ADHD worsens stress and decreases sleep in adolescents

Adolescents with attention-deficit/hyperactivity disorder (ADHD) will often experience stress and sleep problems, according to a recent study. 

Between 5% and 7% of pediatric individuals worldwide experience ADHD, often feeling symptoms of inattention, hyperactivity, and impulsivity. In different cases of ADHD,1 or both symptoms will be present.

Children with ADHD have been observed with high comorbidity rates, as about half of children with ADHD experience an external disorder such as oppositional defiant disorder or conduct disorder, and about 40% experience an emotional disorder such as anxiety or depression. Over half face difficulties in relationships, while 25% to 70% experience sleep problems.

While there is little evidence on the connection between stress and ADHD, the evidence collected has associated them with one another. ADHD can worsen perceived stress and lead to more stressors, along with leading to negative emotions such as anxiety. High stress can also worsen sleep, a symptom often seen in cases of ADHD.

As stress and poor sleep can worsen daily functioning and health, it is important to establish a link between ADHD and stress. To determine whether stress and sleep problems are symptoms of ADHD or a comorbidity issue, researchers analyzed ADHD and comorbid symptoms in adolescents with ADHD.

Over 300 adolescents aged 13 to 19 years participated in the study, with about 67% being female. Almost 200 participants had been diagnosed with ADHD, with the remaining being controls. The ADHD group was divided into 2 subgroups; one of a smaller group to study the effects of psychotherapy, while a larger, younger group participated in a feasibility study. About 130 individuals from the ADHD group had been prescribed ADHD medication.

Individuals with severe depression, suicidality, intellectual disability, psychosis, brain injury, bipolar disorder without stable medication, autism, or on-going substance abuse were excluded from the study. About 60% of participants in the first subsample and about 49% in the second subsample had indications of psychiatric comorbidity.

Participants with ADHD not taking medication experienced a significant increase in inattention compared to those with ADHD taking medication. Hyperactivity, impulsivity, perceived stress, and sleep problems did not differ between the 2 groups. 

Stress increased in adolescents with ADHD compared to those without ADHD, and those with sleep and stress problems reported a much greater increase in perceived stress. Sleep problems were most common in adolescents experiencing high amounts of inattention. Girls with ADHD more often experienced stress, but sleep problems did not change. Also, age did not affect ADHD or any of the studied symptoms.

Researchers recommended reducing ADHD symptoms to control stress and improve sleep, while targeting comorbid symptoms to further improve wellbeing. Based on the study’s findings, all these symptoms are intricate.

Reference

Frick, MA, Meyer, J, Isaksson, J. The role of comorbid symptoms in perceived stress and sleep problems in adolescent ADHD. Child Psychiatry Hum Dev (2022). https://doi.org/10.1007/s10578-022-01320-z