The relationship of executive functions and sleep habits with adhd treatment in children and adolescents diagnosed with attention deficit and hyperactivity disorder

There have been many studies reporting that executive dysfunctions are frequently seen in the cases of Attention-Deficit / Hyperactivity Disorder (ADHD) improve with treatment. It is known that sleep problems are also frequently observed in patients with ADHD. It is still being debated whether drug holidays should be given or not due to the side effects of methylphenidate during the treatment of ADHD. In the literature, there are limited numbers of studies examining the effects of drug holidays on ADHD symptom severity, but no study investigating the effect of drug holidays on executive functions and sleep problems. In our study, we aimed to evaluate executive functions and sleep problems in ADHD patients three times: before treatment, at least 8 weeks after methylphenidate treatment and at least 8 weeks after a drug holiday. Also, we aimed to investigate the effects of drug treatment and drug holidays on executive functions and sleep habits. Our study was designed as a longitudinal study and was conducted between September 2018 and September 2019 in the Bolu Abant Izzet Baysal University Child and Adolescent Psychiatry Outpatient Clinic. Fifty-one patients aged between 7-18 years, who were admitted to our outpatient clinic between September 2018 and November 2018, diagnosed with ADHD and fulfilled the inclusion criteria were included in the study. Stroop test and Clinical Global Impression Scale (CGI) were applied to the subjects before treatment, after treatment and after drug holiday. In the same periods, Conners' Parent Rating Scale-Short Form (CPRS:S) and Child Sleep Habits Questionnaire (CSHQ) to be filled by parents, and Conners' Teacher Rating Scale (CTRS:S) to be filled by the teacher were given. When the results of the study were examined, it was observed that 22 of the patients (43%) discontinued the treatment during the follow-up period. In our study, when the groups that continued and did not continue to treatment were compared, no statistically significant difference was found in terms of socio-demographic data (p> 0.05), only the number of siblings was significantly higher in the non-treatment group (p=0.045). There was no significant difference in the severity of the disease between the groups who continued and who did not. When the subjects were evaluated with CGI, it was found that the patients received a statistically significant lower score after treatment than the pre-treatment (p<0.001), and there was a significant increase in scores after the drug holiday (p<0.001). When the CPRS subscale scores of the subjects participated in our study were examined, it was observed that there was a significant decrease in the DE subscale after treatment compared to the pre-treatment (p<0.001). When the CTRS subscale scores of the subjects participated in our study were examined, it was observed that DE and DS subscale scores decreased after the treatment compared to the pre-treatment (p values respectively: 0.014, 0.012). When the Stroop test data applied to the subjects participated in our study were examined, it was found that the duration of completion was shortened in completion of 5 sections of the Stroop test after the treatment compared to the before treatment. After treatment, it was found that they made fewer errors and less correction in Stroop 5 than before treatment (p=0.005, p=0.007). After the drug holiday, it was observed that they made more errors in Stroop 5 than the after treatment (p = 0.037). When the CSHQ subscale scores completed by the parents of participants were examined, it was found that there was a significant improvement in the parasomnias subscale after the treatment compared to the before treatment (p=0.026). When examining the results of our study in general; it has been observed that ADHD treatment leads to improvement in executive dysfunctions and sleep problems. On the other hand, it was determined that the drug holiday given during the summer holiday impaired the executive functions and had no effect on sleep problems. As a result, it would be appropriate for the clinician to decide on a drug holiday by considering the individual profit-loss balance.