ADHD, circadian rhythms and seasonality.
OBJECTIVE
We evaluated whether the association between Adult Attention-Deficit/Hyperactivity Disorder (ADHD) and Seasonal Affective Disorder (SAD) was mediated by the circadian rhythm.


METHOD
Data of 2239 persons from the Netherlands Study of Depression and Anxiety (NESDA) were used. Two groups were compared: with clinically significant ADHD symptoms (N = 175) and with No ADHD symptoms (N = 2064). Sleep parameters were sleep-onset and offset times, mid sleep and sleep duration from the Munich Chronotype Questionnaire. We identified the prevalence of probable SAD and subsyndromal SAD using the Seasonal Pattern Assessment Questionnaire (SPAQ). Clinically significant ADHD symptoms were identified by using a T score>65 on the Conners Adult ADHD Rating Scale.


RESULTS
The prevalence of probable SAD was estimated at 9.9% in the ADHD group (vs. 3.3% in the No ADHD group) and of probable s-SAD at 12.5% in the ADHD group (vs 4.6% in the No ADHD group). Regression analyses showed consistently significant associations between ADHD symptoms and probable SAD, even after adjustment for current depression and anxiety, age, sex, education, use of antidepressants and benzodiazepines (B = 1.81, p < 0.001). Late self-reported sleep onset was an important mediator in the significant relationship between ADHD symptoms and probable SAD, even after correction for confounders (total model effects: B = 0.14, p ≤ 0.001).


CONCLUSION
Both seasonal and circadian rhythm disturbances are significantly associated with ADHD symptoms. Delayed sleep onset time in ADHD may explain the increase in SAD symptoms. Treating patients with SAD for possible ADHD and delayed sleep onset time may reduce symptom severity in these complex patients.
['Wynchank|Dora S|DS|', 'Bijlenga|Denise|D|', 'Lamers|Femke|F|', 'Bron|Tannetje I|TI|', 'Winthorst|Wim H|WH|', 'Vogel|Suzan W|SW|', 'Penninx|Brenda W|BW|', 'Beekman|Aartjan T|AT|', 'Kooij|J Sandra|JS|']
D000293:Adolescent D000328:Adult D000368:Aged D001289:Attention Deficit Disorder with Hyperactivity D002940:Circadian Rhythm D005260:Female D006801:Humans D008297:Male D008875:Middle Aged D009426:Netherlands D015995:Prevalence D016574:Seasonal Affective Disorder D011795:Surveys and Questionnaires D055815:Young Adult
Circadian rhythm Seasonal affective disorder Attention deficit/hyperactivity disorder Delayed sleep phase