July 24, 2021
We are only beginning to explore how ADHD affects sleep in adults. A team of European researchers recently published the first meta-analysis on the subject, drawing on thirteen studies with 1,439 participants. They examined both subjective evaluations from sleep questionnaires and objective measurements from actigraphy and polysomnography. However, due to differences among the studies, only two to seven could be combined for any single topic, generally with considerably fewer participants (88 to 873).
Several patterns emerged. Looking at results from sleep questionnaires, they found that adults with ADHD were far more likely to report general sleep problems (very large SMD effect size 1.55). Getting more specific, they were also more likely to report frequent night awakenings(medium effect size 0.56), taking longer to get to sleep (medium-to-large effect size 0.67), lower sleep quality (medium-to-large effect size 0.69), lower sleep efficiency (medium effect size 0.55), and feeling sleepy during the daytime(large effect size 0.75).
There was little to no sign of publication bias, though considerable heterogeneity on all but night awakenings and sleep quality.
Actigraphy readings confirmed some subjective reports. On average, adults with ADHD took longer to get to sleep (large effect size 0.80) and had lower sleep efficiency (medium-to-large effect size 0.68). They also spent more time awake (small-to-medium effect size 0.40). There was little to no sign of publication bias and there was little heterogeneity among studies.
None of the polysomnography measurements, however, found any significant differences between adults with and without ADHD. All effect sizes were small (under 0.20), and none came close to being statistically significant.
There were four instances where measurement criteria overlapped those from actigraphy and self-reporting, with varying degrees of agreement and divergence. There was no significant difference in total sleep time, matching findings from both the questionnaires and actigraphy. On percent time spent awake, polysomnography found little to no effect size with no statistical significance, whereas actigraphy found a small-to-medium effect size that did not quite reach significance, and self-reporting came up with a medium effect size that was statistically significant. Sleep onset latency and sleep efficiency, for which questionnaires and actigraphy found medium-to-large effects, the polysomnography measurements found little to none, with no statistical significance.
Polysomnography found no significant differences in stage 1-sleep, stage 2-sleep, slow-wave sleep, and REM sleep. Except for slow-wave sleep, there was no sign of publication bias. Heterogeneity was generally minimal.
One problem with the extant literature is that many studies did not take medication status into account.
The authors concluded, "future studies should be conducted in medicatio- naïve samples of adults with and without ADHD matched for comorbid psychiatric disorders and other relevant demographic variables."
In summary, these findings provide robust evidence that ADHD adults report a variety of sleep problems. In contrast, objective demonstrations of sleep abnormalities have not been consistently demonstrated. More work in medication-naïve samples is needed to confirm these conclusions.
Amparo DiÌaz-RomaÌn, Raziya Mitchell, SamueleCortese, "Sleep in adults with ADHD: Systematic review and meta-analysis of subjective and objective studies," Neuroscience and biobehavioral reviews, vol. 89, p. 61-71(2018).
Meta-analysis finds vocal emotion recognition accuracy is significantly lower in ADHD
Emotion dysregulation (ED) refers to the difficulty someone has in managing their emotions. People with ED might experience strong reactions like anger, irritability, emotional outbursts, or even excessive happiness. This issue affects 25% to 45% of children with ADHD and 30% to 70% of adults with ADHD. ED may come from challenges in recognizing emotions—like anger, sadness, fear, or happiness—based on facial expressions or tone of voice. People with ADHD struggle to control their emotions in a similar way that they have trouble controlling their attention and behavior.
One way researchers study ED in people with ADHD is by testing how well they recognize emotions. In these studies, participants are shown faces or hear voices expressing different emotions, and they are asked to identify which emotion is being shown. This helps measure how accurately people with ADHD recognize emotions compared to people without ADHD (referred to as typically developing, or TD, individuals).
A group of psychologists from the UK reviewed many studies that compared how well people with ADHD and TD individuals performed on emotion recognition tasks. They focused on studies that looked specifically at how well participants could recognize emotions through vocal expressions (such as changes in tone of voice).
They combined the results of 20 different studies, which together included 1,651 participants, and found that people with ADHD had more difficulty recognizing emotions than those without ADHD. The overall difference between the two groups was moderate, meaning the ADHD group consistently had more trouble, but the differences weren’t extreme. Only two of the 20 studies showed slightly different results, and there was no sign that the studies were biased. Whether or not participants were taking medication for ADHD didn’t change the outcomes.
The study found that people with ADHD had more trouble recognizing both positive and negative emotions compared to the TD group:
The study found that emotion recognition difficulties were more pronounced in children with ADHD than in adults. Among children, the deficit was large, while among adults, the difference was moderate.
The psychologists concluded that their analysis provides strong evidence that people with ADHD struggle with recognizing emotions, particularly through vocal expressions. They also found that these difficulties aren’t specific to certain emotions (like only anger or sadness), but rather seem to affect emotion recognition in general. This supports the idea that ED in ADHD is partly due to the same attention problems that make it difficult for people with ADHD to focus or control their behavior. The findings highlight that emotion dysregulation in ADHD may be a secondary problem caused by these underlying attention issues.
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ADHD (Attention-Deficit/Hyperactivity Disorder) has often been seen as a condition that mainly affects boys, especially when it comes to hyperactivity. However, a new study challenges this idea by showing that hyperactivity is also common in women with ADHD, pointing out the need for better diagnoses.
The study included 13,179 adults with ADHD and 1,910 adults without it. Researchers measured how active participants were using a special test, looking at both "provoked" activity (activity triggered by specific tasks that puts the brain “online”) and "basal" activity (resting or natural activity levels when the brain is “offline”). The study included almost an equal number of men and women, with the goal of finding out if there were any differences between the sexes in ADHD diagnosis, particularly in hyperactivity.
The results were eye-opening. Although men generally showed higher levels of activity when the brain was online, both men and women with ADHD had much higher levels of both offline and online activity compared to people without ADHD. Specifically, those with ADHD had about twice the resting activity and three times the provoked activity compared to those without the disorder.
A key finding was that women with ADHD had hyperactivity levels similar to men with ADHD. This goes against the common belief that women with ADHD don’t show hyperactivity or show it less. It suggests that hyperactivity in women may be missed or misunderstood due to societal expectations or differences in behavior.
These findings have big implications. They suggest that the way we currently understand ADHD, especially hyperactivity in women, might be wrong. By recognizing that women with ADHD can have significant hyperactivity, doctors can diagnose ADHD more accurately. This could lead to earlier treatment and better management of ADHD in women, which might also lower the chances of related problems like anxiety or depression.
The study highlights the importance of thinking about gender differences when diagnosing and treating ADHD. By realizing that hyperactivity isn't just a "male" trait, we can better support everyone with ADHD and ensure they get the right care. As research on ADHD continues, it’s important to challenge old assumptions and take a more inclusive approach to understanding and treating the disorder.
Congenital heart disease (CHD) is a common birth defect where the heart’s blood vessels don’t develop normally before birth. This condition affects about 9% of all births worldwide, meaning about one in eleven babies is born with CHD. A recent analysis found that children with CHD have three times the risk of developing ADHD compared to children without CHD. However, that study only included five smaller studies, and almost 90% of the results varied between studies, making the findings less reliable. To improve on this, a team of researchers conducted a new, more thorough analysis.
The updated analysis combined eleven studies, involving nearly 300,000 people. This larger study also confirmed that children with CHD are three times more likely to develop ADHD than those without CHD. Importantly, there was no evidence that the results were biased by only including studies that showed stronger results ("publication bias"). The variation between the studies (heterogeneity) was lower in this new analysis, down to a more manageable 60%.
The researchers looked at two types of studies: cohort studies and cross-sectional studies, and found different levels of risk:
While both types of studies suggest a strong link between CHD and ADHD, cohort studies are more reliable because they track children over time, which helps researchers establish that CHD occurred before ADHD, suggesting a stronger cause-and-effect relationship. Both types of studies are observational. In any observational study, researchers look at data without actively changing or controlling anything in the study environment. Because they aren't conducting controlled experiments, it's possible that some important factors, known as "confounding factors," aren't being measured or accounted for. These factors can influence both the exposure (what the study is investigating, like CHD) and the outcome (ADHD) in a way that creates an association that is apparent but not rea.
Nine of the studies, which included almost 300,000 participants, adjusted their findings to account for "confounding factors"—things like age, gender, or other health conditions that could also influence whether a child develops ADHD. Even after making these adjustments, the risk of ADHD in children with CHD was still three times higher.
The researchers also found that the way ADHD was diagnosed—whether through clinical assessments or standardized symptom checklists—didn’t change the results much. Additionally, there was no major difference between studies done in the U.S. and those conducted in other countries, or between higher- and lower-quality studies.
The research team concluded that children born with congenital heart disease are at a much higher risk of developing ADHD than children without CHD. They suggested that children with CHD should be monitored more closely for ADHD as they grow up to ensure early intervention if needed.
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