title: Attention-Deficit/Hyperactivity Disorder (ADHD) Symptoms in Pediatric Narcolepsy: A Cross-Sectional Study.
abstract: OBJECTIVE
  To evaluate the frequency, severity, and associations of symptoms of attention-deficit/hyperactivity disorder (ADHD) in children with narcolepsy with and without cataplexy.
  
  
  METHODS
  Cross-sectional survey.
  
  
  METHODS
  Four French national reference centers for narcolepsy.
  
  
  METHODS
  One hundred eight consecutively referred children aged younger than 18 y with narcolepsy, with (NwC, n = 86) or without cataplexy (NwoC, n = 22), and 67 healthy controls.
  
  
  METHODS
  The participants, their families, and sleep specialists completed a structured interview and questionnaires about sleep, daytime sleepiness, fatigue, and ADHD symptoms (ADHD-rating scale based upon Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision [DSM-IV-TR] symptoms), and use of psychostimulants for the treatment of narcolepsy (administered in 68.2%). Polysomnographic measures were collected.
  
  
  RESULTS
  Clinically significant levels of ADHD symptoms were found in 4.8% of controls compared with 35.3% in patients with NwoC (P < 0.001) and 19.7% in patients with NwC (P < 0.01). Total ADHD scores were 6.4 (95% confidence interval [CI]: 4.5, 9.0) in controls compared with 14.2 (95% CI: 10.6, 18.9; P < 0.001), in patients with NwoC and 12.2 (95% CI: 9.8, 15.3; P < 0.01) in patients with NwC; subscores of inattention and hyperactivity/impulsivity were also significantly higher in both narcolepsy groups compared with controls. No difference was found between the NwC and NwoC groups for any ADHD measure. ADHD symptom severity was associated with increased levels of sleepiness, fatigue, and insomnia. Compared with the 34 untreated patients, the 73 patients treated with psychostimulants (modafinil in 91%) showed a trend toward lower narcolepsy symptoms but not lower ADHD symptoms.
  
  
  CONCLUSIONS
  Pediatric patients with narcolepsy have high levels of treatment-resistant attention-deficit/hyperactivity disorder (ADHD) symptoms. The optimal treatment for ADHD symptoms in these patients warrants further evaluation in longitudinal intervention studies.
authors.affiliation: AP-HP, Pediatric Sleep Center, CHU Robert-Debré, Paris, France.|National Reference Centre for Orphan Diseases, Narcolepsy, Idiopathic hypersomnia and Kleine-Levin Syndrome, France.
authors.forename: Michel
authors.initials: M
authors.lastname: Lecendreux
authors.affiliation: National Reference Centre for Orphan Diseases, Narcolepsy, Idiopathic hypersomnia and Kleine-Levin Syndrome, France.|AP-HP, Groupe Hospitalier Pitié-Salpétrière, Service des Pathologies du Sommeil & Université Pierre et Marie Curie - Paris 6, Centre de Recherche de l'Institut du Cerveau et de la Moelle épinière, Paris, France.
authors.forename: Sophie
authors.initials: S
authors.lastname: Lavault
authors.affiliation: National Reference Centre for Orphan Diseases, Narcolepsy, Idiopathic hypersomnia and Kleine-Levin Syndrome, France.|Sleep Disorders Center, Department of Neurology, Gui-de-Chauliac Hospital, CHU Montpellier, Inserm U1061, Montpellier, France.
authors.forename: Régis
authors.initials: R
authors.lastname: Lopez
authors.affiliation: Integrative Physiology of Brain Arousal System, CRNL, University Lyon 1, Lyon, France.
authors.forename: Clara Odilia
authors.initials: CO
authors.lastname: Inocente
authors.affiliation: AP-HP, Pediatric Sleep Center, CHU Robert-Debré, Paris, France.|National Reference Centre for Orphan Diseases, Narcolepsy, Idiopathic hypersomnia and Kleine-Levin Syndrome, France.|AP-HP, Groupe Hospitalier Pitié-Salpétrière, Service des Pathologies du Sommeil & Université Pierre et Marie Curie - Paris 6, Centre de Recherche de l'Institut du Cerveau et de la Moelle épinière, Paris, France.
authors.forename: Eric
authors.initials: E
authors.lastname: Konofal
authors.affiliation: Department of Psychology, Developmental Brain-Behaviour Laboratory, University of Southampton, Southampton, UK.|New York University Child Study Center, New York, NY.
authors.forename: Samuele
authors.initials: S
authors.lastname: Cortese
authors.affiliation: National Reference Centre for Orphan Diseases, Narcolepsy, Idiopathic hypersomnia and Kleine-Levin Syndrome, France.|Integrative Physiology of Brain Arousal System, CRNL, University Lyon 1, Lyon, France.|Pediatric Sleep Unit, Hôpital Femme-Mère Enfant, University Lyon 1, Lyon, France.
authors.forename: Patricia
authors.initials: P
authors.lastname: Franco
authors.affiliation: National Reference Centre for Orphan Diseases, Narcolepsy, Idiopathic hypersomnia and Kleine-Levin Syndrome, France.|AP-HP, Groupe Hospitalier Pitié-Salpétrière, Service des Pathologies du Sommeil & Université Pierre et Marie Curie - Paris 6, Centre de Recherche de l'Institut du Cerveau et de la Moelle épinière, Paris, France.
authors.forename: Isabelle
authors.initials: I
authors.lastname: Arnulf
authors.affiliation: National Reference Centre for Orphan Diseases, Narcolepsy, Idiopathic hypersomnia and Kleine-Levin Syndrome, France.|Sleep Disorders Center, Department of Neurology, Gui-de-Chauliac Hospital, CHU Montpellier, Inserm U1061, Montpellier, France.
authors.forename: Yves
authors.initials: Y
authors.lastname: Dauvilliers
mesh_terms: D000293:Adolescent; D001289:Attention Deficit Disorder with Hyperactivity / Q000150:complications* / Q000523:psychology*; D001559:Benzhydryl Compounds / Q000627:therapeutic use; D016022:Case-Control Studies; D002385:Cataplexy / Q000150:complications / Q000188:drug therapy / Q000503:physiopathology / Q000523:psychology; D000697:Central Nervous System Stimulants / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D039721:Diagnostic and Statistical Manual of Mental Disorders; D005221:Fatigue / Q000150:complications; D005260:Female; D005602:France; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D000077408:Modafinil; D009290:Narcolepsy / Q000150:complications* / Q000188:drug therapy / Q000503:physiopathology / Q000523:psychology*; D007319:Sleep Initiation and Maintenance Disorders / Q000150:complications; D012894:Sleep Stages; D011795:Surveys and Questionnaires
chemical_list: D001559:Benzhydryl Compounds; D000697:Central Nervous System Stimulants; D000077408:Modafinil
keywords: attention-deficit disorder with hyperactivity; methylphenidate; modafinil; narcolepsy; pediatrics