Sleep & cognition
Does sleep help children with ADHD lock in rewarded habits?
Open access · cc by · source: Europe PMC
Healthy boys held on to reward-learned choices more strongly after a night's sleep than after a day awake, but boys with ADHD and conduct problems showed no such sleep benefit.
Study at a glance
- Design
- Human experiment — Mixed design: each boy learned a probabilistic reward task, then had a 12-hour retention interval containing either a night of sleep (polysomnography) or a day awake, followed by a reversal block; patients vs controls compared.
- N
- N=34 · 34 boys: 17 inpatients with ADHD plus comorbid conduct or oppositional defiant disorder and 17 healthy controls, each tested in both sleep and wake conditions.
- Population
- Boys aged 8-12 from Kiel, Germany: psychiatric inpatients with ADHD + CD/ODD and typically developing controls
- Outcome
- Drop in preference for the previously rewarded choice from the end of encoding to the start of reversal learning (resistance to reversal as a consolidation index); correlations with REM and non-REM sleep
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Key findings
Both groups learned the task equally well and slept similar amounts. The key three-way interaction showed that healthy boys' preference for the old choice was harder to reverse after sleep than after wake, whereas in the ADHD group sleep and wake did not differ. Contrary to the prediction that REM sleep drives reward consolidation, healthy boys' consolidation tended to track non-REM sleep more than REM sleep.
Methodology
Boys with ADHD plus conduct or oppositional defiant disorder and matched healthy boys played a 'pirate game' in which they learned by trial and error which of two islands usually hid treasure. After 12 hours spent either asleep overnight in a sleep lab or awake during the day, they replayed one learned pair with the rewards secretly reversed, so persisting with the old choice indicated how well the earlier learning had been consolidated. Sleep was recorded with EEG, and alertness, mood and wakefulness were measured as controls.
Limitations
The sample was small and all-male, and patients were severe inpatients with comorbid conduct or oppositional disorders, so the result may not apply to girls or to milder, pure ADHD, as the authors note. The sleep-stage conclusions rest on a difference between two non-significant correlations, and the group effect disappeared when subjective wakefulness was added as a covariate. Sleep stages were not experimentally manipulated, so the study cannot show which part of sleep causes consolidation.
How this study connects
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