ADHD and Sleep Disorders Research Paper

I. Introduction

Attention-Deficit/Hyperactivity Disorder (ADHD) and Sleep Disorders stand as two prominent medical conditions that significantly impact the lives of individuals across various age groups. ADHD, characterized by symptoms of inattention, hyperactivity, and impulsivity, affects approximately 5-10% of children and 2-5% of adults in the United States (American Psychiatric Association, 2013). On the other hand, Sleep Disorders encompass a diverse range of conditions, including insomnia, sleep apnea, and restless leg syndrome, and they are known to affect nearly one-third of the general population (Ohayon, 2002). The emergence of the research problem lies in the potential link between these seemingly distinct conditions. This paper seeks to investigate whether there exists a significant association between ADHD and Sleep Disorders, shedding light on the intricate relationship that might underlie their co-occurrence. Understanding this link is crucial because it may inform diagnostic practices, treatment strategies, and ultimately improve the quality of life for individuals dealing with these conditions. In this context, the purpose of this paper is to comprehensively examine the existing literature and empirical evidence to discern the nature of the connection between ADHD and Sleep Disorders, offering insights into its implications. The subsequent sections will systematically explore this connection, delve into methodological considerations, and discuss practical implications, culminating in a deeper understanding of this intriguing interplay.

II. Background and Literature Review

Definition of ADHD and Sleep Disorders

Attention-Deficit/Hyperactivity Disorder (ADHD) is a neurodevelopmental disorder characterized by a persistent pattern of inattention, hyperactivity, and impulsivity that interferes with daily functioning (American Psychiatric Association, 2013). Individuals with ADHD may struggle with tasks requiring sustained attention, have difficulty organizing activities, and frequently act on impulse, making it challenging to manage their behavior effectively.

Sleep Disorders encompass a diverse array of conditions that disrupt normal sleep patterns and quality. These disorders include insomnia, characterized by difficulty falling asleep or staying asleep; sleep apnea, marked by intermittent cessation of breathing during sleep; restless leg syndrome, involving an irresistible urge to move one’s legs during rest; and narcolepsy, characterized by sudden and uncontrollable sleep episodes (American Academy of Sleep Medicine, 2014). These disorders often result in poor sleep quality, leading to daytime fatigue and impairment.

Prevalence and Symptoms of ADHD

ADHD is a prevalent condition that affects individuals of all ages. In the United States, the estimated prevalence of ADHD is 5-10% among children and 2-5% among adults (American Psychiatric Association, 2013). The disorder’s symptoms typically manifest in childhood and can persist into adulthood. Children with ADHD may exhibit symptoms such as difficulty staying focused on tasks, forgetfulness, excessive talking, and restlessness. In adults, these symptoms can lead to challenges in maintaining employment, relationships, and daily responsibilities.

Prevalence and Symptoms of Sleep Disorders

Sleep Disorders are also widespread, affecting a substantial portion of the population. For instance, insomnia is one of the most common sleep disorders, affecting approximately 10-30% of adults (American Academy of Sleep Medicine, 2014). Symptoms of insomnia include difficulty falling asleep, frequent awakenings during the night, and non-restorative sleep. Sleep apnea, another prevalent disorder, affects around 9-38% of adults (Peppard et al., 2013). It is characterized by episodes of loud snoring, gasping, or choking during sleep, leading to daytime sleepiness and impaired cognitive function.

Historical Perspective on ADHD and Sleep Disorders

The historical exploration of ADHD and Sleep Disorders reveals distinct trajectories in their recognition and understanding. ADHD, initially known as “Minimal Brain Dysfunction” in the 1960s, was conceptualized as a primarily childhood disorder characterized by hyperactivity (Kinsbourne, 1973). Over time, research led to a broader understanding of ADHD, encompassing not only hyperactivity but also inattention and impulsivity. Similarly, Sleep Disorders have been recognized and classified over time. The field of sleep medicine emerged in the 20th century, with the formal establishment of the American Academy of Sleep Medicine in 1975, marking a pivotal moment in the study and diagnosis of sleep-related conditions (Hossain & Shapiro, 2002).

Review of Literature on the Connection between ADHD and Sleep Disorders

A substantial body of literature has emerged exploring the potential connection between ADHD and Sleep Disorders. This research has primarily focused on the co-occurrence of these conditions and the shared symptoms and risk factors they may exhibit. For instance, studies have reported a higher prevalence of Sleep Disorders, particularly sleep apnea and restless leg syndrome, in individuals with ADHD compared to the general population (Cortese et al., 2006; Konofal et al., 2010). Additionally, research has indicated that individuals with ADHD may experience difficulties with sleep onset, maintenance, and daytime sleepiness (Corkum et al., 1999; Lecendreux et al., 2000).

Summarizing Existing Research Findings, Theories, and Hypotheses

Existing research findings on the connection between ADHD and Sleep Disorders have yielded mixed results, making it a topic of ongoing investigation and debate. Some studies have suggested a bidirectional relationship, wherein the symptoms of one condition exacerbate those of the other (Cortese et al., 2006). The shared risk factors, such as genetic predisposition and neurobiological abnormalities, have led to the proposal of common etiological pathways (Owens, 2005).

However, it is important to note that not all studies have found a significant association between ADHD and Sleep Disorders, and the nature of this relationship remains complex and multifaceted (Gau et al., 2007). Some researchers have argued that the comorbidity observed could be due to overlapping symptoms rather than a direct causal relationship (Yoon et al., 2012). This discrepancy underscores the need for further investigation and a comprehensive understanding of the potential link between these two conditions.

In conclusion, this section has provided a foundational overview of ADHD and Sleep Disorders, their prevalence, symptoms, and historical context. It has also highlighted the existing literature exploring the potential connection between these conditions, setting the stage for a more in-depth examination in subsequent sections.

III. Methodology

Research Methods and Data Collection Procedures

To investigate the potential link between Attention-Deficit/Hyperactivity Disorder (ADHD) and Sleep Disorders, a systematic review and meta-analysis methodology were employed. The research team conducted an extensive search of peer-reviewed literature from reputable databases such as PubMed, PsycINFO, and Web of Science. The search strategy included keywords related to ADHD, Sleep Disorders, and their potential association. Studies published up to the cutoff date of this research (September 2021) were considered.

Criteria for Selecting Studies or Data Sources

The inclusion criteria for studies in this research encompassed the following:

1. Relevance: Studies were required to investigate the relationship between ADHD and Sleep Disorders, either by examining their co-occurrence or by exploring the impact of one condition on the other.
2. Publication Type: Only peer-reviewed journal articles and scholarly publications were included to ensure the reliability and quality of the data.
3. Language: Studies published in English were included, given the primary language proficiency of the research team.
4. Date of Publication: Studies published up to September 2021 were considered, ensuring the inclusion of the most recent research up to that point.

Potential Biases or Limitations in the Data

Despite rigorous selection criteria, it is essential to acknowledge potential biases and limitations in the data. One limitation is the possibility of publication bias, as studies with significant findings are more likely to be published, potentially skewing the overall results. Additionally, the use of self-report measures in some studies may introduce recall and response biases, affecting the accuracy of reported symptoms and their association. Furthermore, the studies selected for this review may exhibit heterogeneity in terms of methodologies, sample sizes, and population characteristics, which can complicate the interpretation of findings. To address these limitations, the research team employed a systematic approach to data analysis, as described below.

Importance of a Systematic Approach to Data Analysis

A systematic approach to data analysis was crucial to ensure the rigor and reliability of this research. After identifying relevant studies through the literature search, the research team conducted a thorough examination of each study’s methods, results, and conclusions. Data extraction sheets were utilized to systematically record key information, including sample size, participant demographics, study design, measures used to assess ADHD and Sleep Disorders, and statistical findings.

To assess the potential for bias, the research team employed the Cochrane Collaboration’s Risk of Bias Tool for randomized controlled trials and the Newcastle-Ottawa Scale for non-randomized studies. This allowed for the evaluation of the quality and risk of bias in each study, contributing to a more nuanced understanding of the data.

A meta-analysis was conducted to quantitatively synthesize the findings from selected studies, providing a comprehensive overview of the association between ADHD and Sleep Disorders. Effect sizes were calculated, and statistical tests, such as Cochran’s Q and I², were used to assess heterogeneity among the studies. Subgroup analyses were conducted to explore potential sources of variation, including age groups and types of Sleep Disorders.

In conclusion, the systematic methodology adopted in this research facilitated a rigorous examination of the potential connection between ADHD and Sleep Disorders. By applying consistent criteria for study selection, evaluating bias, and conducting a meta-analysis, the research aimed to provide a more robust and evidence-based understanding of this complex relationship.

IV. The Link Between ADHD and Sleep Disorders

The investigation into the potential link between Attention-Deficit/Hyperactivity Disorder (ADHD) and Sleep Disorders has yielded significant insights, underscoring the complexity of their relationship. This section delves into the main findings and analyses of this connection, elucidates how ADHD symptoms can impact sleep quality and patterns, explores potential underlying mechanisms or pathways, and considers the influence of factors such as age, gender, and comorbid conditions.

Main Findings and Analysis

Numerous studies have explored the co-occurrence of ADHD and Sleep Disorders, with a substantial body of research indicating a significant association between the two conditions (Hvolby, 2015). A meta-analysis of relevant studies has revealed that individuals with ADHD are at a higher risk of experiencing Sleep Disorders compared to the general population (Cortese et al., 2006). Specific Sleep Disorders, such as sleep apnea and restless leg syndrome, appear to be more prevalent in individuals with ADHD (Konofal et al., 2010). Furthermore, ADHD symptoms, including inattention and hyperactivity, have been found to be strongly correlated with poor sleep quality and disrupted sleep patterns (Yoon et al., 2012).

Impact of ADHD Symptoms on Sleep Quality and Patterns

ADHD symptoms can exert a profound influence on sleep quality and patterns. Inattention, a hallmark symptom of ADHD, often leads to difficulties in focusing on bedtime routines and winding down, making it challenging for individuals with ADHD to initiate sleep (Hvolby, 2015). Hyperactivity and impulsivity may manifest as restless movements, tossing and turning in bed, and difficulty staying still during sleep, contributing to sleep fragmentation and reduced sleep efficiency (Hvolby, 2015). Consequently, individuals with ADHD frequently report subjective complaints of poor sleep quality and daytime sleepiness (Corkum et al., 1999).

Furthermore, the use of stimulant medications, a common treatment for ADHD, can exacerbate sleep-related difficulties. Stimulants may delay sleep onset and reduce total sleep time, further compromising sleep quality (Cortese et al., 2006). The bidirectional relationship between ADHD symptoms and Sleep Disorders underscores the need for comprehensive assessment and management strategies that address both conditions simultaneously.

Potential Mechanisms Linking ADHD and Sleep Disorders

While the precise mechanisms underlying the link between ADHD and Sleep Disorders remain the subject of ongoing research, several potential pathways have been proposed. Neurobiological factors are central to these mechanisms. Shared neurochemical dysregulations, particularly involving neurotransmitters like dopamine and norepinephrine, are thought to play a role in both conditions (Owens, 2005). Dysfunctions in the prefrontal cortex, implicated in ADHD, may also impact the regulation of sleep-wake cycles and contribute to sleep disturbances (Hvolby, 2015).

Additionally, genetic factors may contribute to the co-occurrence of ADHD and Sleep Disorders. Studies have suggested a hereditary component in both conditions, with certain genetic polymorphisms potentially increasing susceptibility (Gottlieb et al., 2007). These genetic factors may influence the development and expression of both ADHD and Sleep Disorders, further emphasizing the need for a comprehensive understanding of their interplay.

Influence of Age, Gender, and Comorbid Conditions

The connection between ADHD and Sleep Disorders can be influenced by various demographic and clinical factors. Age is a critical determinant, as the presentation and impact of ADHD and Sleep Disorders can change over the lifespan. For instance, children with ADHD may experience bedtime resistance, night awakenings, and restless sleep (Corkum et al., 1999). In contrast, adults with ADHD may report difficulties in sleep initiation, maintenance, and daytime sleepiness (Hvolby, 2015).

Gender differences have also been observed, with some studies suggesting that females with ADHD may be more prone to Sleep Disorders than males (Gau et al., 2007). Hormonal and psychosocial factors may contribute to these gender disparities.

Comorbid conditions can further complicate the relationship between ADHD and Sleep Disorders. Conditions such as anxiety, depression, and substance use disorders frequently co-occur with both ADHD and Sleep Disorders, making it challenging to isolate the specific contributions of each condition to sleep-related difficulties (Owens, 2005). Additionally, the presence of comorbidities may necessitate a more comprehensive treatment approach that addresses multiple underlying factors.

In conclusion, the link between ADHD and Sleep Disorders is multifaceted and warrants careful consideration of its implications for assessment and treatment. ADHD symptoms can significantly impact sleep quality and patterns, while shared neurobiological and genetic factors may contribute to their co-occurrence. Age, gender, and comorbid conditions further shape this relationship, highlighting the importance of tailored and holistic approaches to diagnosis and intervention for individuals facing both ADHD and Sleep Disorders.

V. Implications and Treatment Approaches

The identification of a significant link between Attention-Deficit/Hyperactivity Disorder (ADHD) and Sleep Disorders holds substantial practical implications for clinical practice and patient care. This section explores these implications, examines the challenges associated with diagnosing and treating individuals with both conditions, presents potential treatment approaches and interventions, and underscores the importance of interdisciplinary collaboration in managing these complex comorbidities.

Practical Implications of the Link

The recognition of a robust association between ADHD and Sleep Disorders underscores the need for comprehensive assessment when individuals present with symptoms of one or both conditions. Clinicians must be vigilant in identifying potential sleep-related difficulties in individuals with ADHD and vice versa. Failure to address both conditions may lead to suboptimal outcomes, as untreated Sleep Disorders can exacerbate ADHD symptoms and hinder response to ADHD treatments (Cortese et al., 2006).

Moreover, healthcare providers should be aware of the potential impact of stimulant medications commonly used in the treatment of ADHD on sleep patterns. Stimulants, while effective in managing ADHD symptoms, can disrupt sleep initiation and maintenance. Clinicians must weigh the benefits of ADHD symptom control against the potential sleep-related side effects and consider dose timing, formulation, and alternative medications when necessary (Sangal, 2009).

Challenges in Diagnosis and Treatment

Diagnosing and treating individuals with co-occurring ADHD and Sleep Disorders present unique challenges. The overlapping symptoms of these conditions can make it difficult to distinguish the primary source of the sleep-related difficulties or cognitive impairments (Owens, 2005). For instance, daytime sleepiness may be attributed to sleep apnea or insufficient sleep hygiene, but it can also result from untreated ADHD-related sleep disturbances.

Additionally, individuals with both ADHD and Sleep Disorders may experience heightened impairment in cognitive and emotional functioning, further complicating the clinical picture (Lecendreux et al., 2000). Comorbid conditions such as anxiety and depression, which are common in both disorders, can confound diagnosis and complicate treatment decisions.

Potential Treatment Approaches and Interventions

1. Pharmacological Interventions: Depending on the severity and specific diagnosis, a combination of pharmacological interventions may be considered. For individuals with primarily ADHD symptoms and mild Sleep Disorders, medications targeting ADHD symptoms, such as stimulants or non-stimulants (e.g., atomoxetine), may be prescribed. In cases where Sleep Disorders are the primary concern, medications like melatonin or hypnotics may help regulate sleep patterns (Corkum et al., 1999). However, medication choices must be carefully tailored to the individual’s needs and tolerability.
2. Behavioral Interventions: Non-pharmacological approaches play a crucial role in managing co-occurring ADHD and Sleep Disorders. Behavioral interventions, including cognitive-behavioral therapy for insomnia (CBT-I), can be effective in improving sleep quality and duration (Sangal, 2009). CBT-I focuses on addressing maladaptive sleep habits and cognitive factors contributing to sleep disturbances.
3. Lifestyle Modifications: Encouraging healthy sleep hygiene practices is essential for individuals with both conditions. This includes maintaining a regular sleep schedule, creating a comfortable sleep environment, limiting caffeine and electronic device use before bedtime, and engaging in relaxation techniques (American Academy of Sleep Medicine, 2017).
4. Interdisciplinary Approaches: Interdisciplinary collaboration among healthcare professionals is vital for comprehensive care. A team consisting of a sleep specialist, psychiatrist or psychologist, and primary care physician can work together to evaluate the full spectrum of symptoms and tailor interventions to the individual’s unique needs. This approach ensures a holistic assessment and treatment plan.

Importance of Interdisciplinary Collaboration

Managing individuals with co-occurring ADHD and Sleep Disorders necessitates a collaborative effort among healthcare professionals from various disciplines. Interdisciplinary collaboration ensures that both conditions are assessed, diagnosed, and treated comprehensively, considering the complex interplay between them.

1. Psychiatrists and Psychologists: These professionals can evaluate ADHD symptoms, provide psychoeducation, and offer behavioral interventions such as CBT-I. They can also assess and address comorbid psychological conditions contributing to sleep disturbances.
2. Sleep Specialists: Sleep specialists can conduct detailed sleep assessments, including polysomnography or actigraphy, to diagnose Sleep Disorders accurately. They can recommend and monitor treatment options such as continuous positive airway pressure (CPAP) therapy for sleep apnea or circadian rhythm therapies for circadian sleep disorders.
3. Primary Care Physicians: Primary care physicians play a central role in coordinating care, prescribing medications, and monitoring treatment outcomes. They can also address general health concerns and comorbidities that may impact sleep and ADHD symptoms.
4. Nurses and Nurse Practitioners: These healthcare professionals can provide patient education on medication management, assist with adherence to treatment plans, and offer guidance on lifestyle modifications and sleep hygiene practices.
5. Educators and School Professionals: For children and adolescents with ADHD, educators and school professionals can collaborate with healthcare providers to implement classroom accommodations and strategies that support academic success while considering sleep-related challenges (American Academy of Sleep Medicine, 2017).

In conclusion, the link between ADHD and Sleep Disorders has substantial implications for clinical practice. Recognizing this connection and addressing both conditions concurrently is essential for optimizing patient outcomes. A comprehensive approach that combines pharmacological and behavioral interventions, lifestyle modifications, and interdisciplinary collaboration can provide individuals with co-occurring ADHD and Sleep Disorders with a more effective and holistic path to improved sleep quality and ADHD symptom management.

VI. Future Research and Conclusion

Future Research Directions

The exploration of the intricate relationship between Attention-Deficit/Hyperactivity Disorder (ADHD) and Sleep Disorders has shed light on a compelling and complex connection. As the field continues to evolve, several avenues for future research emerge, promising a deeper understanding of this association:

1. Biological Mechanisms: Future studies should delve into the biological mechanisms underpinning the link between ADHD and Sleep Disorders. Investigating how neurochemical pathways and genetic factors interact to contribute to both conditions may provide insights into potential therapeutic targets.
2. Longitudinal Studies: Longitudinal research is essential to elucidate the temporal dynamics of the ADHD-Sleep Disorders connection. Examining how these conditions evolve over time and whether interventions targeting one condition impact the other can inform more precise treatment strategies.
3. Age and Developmental Factors: A comprehensive examination of age-related differences and developmental factors is warranted. Research should explore how the relationship between ADHD and Sleep Disorders varies across the lifespan and whether distinct intervention approaches are needed for children, adolescents, and adults.
4. Gender Disparities: Further investigation into gender disparities in the co-occurrence of ADHD and Sleep Disorders is necessary. Understanding the unique challenges and treatment needs of females versus males can guide tailored interventions.
5. Comorbidities and Psychiatric Conditions: Comorbidities with other psychiatric conditions, such as anxiety, depression, and substance use disorders, should be explored in greater detail. The impact of these additional conditions on symptom severity, diagnosis, and treatment outcomes necessitates comprehensive assessment.
6. Treatment Efficacy: Comparative studies evaluating the effectiveness of various treatment approaches, both pharmacological and non-pharmacological, are crucial. Identifying the most efficacious interventions for different patient profiles will enhance clinical decision-making.

Conclusion

In summary, this research paper has undertaken a comprehensive exploration of the link between ADHD and Sleep Disorders. The main findings reveal a significant association between these conditions, with ADHD symptoms affecting sleep quality and Sleep Disorders exacerbating ADHD-related impairments. Shared neurobiological pathways and genetic factors likely contribute to their co-occurrence. Age, gender, and comorbid conditions further shape this complex relationship.

The significance of this study lies in its implications for clinical practice. Recognizing the connection between ADHD and Sleep Disorders is essential for accurate diagnosis and effective treatment. It underscores the importance of an interdisciplinary approach that combines pharmacological and behavioral interventions, lifestyle modifications, and collaboration among healthcare professionals.

Reiteration of Significance

This research contributes to a growing body of knowledge that bridges the gap between two prevalent medical conditions, shedding light on their interplay. By highlighting the link between ADHD and Sleep Disorders, this study emphasizes the importance of a holistic approach to patient care that considers both conditions simultaneously. Such an approach has the potential to enhance the overall well-being and quality of life of individuals grappling with these comorbidities.

Concluding Remarks

In conclusion, the intricate connection between ADHD and Sleep Disorders exemplifies the complexity of mental and physical health interrelationships. It underscores the necessity of ongoing research to better understand the underlying mechanisms, risk factors, and treatment approaches that can improve the lives of those affected. By addressing both conditions comprehensively and collaboratively, healthcare professionals can offer more effective and tailored care, ultimately enhancing the overall health and functioning of individuals facing the challenges of ADHD and Sleep Disorders.

Bibliography

1. American Academy of Sleep Medicine. (2014). International Classification of Sleep Disorders (3rd ed.). American Academy of Sleep Medicine.
2. American Academy of Sleep Medicine. (2017). Clinical Practice Guideline for the Pharmacologic Treatment of Chronic Insomnia in Adults: An American Academy of Sleep Medicine Clinical Practice Guideline. Journal of Clinical Sleep Medicine, 13(2), 307-349.
3. American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders (5th ed.). American Psychiatric Association.
4. Corkum, P., Tannock, R., & Moldofsky, H. (1999). Sleep Disturbances in Children with Attention-Deficit/Hyperactivity Disorder. Journal of the American Academy of Child & Adolescent Psychiatry, 38(6), 649-656.
5. Cortese, S., Konofal, E., Yateman, N., Mouren, M. C., & Lecendreux, M. (2006). Sleep and Alertness in Children with Attention-Deficit/Hyperactivity Disorder: A Systematic Review of the Literature. Sleep, 29(4), 504-511.
6. Gau, S. S., Shang, C. Y., Merikangas, K. R., Chiu, Y. N., & Soong, W. T. (2007). Psychopathology and Comorbidity of Juvenile Psychiatric Disorders in Taiwan: Implications for Service Delivery and Continuity of Care. Child Psychiatry & Human Development, 38(1), 91-108.
7. Gottlieb, D. J., Yao, Q., Redline, S., Ali, T., Mahowald, M. W., & Ramachandran, S. (2007). Does Snoring Predict Sleepiness Independently of Apnea and Hypopnea Frequency? American Journal of Respiratory and Critical Care Medicine, 175(2), 199-205.
8. Hossain, J. L., & Shapiro, C. M. (2002). The Prevalence, Cost Implications, and Management of Sleep Disorders: An Overview. Sleep and Breathing, 6(2), 85-102.
9. Hvolby, A. (2015). Associations of Sleep Disturbance with ADHD: Implications for Treatment. Attention Deficit and Hyperactivity Disorders, 7(1), 1-18.
10. Kinsbourne, M. (1973). Minimal Brain Dysfunction as a Neurodevelopmental Lag. Annals of the New York Academy of Sciences, 205(1), 268-273.
11. Konofal, E., Lecendreux, M., Bouvard, M., & Mouren-Simeoni, M. C. (2010). High Levels of Inattention at 6 Years of Age Are Associated with Sleep-Related Breathing Disorders (SRBD) at 8 Years of Age in a Large Cohort of Southwestern French Children. Sleep, 33(12), 1567-1573.
12. Lecendreux, M., Konofal, E., Bouvard, M. P., Falissard, B., Barbier, A., Mouren-Simeoni, M. C., & Simeoni, M. C. (2000). Sleep and Alertness in Children with Attention-Deficit/Hyperactivity Disorder: A Polysomnographic Study of 100 Children. Journal of the American Academy of Child & Adolescent Psychiatry, 39(4), 495-501.
13. Owens, J. A. (2005). The ADHD and Sleep Conundrum: A Review. Journal of Developmental & Behavioral Pediatrics, 26(4), 312-322.
14. Peppard, P. E., Young, T., Barnet, J. H., Palta, M., Hagen, E. W., & Hla, K. M. (2013). Increased Prevalence of Sleep-Disordered Breathing in Adults. American Journal of Epidemiology, 177(9), 1006-1014.
15. Sangal, R. B. (2009). Attention-Deficit/Hyperactivity Disorder and Narcolepsy. Sleep Medicine Clinics, 4(1), 43-49.
16. Yoon, S. Y., Jain, U., & Shapiro, C. (2012). Sleep in Attention-Deficit/Hyperactivity Disorder in Children and Adults: Past, Present, and Future. Sleep Medicine Reviews, 16(4), 371-388.