Chronotype in ADHD Associated With Behavioral Problems, Study Finds

A recent study found that behavioral problems in adolescents with attention deficit/hyperactivity disorder (ADHD) were associated with chronotype, a person’s circadian preference.

A study published in Archives de Pediatrie found that behavioral problems in adolescents with attention deficit/hyperactivity disorder (ADHD) were influenced by their chronotype, which is a person’s circadian preference. The aim of the study was to investigate circadian preferences, sleep habits, and behavior in adolescents with ADHD to assess the relationship.

Participants were parents of adolescents aged 12 anto d 18 years. All adolescents had an ADHD idiagnosis in accordance with Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, and all were receiving routine health care at the time of recruitment.

Parents and adolescents were given 2 questionnaires. Both groups received the Strengths and Difficulties Questionnaire (SDQ), just the parents were given the Pediatric Sleep Questionnaire (PSQ), and just the adolescents got the Morningness-Eveningness Scale for Children (MESC).

The SDQ measures 25 attributes, separated into 5 scales: emotional symptoms, conduct problems, hyperactivity/inattention, peer relationship problems, and prosocial behavior. It is scored from 0 to 40. The PSQ contains 22 symptom items that ask about snoring frequency, loud snoring, observed apnea, difficulty breathing during sleep, daytime sleepiness, and inattentive or hyperactive behavior. A cut-off of 33% positive responses was used.

Chronotype was assessed through the MESC, which evaluates the preferred time to complete activities. Scores range from 10 to 42, with higher scores indicating greater preference for morning activities. Cut-off points of 10th and 90th percentiles were used to differentiate chronotypes into evening preference, morning preference, or neither.

The 84 parents and adolescents who gave consent were included in this study. The mean (SD) age of the adolescents was 14.04 (1.54) years, and most were male (72%). Sixty-eight percent of children were undergoing stimulant-based drug therapy during the study.

The results identified 54% of adolescents who had an intermediate chronotype, 27% who were morning types, and 19% who were evening types. The mean MESC score was 24.84 (4.41). No correlations between sex, body mass index, or total PSQ were see in the results. Further, parents scored higher than their children on all SDQ subscales except for pro-social behavior.

A negative correlation was found between MESC and hyperactivity/inattention score on the SDQ scale, when MESC was completed by the adolescents (–0.241). Sleep problems collected through the PSQ questionnaire were present in 30.9% of adolescents in the study. Chronotype was determined to not be a significant predictor of a greater degree of sleep problems.

There were some limitations to this study. Assessments were based on subjective reports, which could have influenced the results. This study also only used a single assessment, which is not as strong as a long-term cohort study would be, the authors noted. A larger sample size and the presence of a control group should be present in any future study.

The researchers concluded that adolescents tend to have the intermediate chronotype and a preference for the evening is related to hyperactivity/inattention.

“Focusing on circadian preference and sleep in adolescents, as part of intervention and prevention programs, could lead to an improvement in behavioral issues,” they wrote.


Martinez-Cayuelas E, Moreno-Vinues B, Losada-Del Pozo R, Rodrigo-Moreno M, Soto-Insuga V, Perez-Villena A. Sleep, chronotype, and behavior in adolescents with attention-deficit/hyperactivity disorder. Arch Pediatr. Published online April 3, 2022. doi:10.1016/j.arcped.2022.02.005