The Bidirectional Relationship Between Sleep Disturbances and ADHD: A Narrative Review of Behavioral, Cognitive, and Neurobiological Mechanisms

Yi Jiang

doi:10.63808/jmh.v2i1.431

The Bidirectional Relationship Between Sleep Disturbances and ADHD: A Narrative Review of Behavioral, Cognitive, and Neurobiological Mechanisms

Authors

Yi Jiang School of Education, The University of Sheffield, Sheffield S10 2TN, United Kingdom

DOI:

https://doi.org/10.63808/jmh.v2i1.431

Keywords:

Attention-deficit/hyperactivity disorder, Sleep disturbance, Bidirectional relationship, Circadian rhythm, Non-pharmacological intervention

Abstract

ADHD and sleep disturbances represent one of the most clinically significant yet incompletely understood comorbid relationships in contemporary psychiatry, in part because much of the previous literature has treated sleep disturbance as a downstream consequence of ADHD rather than as a potential contributing factor to symptom expression. This review presents an integrative bidirectional model that brings together behavioral, cognitive, and neurobiological findings on the ADHD–sleep relationship across the lifespan. A structured narrative synthesis was undertaken, informed by a systematic literature search of five bibliographic databases covering January 2010 to December 2024, with included studies organized according to a three-tier mechanistic framework (behavioral, cognitive, neurobiological) and a corresponding bidirectional model. Across pediatric, adolescent, and adult cohorts, sleep problems are reported in approximately 25–80% of individuals with ADHD, depending heavily on the operational definition and assessment modality used; sleep-onset latency is increased by roughly 15–30 minutes relative to controls in several studies; experimental sleep loss is associated with moderate-to-large cognitive decrements (Hedges’ g ≈ −0.32 to −0.78) in general-population samples, with preliminary evidence that individuals with high ADHD symptom loads may be disproportionately affected; and dim-light melatonin onset is delayed by approximately 1–1.5 hours, alongside reported associations with circadian clock-gene polymorphisms of modest and heterogeneous effect. The review offers an organizing framework for identifying modifiable sleep-related targets in ADHD case formulation and for designing chronotype-informed, non-pharmacological interventions, while explicitly acknowledging the predominantly correlational nature of the underlying evidence.

References

[1] Anand, D., Colpo, G. D., Zeni, G., Zeni, C. P., & Teixeira, A. L. (2017). Attention-deficit/hyperactivity disorder and inflammation: What does current knowledge tell us? A systematic review. Frontiers in Psychiatry, 8, Article 228. https://doi.org/10.3389/fpsyt.2017.00228

[2] Baethge, C., Goldbeck-Wood, S., & Mertens, S. (2019). SANRA—A scale for the quality assessment of narrative review articles. Research Integrity and Peer Review, 4, Article 5. https://doi.org/10.1186/s41073-019-0064-8

[3] Becker, S. P. (2020). ADHD and sleep: Recent advances and future directions. Current Opinion in Psychology, 34, 50–56. https://doi.org/10.1016/j.copsyc.2019.09.006

[4] Bijlenga, D., Vollebregt, M. A., Kooij, J. J. S., & Arns, M. (2019). The role of the circadian system in the etiology and pathophysiology of ADHD: Time to redefine ADHD? ADHD Attention Deficit and Hyperactivity Disorders, 11(1), 5–19. https://doi.org/10.1007/s12402-018-0271-z

[5] Bondopadhyay, U., Diaz-Orueta, U., & Coogan, A. N. (2022). A systematic review of sleep and circadian rhythms in children with attention deficit hyperactivity disorder. Journal of Attention Disorders, 26(2), 149–224. https://doi.org/10.1177/1087054720978556

[6] Cortese, S., Konofal, E., & Lecendreux, M. (2008). Alertness and feeding behaviors in ADHD: Does the hypocretin/orexin system play a role? Medical Hypotheses, 71(5), 770–775. https://doi.org/10.1016/j.mehy.2008.06.017

[7] Cortese, S., Fusetto Veronesi, G., Gabellone, A., Margari, A., Marzulli, L., Matera, E., Petruzelli, M. G., Piarulli, F. M., Tarantino, F., Bellato, A., Parlatini, V., Du Rietz, E., Larsson, H., Hornsey, S., Hill, C., & Margari, L. (2024). The management of sleep disturbances in children with attention-deficit/hyperactivity disorder (ADHD): An update of the literature. Expert Review of Neurotherapeutics, 24(6), 585–596. https://doi.org/10.1080/14737175.2024.2353692

[8] Cortese, S., Song, M., Farhat, L. C., Yon, D. K., Lee, S. W., Kim, M. S., Park, S., Oh, J. W., Lee, S., Cheon, K.-A., Smith, L., Gosling, C. J., Polanczyk, G. V., Larsson, H., Rohde, L. A., Faraone, S. V., Koyanagi, A., Dragioti, E., Radua, J., … Solmi, M. (2023). Incidence, prevalence, and global burden of ADHD from 1990 to 2019 across 204 countries: Data, with critical re-analysis, from the Global Burden of Disease study. Molecular Psychiatry, 28(11), 4823–4830. https://doi.org/10.1038/s41380-023-02228-3

[9] Díaz-Román, A., Mitchell, R., & Cortese, S. (2018). Sleep in adults with ADHD: Systematic review and meta-analysis of subjective and objective studies. Neuroscience & Biobehavioral Reviews, 89, 61–71. https://doi.org/10.1016/j.neubiorev.2018.02.014

[10] Fang, Y., Peng, J., Chu, T., Gao, F., Xiong, F., & Tu, Y. (2025). Glymphatic system dysfunction in adult ADHD: Relationship to cognitive performance. Journal of Affective Disorders, 379, 150–158. https://doi.org/10.1016/j.jad.2025.03.059

[11] Faraone, S. V., Banaschewski, T., Coghill, D., Zheng, Y., Biederman, J., Bellgrove, M. A., Newcorn, J. H., Gignac, M., Al Saud, N. M., Manor, I., Rohde, L. A., Yang, L., Cortese, S., Almagor, D., Stein, M. A., Albatti, T. H., Aljoudi, H. F., Alqahtani, M. M. J., Asherson, P., … Wang, Y. (2021). The World Federation of ADHD International Consensus Statement: 208 evidence-based conclusions about the disorder. Neuroscience & Biobehavioral Reviews, 128, 789–818. https://doi.org/10.1016/j.neubiorev.2021.01.022

[12] Floros, O., Axelsson, J., Almeida, R., Tigerström, L., Lekander, M., Sundelin, T., & Petrovic, P. (2021). Vulnerability in executive functions to sleep deprivation is predicted by subclinical attention-deficit/hyperactivity disorder symptoms. Biological Psychiatry: Cognitive Neuroscience and Neuroimaging, 6(3), 290–298. https://doi.org/10.1016/j.bpsc.2020.09.019

[13] Jernelöv, S., Larsson, Y., Llenas, M., Nasri, B., & Kaldo, V. (2019). Effects and clinical feasibility of a behavioral treatment for sleep problems in adult attention deficit hyperactivity disorder (ADHD): A pragmatic within-group pilot evaluation. BMC Psychiatry, 19(1), Article 226. https://doi.org/10.1186/s12888-019-2216-2

[14] Korman, M., Palm, D., Uzoni, A., Faltraco, F., Tucha, O., Thome, J., & Coogan, A. N. (2020). ADHD 24/7: Circadian clock genes, chronotherapy and sleep/wake cycle insufficiencies in ADHD. The World Journal of Biological Psychiatry, 21(3), 156–171. https://doi.org/10.1080/15622975.2018.1523565

[15] Liang, X., Qiu, H., & Li, S. X. (2023). Objectively measured sleep continuity in children and adolescents with ADHD: A systematic review and meta-analysis. Psychiatry Research, 328, Article 115447. https://doi.org/10.1016/j.psychres.2023.115447

[16] Lim, J., & Dinges, D. F. (2010). A meta-analysis of the impact of short-term sleep deprivation on cognitive variables. Psychological Bulletin, 136(3), 375–389. https://doi.org/10.1037/a0018883

[17] Lowe, C. J., Safati, A., & Hall, P. A. (2017). The neurocognitive consequences of sleep restriction: A meta-analytic review. Neuroscience & Biobehavioral Reviews, 80, 586–604. https://doi.org/10.1016/j.neubiorev.2017.07.010

[18] Marten, F., Keuppens, L., Baeyens, D., Boyer, B. E., Danckaerts, M., Cortese, S., & Van der Oord, S. (2023). Sleep parameters and problems in adolescents with and without ADHD: A systematic review and meta-analysis. JCPP Advances, 3(3), Article e12151. https://doi.org/10.1002/jcv2.12151

[19] Menon, V. (2011). Large-scale brain networks and psychopathology: A unifying triple network model. Trends in Cognitive Sciences, 15(10), 483–506. https://doi.org/10.1016/j.tics.2011.08.003

[20] Migueis, D. P., Lopes, M. C., Casella, E., Soares, P. V., Soster, L., & Spruyt, K. (2023). Attention deficit hyperactivity disorder and restless leg syndrome across the lifespan: A systematic review and meta-analysis. Sleep Medicine Reviews, 69, Article 101770. https://doi.org/10.1016/j.smrv.2023.101770

[21] Misiak, B., Wójta-Kempa, M., Samochowiec, J., Schiweck, C., Aichholzer, M., Reif, A., Samochowiec, A., & Stańczykiewicz, B. (2022). Peripheral blood inflammatory markers in patients with attention deficit/hyperactivity disorder (ADHD): A systematic review and meta-analysis. Progress in Neuro-Psychopharmacology & Biological Psychiatry, 118, Article 110581. https://doi.org/10.1016/j.pnpbp.2022.110581

[22] Morales-Muñoz, I., Upthegrove, R., Lawrence, K., Thayakaran, R., Kooij, S., Gregory, A. M., & Marwaha, S. (2023). The role of inflammation in the prospective associations between early childhood sleep problems and ADHD at 10 years: Findings from a UK birth cohort study. Journal of Child Psychology and Psychiatry, 64(6), 930–940. https://doi.org/10.1111/jcpp.13755

[23] Sukhera, J. (2022). Narrative reviews: Flexible, rigorous, and practical. Journal of Graduate Medical Education, 14(4), 414–417. https://doi.org/10.4300/JGME-D-22-00480.1

The Bidirectional Relationship Between Sleep Disturbances and ADHD: A Narrative Review of Behavioral, Cognitive, and Neurobiological Mechanisms

The Bidirectional Relationship Between Sleep Disturbances and ADHD: A Narrative Review of Behavioral, Cognitive, and Neurobiological Mechanisms

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