Sleep problems and disorders among adolescents with persistent and subthreshold attention-deficit/hyperactivity disorders

Sleep. 2009 May;32(5):671-9. doi: 10.1093/sleep/32.5.671.


Study objectives: To investigate the sleep schedules, problems, and disorders among adolescents with persistent attention-deficit/hyperactivity disorder (ADHD) and those with partially remitted ADHD symptoms.

Design: A case-control study.

Setting: National Taiwan University and schools in Taipei Patients or Participants: The sample included 281 adolescents (male, 85.4%; 145 with persistent ADHD, 136 with subthreshold ADHD), aged 11 to 17, who were diagnosed with ADHD, according to DSM-IV criteria, at the mean age of 6.7 years (SD = 3.0) and 185 unaffected control subjects.

Interventions: N/A.

Measurements and results: We conducted psychiatric interviews of participants and their mothers using the Chinese Kiddie-Schedule for Affective Disorders and Schizophrenia-Epidemiology version for making the diagnoses of ADHD, other psychiatric disorders, and sleep problems or disorders. We also collected the medication treatment data and parent and teacher reports of ADHD-related symptoms. Our results showed that adolescents with a childhood diagnosis of ADHD according to DSM-IV criteria, regardless of persistent ADHD, were more likely to have current and lifetime sleep problems and sleep disorders according to DSM-IV (insomnia, sleep terrors, nightmares, bruxism, and snoring). The presence of at least 1 psychiatric comorbid condition increased the risks for insomnia and nightmares. The use of methylphenidate was not associated with further increased risk of sleep problems, except bruxism.

Conclusions: Our findings support a relationship between ADHD and sleep problems, which can be partially explained by the psychiatric comorbidities, but did not support a disturbed sleep schedule. Our study suggests that mental health professionals should screen for sleep problems and psychiatric comorbidities among adolescents with a childhood diagnosis of ADHD regardless of the severity of current ADHD symptoms.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Attention Deficit Disorder with Hyperactivity / diagnosis
  • Attention Deficit Disorder with Hyperactivity / drug therapy
  • Attention Deficit Disorder with Hyperactivity / epidemiology*
  • Central Nervous System Stimulants / adverse effects
  • Central Nervous System Stimulants / therapeutic use
  • Child
  • Comorbidity
  • Cross-Sectional Studies
  • Female
  • Humans
  • Male
  • Methylphenidate / adverse effects
  • Methylphenidate / therapeutic use
  • Sleep Wake Disorders / diagnosis
  • Sleep Wake Disorders / epidemiology*
  • Surveys and Questionnaires
  • Taiwan


  • Central Nervous System Stimulants
  • Methylphenidate