Methylphenidate May Improve Sleep Outcomes in ADHD Without Dysregulation Profile

Children with attention-deficit/hyperactivity disorder (ADHD) with a dysregulation profile may be at risk for worse sleep outcomes after methylphenidate initiation. These are the findings of a study published in Sleep Medicine.

More children with ADHD have sleep disturbances than children without ADHD (approximately 73% vs 25%-40%), respectively. Methylphenidate is a first-line treatment for ADHD and is associated with improved sleep. However, the effect of methylphenidate on sleep outcomes depends on multiple clinical and sociodemographic characteristics.

Researchers recruited children (N=115; mean age, 10 years; boys, 98) with treatment-naïve ADHD presenting at Bambino Gesù Children’s Hospital in Italy. They evaluated patients for the changes in ADHD symptoms and sleep outcomes from baseline to 6 months of methylphenidate treatment in semistructured interviews that used the Child Behavior Checklist (CBCL); Swanson, Nolan and Pelham (SNAP-IV); Adaptive Behavior Assessment System, Second Edition (ABAS-II); and Sleep Disturbance Scale for Children (SDSC) instruments.

In addition to ADHD, 35 patients were diagnosed with oppositional defiant disorder, 30 with learning disorder, 7 with mood disorder, 5 with anxiety disorder, and 5 with language disorder.

Time had a significant effect on SDSC scores (F_[1,114], 4.89; P =.029), in which scores decreased from baseline (mean, 62.02) to follow-up (mean, 60.18).

Similarly, SNAP-IV scores changed over time (F_[1,111], 309.63; P <.0001) and had a significant score-by-time interaction (F_[2,222], 8.50; P =.002). Stratified by SNAP-IV components, inattention (mean, 2.48 vs 1.59; P =.00001), hyperactivity and impulsivity (mean, 2.23 vs 1.24; P <.00001), and oppositional behavior (mean, 2.12 vs 1.42; P =.00002) scores decreased from baseline to month 6, respectively.

Significant correlations between SDSC total score at follow-up and CBCL dysregulation profile (DP; ρ, 0.45; P =.005) and SNAP-IV combined (ρ, 0.26; P =.005) scores at baseline were observed.

Baseline SNAP-IV hyperactivity score accounted for 13.1% and SDSC score 4.0% of the variance in SNAP-IV hyperactive scores at follow-up (P =.046). No significant interactions were observed.

Baseline SDSC score accounted for 32.5% and CBCL-DP score 7.4% of the variance in SDSC score at follow-up (P =.002), with no significant interactions observed.

This study was limited by not assessing adherence to methylphenidate treatment.

“Early identification of [dysregulation profile] in children and adolescents with ADHD might help clinicians foresee MPH response and side effects such as sleep disturbances. Future research are needed to better investigate the role of [dysregulation profile] on sleep disturbances to identify the most appropriate therapy and improve the quality of life of patients with ADHD and their families,” the researchers concluded.