Marching to a different beat: ADHD and circadian rhythms

Oct 03 2012 Published by under Behavioral Neuro

Sometimes, I read a paper, and I'm just suddenly struck by the sheer interconnectedness of the brain. This is one of those papers. Not because of the paper itself, but because when you see the association between one change in the brain (ADHD) and another (circadian rhythm), you can start to intuit other changes that might result from the two systems. Soon, you're just overwhelmed by the idea that it's all a vast web, a pull in one direction changes something in another, different systems adapting to tiny changes elsewhere to maintain homeostasis. The brain is a marvelous thing.

And today's paper concerns an association between two brain "systems" that you might think very different: attention, and circadian clock.


(Source)

Baird et al "Adult attention-deficit hyperactivity disorder is associated with alterations in circadian rhythms at the behavioural, endocrine and molecular levels" Molecular Psychiatry, 2012.

ADHD (attention deficit hyperactivity disorder) is usually thought of as a disorder of attention, associated with behavioral and social difficulties. Scientists are very interested in associations between ADHD and increased likelihood of drug abuse, and of course they are interested in addressing how to relieve the social difficulties that people with ADHD often face. But there are other features of ADHD which tend to be less studied. In particular, people with ADHD often complain of...problems sleeping. Up to 83% of adults with ADHD report sleep problems, and children with ADHD also show differences in sleep patterns.

What kind of sleep difficulties? Pretty much all kinds, trouble falling asleep, increased nighttime movement, decreased REM sleep, you name it. And all of these things are connected with the circadian clock, which generates your biological rhythms. Everything from being hungry to pooping is modulated by the biological rhythm produced by your body. The center for this rhythm is thought to be in the hypothalamus, in a little area called the suprachiasmatic nucleus.


(Source)

Our biological clock runs on a roughly 24 hour schedule, mediated by the presence of light during the day, and with other oscillations that are somewhat independent. As the day goes on, the biological clock controls the transcription of genes and the making of proteins in a specific, 24 hour pattern. Messing with this pattern messes with the rhythm and with your ability to do things like sleep at night and remain alert during the day.

So is there a connection between ADHD and sleep? To look at this, the authors of this study recruited people with ADHD (13 of them), and controls (19 of them, low numbers, but human studies often suffer from this, especially as they had to exclude a lot of other factors, like working night shifts and comorbid psychiatric disorders). They had them wear actigraphs to look at when they were active and awake, and took samples of their saliva and mouth mucosa, to look at the expression of clock related genes and hormones associated with circadian rhythm, in this case cortisol and melatonin.

They found that ADHD patients were overall more active than controls (well it IS hyperactivity disorder after all), but they also showed differences in rhythm. ADHD people tended to be much more active at night (they call this a shift toward "eveningness"), and they also had much more trouble falling asleep, on average taking an hour after going to bed to get some z's, while no controls complained of this.

But when they looked at the clock genes BMAL1 and PER2, they saw something particularly interesting:

What you can see here are the rhythms for controls (the two left graphs), and ADHD (the two right graphs). You can see for BMAL1 (top), and PER2 (bottom), the controls show a nice rhythm, with a peak in the middle of the day and lower at night. In contrast, the ADHD patients showed no discernable rhythm. Not a shift in rhythm, but no rhythm at all.

The hormone studies showed something else interesting:

The controls are still on the left, the ADHD patients are on the right. On the top is melatonin, a hormone which helps control circadian rhythm, and on the bottom is cortisol, which varies with circadian rhythm.

You can see that the melatonin had a very large and obvious rhythm in the controls, but that this was dampened in the ADHD group, they just didn't have as strong a rhythm. With cortisol, while both the controls and the ADHD patients showed a rhythm, in the ADHD patients it was shifted, to 3 hours after the time when they usually woke up. No wonder they complained of feeling sluggish in the morning.

And here we come to another aspect of the inter-relatedness of it all. One of the hormones they looked at was cortisol, which varies on a diurnal schedule. The rhythm was different in people with ADHD. But cortisol is not just a circadian hormone, it's a chemical signal strongly associated with stress response. Is there a link to altered stress response here as well? And stress response alterations are often associated with changes in depressive behaviors and addictive behaviors. How deep does the rabbit hole go? And where do we begin to correct it all?

Clearly, this study does not provide proof that ADHD and insomnia always go together. But it does show an association between ADHD and a disregulated circadian rhythm. Of course, here we have a chicken and egg problem, does the ADHD cause the circadian issues? Do the circadian issues result in ADHD? It's a new angle for ADHD research, and one that might be interesting in the long run. If one thing changes, something else changes too, and it may take a deep understanding of how many different systems work together to figure what puts a brain in balance.

Baird AL, Coogan AN, Siddiqui A, Donev RM, & Thome J (2012). Adult attention-deficit hyperactivity disorder is associated with alterations in circadian rhythms at the behavioural, endocrine and molecular levels. Molecular psychiatry, 17 (10), 988-95 PMID: 22105622

36 responses so far

  • Jason Dick says:

    So that is where light is found in my brain! I'd always wondered....

  • Kate K., PhD says:

    This is so interesting because I was just reading about photosensitive ganglion cells in the eye and how they may have an important role in our circadian rhythm and melatonin production.

    http://en.wikipedia.org/wiki/Photosensitive_ganglion_cell

    It would be interesting to see if ADHD patients react differently to light response.

    • I react different in responce to light. Light is my medicine, and like my younger "people", we can't sleep with it and if their like me, need enough of it to wake up and not be "grumpy".

    • Qukis says:

      I agree with Stanley.
      I am very sensitive to light.
      On a dark day I am completely sluggish and unmotivated. While on a bright day I can focus and accomplish 5x as much!
      If I don't turn the lights off in the evening, I can stay up all night till I'm exhausted, and that's usually the case.
      However, one strange thing, if the sun is too bright in summer, it affects me adversely and I too become depressed and lose energy...
      ADD... is not a candy.

  • Thony C says:

    I find it interesting and at the same time frustrating that nobody ever addresses ADD (non-H) whose sufferers actually make up a substantial part of the adult ADD population.

    P.S. There is a "not" missing from the first sentence of the last paragraph ;)

    • You're right. The author may have the "H" version of ADD. Only someone that wasn't hyperactive would notice that. I thought it just sounded strange.

      • Actually, I feel that it's better not to have a not in that sentence. I'm thinking a little better now a few hours later. The study is enough proof for me to understand almost all those I know, except my brother David. He naturally has better rising and setting patterns than our sun does. Literally. The sun vacilates in summer and winter, as if it has SADD sydrome. Brother Davey doesn't. He doesn't have the suns "mania" either in early summer like the sun has. Especially at the poles when sometimes for a week it will stay up for weeks 24 hours a day, with just a little "dose-off" for maybe an hour or two each day. What was I going to say? Oh ya. I think it provides proof, certainly for most ADHD, including children. By the time some scientists or skeptics are convinced of it's complete validity. I could be using this information to find out other connections - which I already did in terms of parents and some failing school systems. Now I know what my grandchildrens problems at night are and my problems with waking up all of my life are. And am happy now. So in the next sentence after the not having a not one, I would have it say, "Also it does show the association". . .bla bla. The cardadian issues don't result in ADHD otherwise anyone suffering jet lag or some big stress in life would automatically become ADHD. But ADHD does result in stress, resulting in raised cortisol and no doubt messing with your hypothalomous & getting up to eat and turning the light on. We're gunna have an adjusted brain after a while simply by trying to prevent anxiety and depression. If this isn't allowed &/or understood in order to deal with more stress will result. That is why overly strict parents (and to tell the truth must also add educators) make children with add and adhd much WORSE, not better. anyones rythems wouldn't ryme after a while if they had to go through that. Authorities are dumb-dumbs. Being ignorant isn't anyones fault, but it can be an excuse for educated people to avoid responsibility. Someone once blindly said (and may have been right; just not hopefully in the future). Said "ignorance is not an excuse under the law". It sure has been an excuse for many laws around the world by their creators. It's an excuse not to learn about how parents and villages can help children internalize ideal feelings and thus behavior so laws will hardly ever be needed in the future. This is the way we cure crime, deficiets, most mental problems and more goverment deficiets. How obesity can subside via less stress and cortisol causing overeating and more hypothalomous disorders (read October 6, "Science News" magazine if your curious about eating disorders). You know. It's all "easy to understand to him that understandeth", as old King Solomin said in his Proverbs. I'm thirsty, not crazy. That's all I've got to say.

    • Jamie says:

      ADHD is an umbrella term for both the hyperactive, inattentive, and combined type (recently became the official term, according to wikipedia)

      Since it's on a spectrum, many people will show some but not all symptoms of ADHD, it's a blurred line, but it's the same disorder. Personally, I think the only difference is in how it's expressed.

  • me says:

    I would view this paper in a much more skeptical light. They only recruited adults, and give no information about their treatment history, which makes me wonder whether the blunted circadian rhythms are simply a consequence of a life-history filled with amphetamine-type therapies. It'd be much more convincing if they examined children at the time of diagnosis to get at the chicken-before-the-egg issues.....

    • scicurious says:

      I definitely agree they should have looked at their treatment history. I assume if they were medicated, they were not tested drug free, so it could indeed be an effect of the medication. I'd be interested to see that aspect. As far as the children at time of diagnosis, I'd also like to see that study, but I have to keep reminding myself to take studies as they are, and not as I want them to be. I save how I want them to be for manuscript reviews. :)

      That said, this is not the first study linking ADHD and altered sleep, it is instead the first to look at the particular molecular markers, which is why I found it interesting.

    • wrysuitor says:

      OTOH, or maybe As Well, something like 30-50% of children with an ADHD Dx outgrow the symptomology by adulthood, so you could also be narrowing the sample to persistent cases, or "true" cases if you're a skeptic of the Dx (I tend to think it is over-diagnosed due to clinical experience, but fully realize that I'm working with a self-selected sample of the pop based on socio-economic status). You bring up a good point. I haven't encountered a whole lot of data regarding effects of ADHD med.s on developing brains, and most of those med.s ARE stimulants. Nevertheless, I'll be sharing this with others in my field: the link to the endocrine system is pretty fascinating regardless of whether it's iatrogenic, and it would be even more helpful to know in the future to sort out effects of medication v the disorder itself more definitively. That's a real challenge, though, since most people under the age of majority with an ADHD Dx get medicated.

      • becca says:

        "OTOH, or maybe As Well, something like 30-50% of children with an ADHD Dx outgrow the symptomology by adulthood,"
        The question is, do something like 30-50% of adults with ADHD Dx find a way to work night shifts, work in bursts on their own schedules, or otherwise find a way around the Tyranny of the 7am school start?

        Full disclosure: I have high 'eveningness'. My mother had high eveningness, and her mother before her. We figure 10% of the population had to stay awake at night to guard the tribe ;-)

        Anecdotally, most (but not all!) of the relaxed schedule type homeschoolers I knew don't believe in ADHD, even if their kid was Dx while in school.

        On an even more crazy hairbrained note, they're now realizing that kids with cerebral malaria tend to wind up with ADHD types of problems (among other issues- it's pretty severe after all). I would REALLY like to see melatonin rhythms in kids in those general populations, kids that contract malaria, kids that get cerebral malaria, and kids that recover from it by ADHD symptomology.
        (note that I'd hypothesize that more spikey-melatonin rhythms helps the malaria parasite reproduce; a while back Bora wrote up on the molecular studies that have been done there, and melatonin helps the parasite 'know' when it's evening and the mozzies are feeding; if the cerebral-malaria victims who wind up with ADHD symptoms have blunted melatonin rhythms like these adults, it might make them less likely to get malaria in the future. Malaria has been known to do a lot more screwed up things to our genomes than ADHD, just sayin').

        • @Becca

          Super comment - los re: "high eveningness"

          Thanks for the info on cerebral malaria - I'm off to investigate! (btw, your "spikey/reproduction" theory sounds highly probable to moi.
          xx,
          mgh

          Madelyn Griffith-Haynie, CMC, SCAC, MCC
          - ADD Coaching Training Field founder -

    • GREAT article here - much appreciated. Will backlink it to my own "Living with JetLag" (and others to come in the [comorbid] Chronorhythm Disorders Series following "Sleeping with ADD") - one of my readers, Dr. Kinsella, left the link here in his comment; I will move it into the article itself now that I've made time to explore it - will ping back once it's live.

      @me - I can't speak for others BUT, as the kid they had to WAKE for Christmas, my own life-long struggles with circadian rhythm mismatches with the rest of you earthlings LONG predated my experience with stims (almost 40 before I took 'em - and, in fact, they actually HELP balance the ADD brain so that we CAN get to sleep!).

      [My experience, but Thom Brown at Yale is your source for that assertion - one of his life-long specialties is ADD & Sleep Disorders - Thomas E. Brown if you google him]

      STRICT upbringing, I wasn't even a coffee drinker until 18. My Mom was the Betty Crocker of healthy meals make for healthy kids - eat your veggies, drink your milk and finish your salad! (who knew that *milk* wasn't the best idea for ADDers? Certainly exacerbates MY symptoms! but then, who was looking for ADD back then either?)

      I was put to bed at 8 PM until I was 12 year old - RARELY permitted lights after 10-ish pm until I left for college - *hours* of boredom in the dark - practically impossible to awaken in the AM - so don't go THERE either!

      An ADD Pro, practiced (and trained) life-long self-observer -- and ADD Poster Girl with what I know NOW is comorbid DSPS N-24 -- I simply must weigh in (somewhere other than my own blog) in praise of accumulated anecdotal, with a skeptical eye on the "scientific" validity of ANY study.

      ALL studies of humans are skewed by one form of sampling error or another - especially kids (referred participants are already suspect as out of the "norm," right? otherwise, why refer? and where are all the GIRLS?) -- plus, study design itself is a form of its own confirmation bias.

      Studies serve a purpose, and I'm glad we've got 'em (and we need many MORE of 'em!) - but they are not, ipso-facto, TRUTH's handmaiden and messenger.

      We do a great many of the individuals I serve a HUGE disservice by our failure to "listen from *belief*" vs. what we'd like to believe is "enlightened skepticism."

      Oh yeah - and we've got enough accumulated science to know that experiences (and neurology) of kids and adults don't NECESSARILY jibe, right?

      Do agree that baselines would be a SUPER idea as a dx protocol, however. The field needs more than behavioral observations to crack this nut! (in *my* lifetime, please)

      Madelyn Griffith-Haynie, CMC, SCAC, MCC
      - ADD Coaching Field co-founder -
      (ADDandSoMuchMore and ADDerWorld - dot com!)
      "It takes a village to transform a world!"

      • Mindy says:

        Yes! This is EXACTLY how I view my gift! I make music, paint, draw, make jewelry, learned to read, write, paint, and now speak Japanese, and write stories, etc., all while my husband and children sleep. I usually get to bed around 3am and then get up at 8am (would sleep later if kids didn't have school). For so long, I bought into the lie that ADHD was a disorder and that my hyperfocusing made me a bad wife and mom, and it really had a bad effect on my self-esteem. It wasn't until I accepted I didn't fit the school house norm (and, quite frankly, told people that didn't like it, to take a hike), that I began to love the gift that I had been given. It is a blessing and not a curse! Society just needs to be willing to accept that not everyone fits in the 95% of the population. We are the outliers - and we get more stuff done than your average bear;-)

        Oh, and to those who don't understand why ADD wasn't used:
        ADHD is the formal diagnosis used now for all Attention Deficits according to the DSM-TR-IV (new one is out). It just now is subtyped:
        ADHD-I = Inattentive; ADHD-H = Hyperactive; ADHD-IH = Both Inattentive and Hyperactive; and then ADHD-C = Compulsive

        Thought I'd share that. It pisses my sister off all the time;-) LOL!
        Blessings,
        Mindy

      • Alice says:

        Would you mind telling me which stims you take (or like/prefer?)

        I have bee strugling with Post partum and fibromyalgia an have Never been able to get off to sleep since i was a little girl. But my latest one, out of nowhere, is being unable to sleep for the WHOLE night (despite ambien/ativan ect) until about 5-6am, and then falling in to the deepest coma like sleep I have eve encoutered in my life - until around 2.30pm! Luckily my husband is here at the oment but he goes away in a few weeks and I have no idea how I am going to cope with a 7 month old and a 4 year old.

        My psychopharma just prescribd Adderall. Life changing!! I can set the alarm, feel TERRIBLE, pop one of those with my coffee and actually be ablt to get through the day.

        I hear, though, that there are others that some prefer? What was your experience?

  • Joel Haas says:

    I am a sample of one with ADHD my whole 61 years. My circadian rythms were, and always have been, very irregular. I am writing this at 1:59 AM EDT having gotten up this morning at 11:20 AM EDT. As a child, my parents would simply baby proof the apartment and go to bed and I would happily zip around at high speed until 3 AM or so. I was lucky in being one of the first kids diagnosed with ADHD and put on Ritalin. (early 1950s) It worked. I slept better. However, we moved several times and other pediatricians had either never heard of ADHD or believed it was a syndrome only boys had and would outgrow. After I was 4 years old, I did not take any medication. My life would have been very different if I had.

    I was never treated again nor was it even mentioned until after my second marriage ended and at age 59 a therapist diagnosed me with ADD before I had even walked in the door. Suddenly, the whole arc of my life and habits made sense. It was as if the therapist had been reading my mail since I was 6.

    ADD ers react to amphetamines and other stimulants the opposite of the general population. That explained to me why I and other ADD people could have a few expressos before bedtime and fall asleep FASTER.

    To put the science simply, we ADDers have too much stimulation coming into our brains. The extra stimulation from amphetamines, caffeine, whatever, simply clogs up the extra band width or extra avenues of info input.

    ADDers live a high stress life--society disapproves of us and we never know when something we overlooked is going to bite us in the butt. We often have no real basic understanding of cause and effect. We can try to be very careful with a task and make a load of mistakes or dash it off and find we've done it perfectly. We never know which society will decide we have done and that creates constant stress.

    The commenters here are far too wrapped up in whether the subjects were on drugs. Drugs are not the whole solution to treating ADD and I know of no reputable doctor or therapist who thinks they are. A combination of psychotherapy to treat years of low self esteem and judicious regimens of Ritalin and Adderall, in combination or proper doses by themselves, combined with therapy has changed my life. Even without drugs in the subjects, we don't know how much sleep apnea, nasal valve collapse, breathing problems in general, other health issues, etc affect the test subjects or the controls.

    Obviously, though, it has not changed my sleep rhythms. Melatonin sometimes works for me, sometimes not. Xanax works well in low doses to promote sleep, probably because it relieves the stress of cortisol.

    Finally, it might well help researchers to think of ADD as Attention DIFFERENCE, not deficit. One of ADD's cardinal symptoms is the ability to hyper focus beyond what normal people usually can to accomplish a task.

    ADD left me graduating in the bottom of my high school class (Broughton' 69 Raleigh, NC) and making brilliant grades two years at NCSU and then dropping out. However, ADD has been the reason I could hyper focus to teach myself realistic sculpture; ADD was the reason I could focus on becoming a certified welder in various types and positions and become a good abstract sculptor; it's the reason I spent nine years learning Spanish every Monday night; it's the reason I could write paperback Westerns in my 20s, and a few years ago write five drafts of a 93,000 word novel (not a paperback Western); it's the reason I learned a fair amount of programming skills, etc. I don't suffer a deficit, I am simply differently abled than than most people, and not always to my disadvantage.

    Generally, when I or other ADDers are up late, you can bet we're not watching TV. We're probably focused on something and time has slipped away.
    Joel Haas, sculptor. Raleigh, NC USA
    http://www.joelhaasstudio.com http://www.sculpturewalk.org joel@joelhaasstudio.com

    • Reply to Joel Haas. And then to anyone concerned (unconcerned can't make a good difference): I ABSOLUTELY agree with you. I especially like the part of different abilities. I think unempathetic folks who see others only in their own image, don't really understand ADD, or most any uniqueness for that matter. Why would someone need to dis- someone simply because of who they are. Why would anyone try to alter a persons life just to re-create someone like themselves. Schools would do well adapting to peoples true cardadian rythems and learning styles. Students would learn more and our country would have much less drop-outs. The children and teens are not the problem in the schools, but the uneducated ways that make instructing students dis-fuctional. Education is sometimes disabled by not knowing who they are teaching. I cannot know what I'm learning if a teacher or parent don't know HOW and when to teach someone with my stripes. I once heard a nature special about saving everything from whales to tigers. They don't try and dis a whales commumications styles or a tigers stripes, why call mine a disability or a liability? We don't need to make people into our own image in order to appresheate them. That's a lack of empathy and respect. And without these two things, parenting or educating are futile and irresponsable. When the teacher is ready - the student will appear. In my case, the "chicken" (instructors) needed to come first and THEN the"egg" would've appeared. How is an egg going to make a chicken. No wonder ADHD people like Albert Einstein would say things like, "A thought that sometimes makes me hazy: Am I or are the others crazy?" No wonder he dropped out of high school when he was 16. I was HAPPY when my step-daughter did the same when she was 16. Meade county schools in Kentucky haven't heard the end of me. I'm not usually upset. I only get this way if well intentioned teachers are not allowed to learn and teach their students in ways that are most effective for them. Do I think I know how to make schools and other learning centers better? For some children and adults, absolutely. I'm the "chicken" now, even if I'm not afraid to speak my mind. I want to help"lay a golden egg". Otherwise, children and adults like me are dis-criminated against. And that causes avoidance and oppositional behavior. Now we know which came first in the chicken-egg story regarding avoidance or oppositional behavior. It's not that hard to understand. Just hard to let the truth pave the way to freedom. I once beleived in the prejudiced authorities also. But that made me always doubt myself. America can once again be more like our old creed, "The free and the Brave". The secret to happiness is freedom. And the secret to freedom is courage. I'm not a bad person. I once felt like one which caused me to start acting like one. The above report starting saying that scientists are already very interested in things like the causes of drug abuse. Had I knew that, I would've had them study me while I was on and after I was off drugs. But I didn't know anyone was interested. Again, those who assume they know would appear to me as if they already knew everything. Right, and nothing got better. So I became my own authority, even for my brain-changed drug created psycological problems. I don't know who I'm taking to. Maybe the same people that the newscasters are talking to after you turn the radio off. But the reason me and adhd-ers smoke and drank our meds is because we we're unaware that anyone cared. And, for me and those I know, no one did. Without understanding and relating to anothers needs and truth, caring can't care. How could it. It's unaware. I just wrote that because it rymes. Hay, it's 2:11 am and I'm just dreaming while I'm awake now, especially since my cat woke me up after just a couple hours sleep early this morning. This web-site doesn't stop me so I'm like my grand daughter, I don't stop. But I'll stop. Good nite everybody. I don't know anything anymore. . . until tomarrow, which is later today.. soo seeeeeeeeeeeeeeya!

  • pilotgrrl says:

    Diagnosed with ADD as an adult, also an insomniac and bipolar II. Never failed a sleep test. I used to drink pots of extremely strong coffee at all hours, starting in junior high. Obviously self-medicating well before Starbucks was a gleam in Howard Schultz's eye. I do well on generic Adderall, along with a combination of mood stabilizers, antidepressants and sleep drugs. What others take to get high, I take to be normal. I'm not a good day person without my meds, and I'm not a good sleeper if I don't stick to a schedule. Daylight savings time messes me up as much as jet lag. I agree with much of what Joel Haas posted WRT differences in ability, although I posit it has been somewhat more of a hindrance (in my case) due to age and gender.

  • anon says:

    Can anyone confirm that schools receive kickbacks from pharmaceutical companies for every child they refer to be medicated?

    • I consider myself The ADD Poster Girl, and have been an ADD professional and advocate for a quarter of a century now (on meds personally for most of that time, after researching thoroughly). I can assure you that is a myth that refuses to die. It is NOT true.

      A particular "religious" organization actually had a significant BUDGET dedicated to getting ADD Meds off the market at one point (documented history - and they came close to succeeding at several points).

      This particular organization has **A LOT** of money, an agenda of its own, as well as a **l-o-n-g** arm - willing to harass individuals who attempt to oppose their aims. Truly slimy stuff (I personally know some of the people who drilled down to find out & document who was doing what in the early years - although I do not know if this particular myth was started by that organization or one of the other ADD nay-sayers or their minions.)

      Take the time to "read between the lines" & investigate the source of the rumors you come across, and you will find that most of these groups have a marketing agenda -- they are promoting something ELSE and are trying to scare people away from pharmaceutical solutions to get people to buy what they themselves are selling.

      I'm NOT saying that all of these alternatives are bad, but I am saying that scare-tactic marketing of ANY kind is unconscionable.

      Presenting contra-indications (etc) in a charge-neutral fashion that does not attempt to manipulate an emotional choice from the market is one thing, and I personally appreciate that information. HOWEVER, if they try to SCARE me into saying no to one alternative so I will be more likely to embrace theirs, I will toss their stuff in the garbage the SECOND I realize what they are attempting to do, will advise students, clients and colleagues AGAINST considering that company's product, and will seek out a competitor who doesn't pull that stunt for further information or products.

      And spreading rumors that drug companies are in league with the schools, implying that the ADD diagnosis is simply a matter of lining somebody's pocket is HORRENDOUS (I'm NOT saying that's what *you* are doing by asking the question, by the way, and I appreciate the chance to provide an answer that might help squash a dangerous myth).

      Think logically for a minute - whatever you believe about "Big Pharma," they're not stupid. Their entire business would blow up in their faces if this were true - and it would be relatively easy to discover. The government would find some way to shut them down or fine them out of profitability. The DEA (Drug Enforcement Agency) would be all over them like a bug on ugly!!

      Why would they risk it?

      Whatever, the rumor now seems now to have taken on a life of its own, and continues to surface periodically, despite the fact that it is NOT true.

      A similar myth has been spread about each of the [non-profit] organizations that support ADDers (CH.A.D.D., ADDA, etc.) - and it has done EXACTLY what it has been designed to do -- keep those in charge of the organizations too busy to focus on spreading information that will HELP ADDers (and, by extension, undercut belief in the dx itself).

      Myths like this one also make it VERY hard for these non-profit support organizations to fundraise, since they have become afraid to accept financial support from the drug companies as a result.

      Eli Lilly (maker of insulin) supports the various diabetes organizations, the drug companies that make cancer & AIDS pharmaceuticals support those support organizations, even the SLEEP meds producers advertise on sleep sites, etc., and everybody says, "Aren't they great to help in that fashion?"

      To contrast, two of the leaders of CH.A.D.D. were actually hauled in front of a Congressional Investigation Committee under charges that CH.A.D.D. was, essentially, "in league with the drug companies to "subdue" children with medication" -- with STIMULANTS (what, are they brain-dead?)

      In any case, reports that no wrong-doing could be found were barely circulated. The fact that it was investigated spread like wildfire, however, and was presented as "proof" that something was fishy in a "where there's smoke, there's fire" fashion.

      NOT SO. But the rumor mill continues to foster fear among well-intended parents, who delay investigating the possibility that their kids might have ADD and need help -- and then we see long comment threads like these with tales of life-long struggles and late-life diagnoses.

      Many of them report believing (as do I, dx'd at 38) that their lives would have been VERY different and a lot more successful if they'd been dx'd and medicated early enough to avoid the cascade of struggles that negatively impact self-esteem.

      I'd post a survey to get some metrics on that if I thought ADDers could and would follow-through in large enough numbers to create enough buzz to counter the rumors. Unfortunately, I have many experiences that tell me it would be a waste of my time, so I can't afford to use it there.

      I could go on for pages, but I hope this sets your mind to rest somewhat - it's already too long!

      Madelyn Griffith-Haynie, CMC, SCAC, MCC
      - ADD Coaching Field co-founder -
      (ADDandSoMuchMore and ADDerWorld - dot com!)
      "It takes a village to educate a world!"

  • 36yrwoman4yrsADD says:

    This study's circacidian rythym graph of the ADD group seems to align with my lifelong pattern of 10 pm -2 am wide awake compulsion. Like Mr. Hass, I've punished all those who have lived me during my 3 am chaos. In school, I had a permanent hall pass for the 5- 10 minute delays between most classes due to the hyper focus and inability to move on to the next task. Yes, I was late to my first wedding-(forewarning of a bad decision), and to the second wedding and most appointments to the dismay of my timely second husband. To joke away my time issues, but it's true. I was born two weeks overdue on the night the clocks fall back at the time they change. With these coinciding incidents, my internal clock never had a chance to work right. My Mother didn't buy it, and I don't expect anyone else to but it's ironic.
    I've taken sleeping pills for over 10 yrs to force the peg in the day shift demands. I needed them more than ten years before that. I've worked all different shifts including nights, but find it lonely/difficult in my personal and family relationships. My career line is varied and interesting, but not very successful in any one field. I bore after a few years or months or weeks depending on the challenge. In spite of that I've managed to stay more than 7 years at a few companies by changing locations or positions within.
    Changing up Vyvanse, well-butrin, and Di-amphetamine at the max doses combined with psychotherapy and behavior changes (like bed-time routines and cutting caffeine 4 hrs before bed and no sleeping in on off days) have helped, but I don't want to have to take pills forever, and the behavior and therapy alone don't cut it. I've taken myself off and lowered doses without the Dr's okay, and life is getting harder again. My husband doesn't understand why I need the pills and wants to start a family. The pills aren't pregnancy friendly. He says no to adoption, and my Dr. is afraid to take the pills away with my history of failure and severe depression/anxiety. I struggle with regular life sans child and fear that I can't cope with more added to my life. Seeing this study is reassuring that there may be a chemical and molecular connection. I hope there will be more studies to further some knowledge about ADD and insomnia. I'll show this to my psychiatrist for her take. Thank you all for sharing your experiences with insomnia and ADD. Thank you for linking this study through Scientific America's website where I found it.

  • Amaretti says:

    Thank you so much for posting this!

    I was diagnosed with AD/HD (Combined-Type) at age 30, but I have ALWAYS had weird issues with my sleep-wake cycles.

    In fact, when I first read Ed Hallowell's "Driven to Distraction" (in 1999, right before I was evaluated and diagnosed), I was struck by a brief passage in the book regarding a possible correlation between ADHD and abnormal circadian rhythms. Intuitively, based on my personal experience, I felt this might be an important link, and I have been looking for research papers on this topic ever since. However, my searches had proved largely fruitless, so I am, again, very grateful for this post!

    I will definitely track down the paper and read their methods, because I, too, am curious about the role medication played in the subjects' lives. (Were I conducting this study, I would have preferred to include only subjects who had never taken stimulants; at the very least, I would have chosen to exclude subjects who had taken amphetamines within, say, the past 6 months).

    HOWEVER, that said, I believe that my own odd sleep-wake rhythms have been present throughout my life, and that their oddness is in fact UNRELATED to the stimulant medication that I have been taking on-and-off for the past 13 years.

    In fact, one of the things that drove me to seek the ADHD diagnosis in the first place was my distress over my rather bizarre, non-24-hour circadian rhythms: I have always found that, left to my own devices, I function on more of a 36- to 48-hour day, remaining awake and productive for anywhere from 20 to 36 hours, and then sleeping for 8-12 hours. This makes me feel weird and neurotic, in comparison to other people; on the other hand, this schedule also makes me happy because it seems to allow me to achieve maximum productivity. Otherwise, there just really don't seem to be enough hours in the day: It takes me a good long time to "get going" after waking (pretty much consistent with that 3-hour cortisol peak!)....And once I DO get myself focused on a task, I am loathe to tear myself away, as long as I am able to be productive (between multiple, inevitable "distraction breaks," that is.) Additionally, it takes me a long time to "wind down" before sleep. For instance, even if I have been awake and working for 18 to 24 hours or more, and feel exhausted as I make my way home, I often get a burst of energy upon arriving home, and stay awake for several more hours.

    The weird thing is that I would not describe myself as an insomniac at all. I generally don't have trouble falling asleep once I have "wound down" and decided to go to bed. I'm also prone to drifting into sleep when I shouldn't (during lectures/meetings, while driving, etc.) I'm generally a good napper, and there are times that I find myself sleeping too much (e.g. getting up at a "normal" hour but then staying awake for just 6 hours, napping for 3 hours, then awake for 5 hrs, then into a marathon sleep session of 12 or 13 hours, with brief intermittent periods of wakefulness throughout those 12 hours...)

    In other words, the only thing that's really been consistent about my sleep-wake cycle is it's INconsistency!

    Afgain, all of this was true BEFORE I began taking stimulant meds. And, like many of the other commenters here, I was identified as a "night owl" in babyhood.

    I CAN function on a more normal schedule when I absolutely must, but it is always a struggle, and throughout my life I have worked jobs that were more accommodating to my weird cycles. When attempting to work a more "normal" schedule, I usually experience the same thing that other people here have mentioned: I seem to have a decided "peak" of wakefulness between about midnight and 4 am, coupled with difficulty waking at a "normal" hour, and often with bouts of intractable afternoon sleepiness.

    But when I am working on freelance projects and am not REQUIRED to function on a 24-hour-day schedule, I almost inevitably find myself shifting into an unpredictable--but generally much longer--circadian cycle.

    The only difference, now that I have access to stimulant medication, is that I have a little more control over the length of the cycles, and can 'plan in advance' to work a marathon 36-hour day once or twice a week, rather than relying on my goofy, totally UNreliable suprachiasmic nucleus to make me feel sleepy and wakeful at predictable, normal intervals. (Alternately, I can TRY to force myself into a more normal cycle by scheduling my meds accordingly, but this never works very well.)

    For reference: My only psychiatric/neurobehavioral diagnosis is ADHD, and the only medication I have ever taken for it is Adderall (IR, 15 mg per dose, these days). I do sometimes experience mild-to-moderate bouts of depression (which seem to be seasonal, and typically worst in mid-autumn, when day length is decreasing most rapidly), but I have never taken any anti-depressants or other psychoactive drugs.

    Anyway...thanks again to scicurious, and to those who took the time to share their own experiences. I'm very glad I found this blog, and will definitely be checking back frequently for more updates! :-)

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  • Emma says:

    Very interesting article that I found by chance when reading up on Melatonin medication that has just been prescribed for my 14 year old daughter. After nearly a year since the school nurse suggested that our daughter might have ADD, the whole process of diagnosis and referrals to the appropriate clinic has led to a confirmed diagnosis of ADD and a recommendation that medication is the right way for her to go. The situation here in Sweden is very different from in the US, the assessment is more thorough and only 3% of kids with a diagnosis of ADD/ADHD are recommended for medication.
    My daughter has had sleep problems for a long time and the doctor recommended melatonin in conjunction with the stimulants, according to their experience sleep problems and ADD go hand in hand and melatonin often helps to get the kids back into a good sleeping pattern. She has trouble falling asleep in the first place often staying awake until 1am despite the strict bedtime routine of being in bed by 10pm and, left to her own devices will often sleep until midday. She also complains of waking 3 -4 times a night and then taking a long time to get back to sleep. Unfortunately that pattern doesn't fit well with the school routine and at 14 she needs to fit into that routine for a few more years yet. Another point, not noted here, that the doctor found common in ADD/ADHD kids is that they have low Vitamin D levels. After writing the prescriptions, my daughter had a full blood screen performed, all the levels were normal except for low Vitamin D levels, so she is also on supplements for that. They don't know why Vitamin D levels should be low but they check it and when they are, treat it accordingly.
    Apparently there are not enough studies to link ADD/ADHD to poor sleep patterns but there is enough anecdotal evidence here in Sweden that they automatically prescribe melatonin for any kids who are diagnosed, fall into the medication category and complain of sleep problems. The doctor told us that the combined melatonin and stimulant therapy has good results.
    She starts the medications this weekend and we are all hoping that things will improve for our daughter, especially at school. After years of being told that we have a 'bright' daughter who fails to achieve decent grades, never finishes assignments and often fails to do homework, it would be wonderful to see her achieve her full potential.

  • Thanks for a very interesting review article! I believe that many experienced doctors know more about ADHD + circadian rhythms than the researchers do. The latter are just catching up. It's good to see that they are measuring, in humans no less, the hormones and genes involved.

    I don't have ADHD. I do have Delayed Sleep Phase Disorder (DSPD or Syndrome DSPS). Unfortunately most doctors haven't heard of it yet. Many of the comments above are by people with all the symptoms of DSPD: alert until the wee hours, very difficult to awaken, groggy (and unsocial) for a period after awakening, occasionally awake for 36-hours, chronically late to work/school, etc. !

    I'd suggest that ADHD researchers and people with ADHD should read up on DSPD, for example on my blog and/or at the non-profit Circadian Sleep Disorders Network's site:
    http://www.circadiansleepdisorders.org

    Briefly, the three not-always-helpful treatments for DSPD are:
    1. Bright light (special lamp often called a SAD-light, 10000 lux) for 30-60 minutes immediately upon awakening.
    2. Use of the hormone melatonin (1 hour and/or 5-6 hours before bed).
    3. Very dim light and/or blue-blocking goggles for up to several hours before bed.
    The timing of all of this, as well as the dosages of melatonin, are very individual and require experimenting.

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