADHD. These goals will be accomplished by recruiting 54 teens with ADHD who will undergo a three-week sleep manipulation protocol. Specifically, a cross-over design will be used that includes a week of typical sleep followed by weeks of sleep restriction or sleep extension. Sleep functioning will be assessed during these three weeks with daily sleep diary and objective sleep measurement (i.e., actigraphy). After each sleep condition, teens and their parents will complete subjective and objective measures of attention, behavior, mood, and academics. Findings from this study will allow us to identify and address barriers to administering an at-home sleep restriction and extension protocol to teens with ADHD and pursue larger-scale experimental research examining sleep problems as causally linked to impairment. This research is clinically significant since teens with ADHD frequently experience a range of impairments that extend well into adulthood. If short sleep duration contributes to functional impairments in teens with ADHD, then sleep represents a modifiable and overlooked treatment target. The long-term goal of this research program is to identify whether and how sleep problems contribute to impairment and are an important treatment target in teens with ADHD.

Public Health Relevance

Adolescents with attention-deficit/hyperactivity disorder (ADHD) obtain less sleep than their typically developing peers. Observational studies indicate that inadequate sleep is correlated with impairment in adolescents with ADHD, but it remains unknown if sleep is causally related to impairment. This study will use an experimental sleep restriction and extension protocol to evaluate sleep as a contributor to clinically significant impairment and possible target for intervention in adolescents with ADHD.

Agency
National Institute of Health (NIH)
Institute
National Institute of Mental Health (NIMH)
Type
Small Research Grants (R03)
Project #
5R03MH109787-02
Application #
9265963
Study Section
Child Psychopathology and Developmental Disabilities Study Section (CPDD)
Program Officer
Garvey, Marjorie A
Project Start
2016-05-01
Project End
2019-04-30
Budget Start
2017-05-01
Budget End
2019-04-30
Support Year
2
Fiscal Year
2017
Total Cost
Indirect Cost
Name
Cincinnati Children's Hospital Medical Center
Department
Type
DUNS #
071284913
City
Cincinnati
State
OH
Country
United States
Zip Code
45229
Becker, Stephen P; Willcutt, Erik G (2018) Advancing the study of sluggish cognitive tempo via DSM, RDoC, and hierarchical models of psychopathology. Eur Child Adolesc Psychiatry :
Li, Sufang; Yang, Yihong; Hoffmann, Ewa et al. (2017) CYP2A6 Genetic Variation Alters Striatal-Cingulate Circuits, Network Hubs, and Executive Processing in Smokers. Biol Psychiatry 81:554-563
Wang, Laura A; Gonzalez, Daniel; Leeder, J Steven et al. (2017) Metronidazole Metabolism in Neonates and the Interplay Between Ontogeny and Genetic Variation. J Clin Pharmacol 57:230-234
Boileau, Isabelle; Mansouri, Esmaeil; Williams, Belinda et al. (2016) Fatty Acid Amide Hydrolase Binding in Brain of Cannabis Users: Imaging With the Novel Radiotracer [11C]CURB. Biol Psychiatry 80:691-701
Ross, Kathryn C; Gubner, Noah R; Tyndale, Rachel F et al. (2016) Racial differences in the relationship between rate of nicotine metabolism and nicotine intake from cigarette smoking. Pharmacol Biochem Behav 148:1-7
Tyndale, Rachel F; Zhu, Andy Z X; George, Tony P et al. (2015) Lack of Associations of CHRNA5-A3-B4 Genetic Variants with Smoking Cessation Treatment Outcomes in Caucasian Smokers despite Associations with Baseline Smoking. PLoS One 10:e0128109
Boileau, Isabelle; Tyndale, Rachel F; Williams, Belinda et al. (2015) The fatty acid amide hydrolase C385A variant affects brain binding of the positron emission tomography tracer [11C]CURB. J Cereb Blood Flow Metab 35:1237-40
Lerman, Caryn; Schnoll, Robert A; Hawk Jr, Larry W et al. (2015) Use of the nicotine metabolite ratio as a genetically informed biomarker of response to nicotine patch or varenicline for smoking cessation: a randomised, double-blind placebo-controlled trial. Lancet Respir Med 3:131-138
Zhu, Andy Z X; Renner, Caroline C; Hatsukami, Dorothy K et al. (2013) CHRNA5-A3-B4 genetic variants alter nicotine intake and interact with tobacco use to influence body weight in Alaska Native tobacco users. Addiction 108:1818-28
Zhu, Andy Z X; Renner, Caroline C; Hatsukami, Dorothy K et al. (2013) The ability of plasma cotinine to predict nicotine and carcinogen exposure is altered by differences in CYP2A6: the influence of genetics, race, and sex. Cancer Epidemiol Biomarkers Prev 22:708-18