Date of Award

Spring 2023

Document Type

Scholarly Project

Degree Name

Master of Physician Assistant Studies (MPAS)

Department

Physician Assistant Studies

First Advisor

Carr, Kristen

Keywords

circadian rhythm, ADHD, melatonin, light therapy, sleep hygiene intervention, stimulant therapy effects

Abstract

The purpose of this research and systematic literature review is to determine if altering the circadian rhythm in people with Attention-Deficit Hyperactivity Disorder (ADHD) improves their symptoms. Up to 75% of people with childhood-onset ADHD exhibit a delayed circadian rhythm phase. This can cause difficulty in initiating and maintaining sleep, which in turn can cause excessive daytime sleepiness and further exacerbate ADHD symptoms, especially hyperactivity. Journal articles were searched in the databases of PubMed that concerned treatment aspects that would affect circadian rhythm and ADHD. Topics were further divided into themes that included melatonin, light therapy (LT), sleep hygiene intervention, and stimulant therapy effects. The search yielded 126 articles. Exclusionary criteria were articles dated prior to 2000, those not concerning all aspects used in search criteria, additional comorbidities, or those that compared participants with ADHD and those without ADHD. A total of ten articles were reviewed. The current literature revealed that advancing the circadian rhythm had improvements to both sleep and ADHD symptoms (subjectively) even when the duration of sleep time was not increased. However, most patients that were poor sleepers prior to treatment continued to be poor sleepers with treatment. Establishing good sleep hygiene showed benefits to most patients and should be addressed prior to the diagnosis of ADHD or starting therapy. Studies revealed that it can take more than eight weeks on ADHD medication to see benefits to sleep, as medication would commonly have a negative impact to sleep initially. More research needs to be conducted in this area, as most studies had more males versus females, and several were short in duration.

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