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The key role of daytime sleepiness in cognitive functioning of adults with attention deficit hyperactivity disorder

The key role of daytime sleepiness in cognitive functioning of adults with attention deficit hyperactivity disorder

Helfer, Bartosz ORCID: 0000-0001-9863-2871, Bozhilova, Natali, Cooper, Ruth E. ORCID: 0000-0002-9735-4731, Douzenis, Joanna I., Maltezos, Stefanos and Asherson, Philip (2020) The key role of daytime sleepiness in cognitive functioning of adults with attention deficit hyperactivity disorder. European Psychiatry, 63 (1):e31. ISSN 0924-9338 (Print), 1778-3585 (Online) (doi:

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Adults with attention deficit hyperactivity disorder (ADHD) frequently suffer from sleep problems and report high levels of daytime sleepiness compared to neurotypical controls, which has detrimental effect on quality of life.

We evaluated daytime sleepiness in adults with ADHD compared to neurotypical controls using an observer-rated sleepiness protocol during the Sustained Attention Response Task as well as electroencephalogram (EEG) slowing, a quantitative electroencephalographic measure collected during a short period of wakeful rest.

We found that adults with ADHD were significantly sleepier than neurotypical controls during the cognitive task and that this on-task sleepiness contributed to cognitive performance deficits usually attributed to symptoms of ADHD. EEG slowing predicted severity of ADHD symptoms and diagnostic status, and was also related to daytime sleepiness. Frontal EEG slowing as well as increased frontal delta were especially prominent in adults with ADHD. We have validated and adapted an objective observer-rated measure for assessing on-task sleepiness that will contribute to future sleep research in psychology and psychiatry.

These findings indicate that the cognitive performance deficits routinely attributed to ADHD and often conceptualized as cognitive endophenotypes of ADHD are largely due to on-task sleepiness and not exclusively due to ADHD symptom severity. Daytime sleepiness plays a major role in cognitive functioning of adults with ADHD.

Item Type: Article
Additional Information: © The Author(s) 2020. This is an Open Access article, distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike licence (, which permits non-commercial re-use, distribution, and reproduction in any medium, provided the same Creative Commons licence is included and the original work is properly cited. The written permission of Cambridge University Press must be obtained for commercial re-use.
Uncontrolled Keywords: Attention-deficit/hyperactivity disorder; adults; EEG slowing; cognition; observer-rated sleepiness; sleepiness
Subjects: B Philosophy. Psychology. Religion > BF Psychology
Faculty / Department / Research Group: Faculty of Education, Health & Human Sciences
Faculty of Education, Health & Human Sciences > Department of Psychology, Social Work & Counselling
Last Modified: 03 Jun 2021 22:44
Selected for GREAT 2016: None
Selected for GREAT 2017: None
Selected for GREAT 2018: None
Selected for GREAT 2019: None
Selected for REF2021: None

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