Attention-Deficit/Hyperactivity Disorder (ADHD) Symptoms in Pediatric Narcolepsy: A Cross-Sectional Study

Sleep. 2015 Aug 1;38(8):1285-95. doi: 10.5665/sleep.4910.


Study objectives: To evaluate the frequency, severity, and associations of symptoms of attention-deficit/hyperactivity disorder (ADHD) in children with narcolepsy with and without cataplexy.

Design: Cross-sectional survey.

Settings: Four French national reference centers for narcolepsy.

Patients: One hundred eight consecutively referred children aged younger than 18 y with narcolepsy, with (NwC, n = 86) or without cataplexy (NwoC, n = 22), and 67 healthy controls.

Interventions: The participants, their families, and sleep specialists completed a structured interview and questionnaires about sleep, daytime sleepiness, fatigue, and ADHD symptoms (ADHD-rating scale based upon Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision [DSM-IV-TR] symptoms), and use of psychostimulants for the treatment of narcolepsy (administered in 68.2%). Polysomnographic measures were collected.

Measurements and results: Clinically significant levels of ADHD symptoms were found in 4.8% of controls compared with 35.3% in patients with NwoC (P < 0.001) and 19.7% in patients with NwC (P < 0.01). Total ADHD scores were 6.4 (95% confidence interval [CI]: 4.5, 9.0) in controls compared with 14.2 (95% CI: 10.6, 18.9; P < 0.001), in patients with NwoC and 12.2 (95% CI: 9.8, 15.3; P < 0.01) in patients with NwC; subscores of inattention and hyperactivity/impulsivity were also significantly higher in both narcolepsy groups compared with controls. No difference was found between the NwC and NwoC groups for any ADHD measure. ADHD symptom severity was associated with increased levels of sleepiness, fatigue, and insomnia. Compared with the 34 untreated patients, the 73 patients treated with psychostimulants (modafinil in 91%) showed a trend toward lower narcolepsy symptoms but not lower ADHD symptoms.

Conclusions: Pediatric patients with narcolepsy have high levels of treatment-resistant attention-deficit/hyperactivity disorder (ADHD) symptoms. The optimal treatment for ADHD symptoms in these patients warrants further evaluation in longitudinal intervention studies.

Keywords: attention-deficit disorder with hyperactivity; methylphenidate; modafinil; narcolepsy; pediatrics.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Attention Deficit Disorder with Hyperactivity / complications*
  • Attention Deficit Disorder with Hyperactivity / psychology*
  • Benzhydryl Compounds / therapeutic use
  • Case-Control Studies
  • Cataplexy / complications
  • Cataplexy / drug therapy
  • Cataplexy / physiopathology
  • Cataplexy / psychology
  • Central Nervous System Stimulants / therapeutic use
  • Child
  • Child, Preschool
  • Cross-Sectional Studies
  • Diagnostic and Statistical Manual of Mental Disorders
  • Fatigue / complications
  • Female
  • France
  • Humans
  • Interviews as Topic
  • Male
  • Modafinil
  • Narcolepsy / complications*
  • Narcolepsy / drug therapy
  • Narcolepsy / physiopathology
  • Narcolepsy / psychology*
  • Sleep Initiation and Maintenance Disorders / complications
  • Sleep Stages
  • Surveys and Questionnaires


  • Benzhydryl Compounds
  • Central Nervous System Stimulants
  • Modafinil