Results

The Effects of ADHD Symptomology on Sleep  Leah Doghramji 

Faculty Mentor: Dr. KnouseDepartment of Psychology, University of Richmond

Background

Recruitment and Procedure

Discussion

Because depression is commonly comorbid with ADHD, we conducted a multiple regression analysis to see if depressive symptoms could account for the relationship between hyperactive symptoms at time 1 and ISI score at time 2.

In Step 1, depressive symptoms at time 1 predicted insomnia at time 2 (F(1, 6) = 5.8, p = .05, R2 = .49, R2

adjusted = .41). In Step 2, symptoms of depression and hyperactive symptoms at time 1 explained a

marginally significant amount of variance in the ISI total at time 2, although the relationship was moderate in magnitude in this small sample (F(2, 5) = 5.2, p = .06, R2 = .68, R2

adjusted = .55). Importantly, with depressive symptoms in the model, hyperactive symptoms no longer

predicted insomnia.

RV DHD

ADHD affects 4.4% of adults (Kessler et al., 2006) Chronic insomnia affects 54.5% of adults with ADHD, which is higher than the

rate in the general population (Voinescu, Szentagotai, & David, 2012). Some symptoms of ADHD include restlessness, feeling as if “driven by a

motor,” fidgeting, losing everyday objects often, easily distracted, unable to keep attention, and unable to wait turn.

Insomnia leads to cognitive deficits in working memory, episodic memory, problem solving, and, most importantly, executive functioning (Fortier-Brochu, Beaulieu-Bonneau, Iversm, & Morin, 2012).

Both ADHD and Insomnia negatively affects the prefrontal cortex, which is home to executive functioning and many related cognitive functions, including attention and organization (Barkley, Murphy, & Fischer, 2008; Fortier-Brochu et al., 2012).

Research question 1: Do hyperactive/impulsive and/or inattentive symptoms relate to risky behaviors, e.g. risky drinking?

Research question 2: Do hyperactive/impulsive and/or inattentive symptoms relate to sleep problems?

Participants were recruited from the community through flyers, newspaper ads, Craiglist, and Facebook.

Potential participants completed an online screening in order to determine eligibility, which looked for a prior clinical diagnosis of ADHD, current symptoms above the clinical cutoff for inattentive or combined ADHD, and no disorders that would interfere with participation (e.g. schizophrenia).

We recruited a total of 12 participants at time 1 (3 men, 9 women). Four months later, 8 of these participants completed the follow-up self-report survey online (Time 2).

At Time 1, eligible participants came in for a three-hour session that consisted of structured clinical interviews, subscales assessing for processing speed, abstract thinking, and reasoning skills using the Weschler Adult Intelligence Scale, and a self-report survey battery.

Included in the self-report surveys were the Barkley Adult ADHD Rating Scale (BAARS), Pittsburg Sleep Quality Index (PSQI), Center for Epidemiological Studies – Depression (CES-D), Alcohol Use Disorder Identification Test (AUDIT), and the Insomnia Severity Index (ISI).

Examples BAARS (α=.87)

Inattentive: “Prone to daydreaming when I should be concentrating on something or working”

Hyperactive/Impulsive: “Interrupt or intrude on others” PSQI

Efficiency: “How many hours of actual sleep did you get at night?” CES-D (α=.87)

“I felt everything I did was an effort” AUDIT

“How often during the last year have you failed to do what was normally expected of you because of drinking?”

ISI (α T1=.82, α T2=.64) “To what extent do you consider your sleep problem to interfere with

your daily functioning?”

Hyperactive/impulsive symptoms significantly, positively correlated with AUDIT scores, showing the relationship between impulsivity and risky drinking.

Both H/I and inattentive symptoms were significantly related to poor sleep efficiency, indicating the negative relationship between ADHD symptoms and sleep quality.

Although only marginally significant, inattentive symptoms were positively correlated with sleep disturbance, the overall PSQI score, and insomnia at time 1, which was not found for H/I symptoms, elucidating the stronger negative relationship between inattentive symptoms and sleep quality at the same point in time.

An interesting relationship was found between H/I symptoms at Time 1 and insomnia at time 2, which we hypothesized might be accounted for by a relationship between ADHD and depression.

Depression partially accounted for the relationship between H/I symptoms at time 1 and insomnia at time 2.

Further research with a larger sample size would clarify this surprising relationship. In light of the findings from this research, it would be important to assess for sleep

problems in the ADHD population, as correcting any sleep deficiencies might ultimately help with both types of symptoms of ADHD as well as depressive symptoms.

InsomniaTime 2

Depression Time 1

Hyperactivity Time 1

BAARS_HI_T1 BAARS_Inatt_T1 AUDIT_Total ISI_Total PSQI_EFF PSQI_DISTB PSQI_LATE PSQI_DayDys PSQI_Total ISI_Score_T2

Pearson Correlation

1 .663** .597* .156 .552* .175 -.179 -.049 .239 -.757*

Sig. (1-tailed) .009 .016 .314 .031 .293 .289 .440 .227 .015

N 13 12 13 12 12 12 12 12 12 8Pearson Correlation

.663** 1 .232 .435 .563* .491 -.048 .156 .489 -.484

Sig. (1-tailed)

.009 .234 .079 .028 .052 .441 .314 .053 .136

N 12 12 12 12 12 12 12 12 12 7

Correlations

BAARS_HI_T1

BAARS_Inatt_T1

Standardized Coefficients

B Std. Error Beta

(Constant)-10.468 9.948 -1.052 .333

CESD_tot_T1.570 .237 .701 2.408 .053

(Constant) 14.203 17.060 .833 .443CESD_tot_T1

.319 .255 .393 1.250 .267

BAARS_HI_T1-.612 .364 -.528 -1.682 .153

Model

Unstandardized Coefficients

t Sig.1

2

Illustration of overlapping variance among Insomnia at Time 2 and Depression and Hyperactivity/Impulsivity at Time 1