Malhi N, Weiss M, Waxmonsky J, Baweja R. Sleep disturbances in children and adolescents with attention-deficit/hyperactivity disorder: A narrative review. World J Clin Pediatr 2025; 14(4): 110612 [DOI: 10.5409/wjcp.v14.i4.110612]
Corresponding Author of This Article
Raman Baweja, MD, Professor, Department of Psychiatry and Behavioral Health, Penn State College of Medicine, 500 University Drive, Hershey, PA 17033, United States. rbaweja@pennstatehealth.psu.edu
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Psychiatry
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Review
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This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Dec 9, 2025 (publication date) through Nov 3, 2025
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World Journal of Clinical Pediatrics
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2219-2808
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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA
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Malhi N, Weiss M, Waxmonsky J, Baweja R. Sleep disturbances in children and adolescents with attention-deficit/hyperactivity disorder: A narrative review. World J Clin Pediatr 2025; 14(4): 110612 [DOI: 10.5409/wjcp.v14.i4.110612]
World J Clin Pediatr. Dec 9, 2025; 14(4): 110612 Published online Dec 9, 2025. doi: 10.5409/wjcp.v14.i4.110612
Sleep disturbances in children and adolescents with attention-deficit/hyperactivity disorder: A narrative review
Narpinder Malhi, Margaret Weiss, James Waxmonsky, Raman Baweja
Narpinder Malhi, Department of Behavioral Health, ChristianaCare, Wilmington, DE 19899, United States
Margaret Weiss, Department of Psychiatry, Cambridge Health Alliance, Cambridge, MA 02139, United States
James Waxmonsky, Raman Baweja, Department of Psychiatry and Behavioral Health, Penn State College of Medicine, Hershey, PA 17033, United States
Author contributions: Malhi N performed the initial literature review and prepared the original draft; Weiss M and Waxmonsky J reviewed & edited the original draft; Baweja R edited the draft and approved the final version; All authors approved the final manuscript as submitted and agree to be accountable for all aspects of the work.
Conflict-of-interest statement: Weiss M has received consulting fees/honoraria from Ironshore, Revibe Technologies, and Peri; was previously on the advisory boards of Ironshore, Revibe Technologies, and Periapt; and has received royalties from Multi Health Systems. Waxmonsky J served as consultant Ironshore Pharma. Baweja R has received grant funding from the Cardinal Health Foundation (through the Children’s Hospital Association and the Zero Suicide Initiative), research contract with Supernus, and served on the advisory board for Ironshore. Malhi N has no biomedical financial interests or potential conflicts of interest.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Raman Baweja, MD, Professor, Department of Psychiatry and Behavioral Health, Penn State College of Medicine, 500 University Drive, Hershey, PA 17033, United States. rbaweja@pennstatehealth.psu.edu
Received: June 11, 2025 Revised: June 23, 2025 Accepted: September 11, 2025 Published online: December 9, 2025 Processing time: 143 Days and 10.7 Hours
Abstract
Sleep disturbances and disorders are commonly associated with attention-deficit/hyperactivity disorder (ADHD), with affected children frequently experiencing delayed sleep onset, frequent nighttime awakenings, morning fatigue, and excessive daytime sleepiness. A bidirectional relationship exists between ADHD and sleep disturbances: Sleep deprivation is linked to increased inattention and emotional dysregulation, while evening hyperactivity and impulsivity may contribute to difficulty falling asleep. Central nervous system stimulants remain the first-line treatment for managing ADHD symptoms; however, insomnia can be a common side effect. Notably, newer and long-acting stimulants formulations have demonstrated extended benefit into evening with limited impact on sleep in recent studies. This narrative review summarizes the various sleep disorders associated with ADHD, outlines clinical approaches for sleep assessment, and evaluates the impact of ADHD treatments on sleep. It also highlights both non-pharmacological and pharmacological interventions for managing sleep problems in children with ADHD. Finally, the review offers practical recommendations to help clinicians optimize both sleep and daytime functioning in patients with ADHD. ADHD should be conceptualized as a 24-hour disorder, requiring integrated treatment strategies that address both daytime symptoms and nighttime sleep challenges.
Core Tip: Children with attention-deficit/hyperactivity disorder (ADHD) frequently experience sleep disturbances, and many primary sleep disorders can worsen attention, hyperactivity and emotion regulation. It is essential for clinicians to assess for underlying sleep issues in children referred for ADHD evaluation. Recognizing that ADHD can impact both daytime functioning and nighttime sleep supports a comprehensive treatment approach that combines behavioral strategies, medication adjustments, and targeted sleep interventions. This review offers practical guidance to help clinicians effectively manage both sleep and ADHD symptoms, ultimately improving clinical outcomes.
