***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Sleep habits and circadian preference ( morningness/eveningness , M/E ) have been extensively analyzed in adolescents and young adults , while few studies were conducted on children and early adolescents . Aim of the present study was to investigate the developmental changes of circadian preference and to analyze its relationship with sleep habits , sleep problems and circadian preference in a large sample by means of a school-based survey . One thous and seventy-three participants ( 50.8 % boys and 49.2 % girls ; mean age = 10.6 ; range = 8 - 14 years ) , recruited from four schools r and omly extracted within the district of Rome , completed a modified version of  School Sleep Habits Survey developed by Carskadon et al. The question naire included items about  sleep habits during schooldays and weekends ; a  Sleepiness Scale ;  a  Sleep-Wake Problems Behaviour Scale ;  a  Morningness/Eveningness scale .  The results show a consistent age-related change in sleep habits , particularly in the weekends . The difference in sleep duration between schooldays and weekends increases linearly with age . No gender difference was observed in morningness/eveningness , while a significant linear increase in evening preference was found with increasing ages . M/E total scores correlated significantly with both self-reported sleep/wake problems and daytime sleepiness indicating a higher prevalence of sleep complaints in evening-type subjects . Overall , the present results support the existence of consistent age-related changes in sleep habits and M/E dimension in the 8- to 14-year age range Objective To examine whether behavioural strategies design ed to improve children ’s sleep problems could also improve the symptoms , behaviour , daily functioning , and working memory of children with attention deficit hyperactivity disorder ( ADHD ) and the mental health of their parents . Design R and omised controlled trial . Setting 21 general paediatric practice s in Victoria , Australia . Participants 244 children aged 5 - 12 years with ADHD attending the practice s between 2010 and 2012 . Intervention Sleep hygiene practice s and st and ardised behavioural strategies delivered by trained psychologists or trainee paediatricians during two fortnightly consultations and a follow-up telephone call . Children in the control group received usual clinical care . Main outcome measures At three and six months after r and omisation : severity of ADHD symptoms ( parent and teacher ADHD rating scale IV— primary outcome ) , sleep problems ( parent reported severity , children ’s sleep habits question naire , actigraphy ) , behaviour ( strengths and difficulties question naire ) , quality of life ( pediatric quality of life inventory 4.0 ) , daily functioning ( daily parent rating of evening and morning behavior ) , working memory ( working memory test battery for children , six months only ) , and parent mental health ( depression anxiety stress scales ) . Results Intervention compared with control families reported a greater decrease in ADHD symptoms at three and six months ( adjusted mean difference for change in symptom severity −2.9 , 95 % confidence interval −5.5 to −0.3 , P=0.03 , effect size −0.3 , and −3.7 , −6.1 to −1.2 , P=0.004 , effect size −0.4 , respectively ) . Compared with control children , intervention children had fewer moderate-severe sleep problems at three months ( 56 % v 30 % ; adjusted odds ratio 0.30 , 95 % confidence interval 0.16 to 0.59 ; P<0.001 ) and six months ( 46 % v 34 % ; 0.58 , 0.32 to 1.0 ; P=0.07 ) . At three months this equated to a reduction in absolute risk of 25.7 % ( 95 % confidence interval 14.1 % to 37.3 % ) and an estimated number needed to treat of 3.9 . At six months the number needed to treat was 7.8 . Approximately a half to one third of the beneficial effect of the intervention on ADHD symptoms was mediated through improved sleep , at three and six months , respectively . Intervention families reported greater improvements in all other child and family outcomes except parental mental health . Teachers reported improved behaviour of the children at three and six months . Working memory ( backwards digit recall ) was higher in the intervention children compared with control children at six months . Daily sleep duration measured by actigraphy tended to be higher in the intervention children at three months ( mean difference 10.9 minutes , 95 % confidence interval −19.0 to 40.8 minutes , effect size 0.2 ) and six months ( 9.9 minutes , −16.3 to 36.1 minutes , effect size 0.3 ) ; however , this measure was only completed by a subset of children ( n=54 at three months and n=37 at six months ) . Conclusions A brief behavioural sleep intervention modestly improves the severity of ADHD symptoms in a community sample of children with ADHD , most of whom were taking stimulant medications . The intervention also improved the children ’s sleep , behaviour , quality of life , and functioning , with most benefits sustained to six months post-intervention . The intervention may be suitable for use in primary and secondary care . Trial registration Current Controlled Trials IS RCT N68819261 OBJECTIVE . Our goal was to identify characteristics associated with inadequate sleep for a national r and om sample of elementary school – aged children ( 6–11 years ) and adolescents ( 12–17 years ) . METHODS . Data from 68418 participants in the 2003 National Survey of Children 's Health were analyzed by using weighted bivariate and multivariate regression models . The dependent variable was report of not getting enough sleep for a child of his or her age ≥1 night of the past week . Independent variables included demographic characteristics , child health , school and other activities , and family life . RESULTS . Parents of elementary school – aged children with inadequate sleep were more likely to report that their child was having problems at school or had a father with fair or poor health .  Parents of adolescents with inadequate sleep were more likely to report that their child had an atopic condition , frequent or severe headaches , a parent with less-than-excellent emotional health , or experienced frequent parental anger . Inadequate sleep in both age groups was associated with parental report that their child usually or always displayed depressive symptomatology , family disagreements involved heated arguing , or parental concern that the child was not always safe at home , at school , or in their neighborhood . CONCLUSIONS . Approximately 15 million American children are affected by inadequate sleep . Primary care providers should routinely identify and address inadequate sleep and its associated health , school , and family factors OBJECTIVES This study examined the hypothesis that domains of neurobehavioral function would be selectively affected by sleep-disordered breathing ( SDB ) . Therefore , we assessed potential relationships between objective ly measured sleep disturbances and neurobehavioral function in children with reported symptoms of attention-deficit/hyperactivity disorder ( ADHD ) and also determined the incidence of snoring and other sleep problems in 5- to 7-year-old children in the local community and potential relationships to parental snoring and passive smoking . METHODS Parents of 5- to 7-year-old children in public schools were surveyed about their child 's sleeping habits using a vali date d question naire . The question naire also asked whether they believed their child to be hyperactive or have ADHD . Children with reported symptoms of ADHD and control children were r and omly selected and invited to the Sleep Medicine Center for an overnight polysomnographic assessment and a battery of neurocognitive tests . RESULTS The question naire response rate was 47.6 % ( n = 5728 ) . Frequent and loud snoring was reported for 673 children ( 11.7 % ) . Similarly , 418 ( 7.3 % ) children were reported to have hyperactivity/ADHD , 313 ( 76.5 % ) of which were boys . Eighty-three children with parentally reported symptoms of ADHD were invited for full evaluation at the Sleep Medicine Center together with 34 control children . After assessment with the Conners ' Parent Rating Scale , 44 children were design ated as having " significant " symptoms of ADHD , 27 as " mild , " and 39 design ated as " none " ( controls ) . Overnight polysomnography indicated that obstructive sleep apnea was present in 5 % of those with significant ADHD symptoms , 26 % of those with mild symptoms , and 5 % of those with no symptoms . In the cohort , no sleep variable accounted for more than a negligible proportion of the variance in domains of neurobehavioral function . CONCLUSIONS An unusually high prevalence of snoring was identified among a group of children design ated as showing mild symptoms of ADHD based on the Conners ' ADHD index identified from a community sample . However , whereas SDB is not more likely to occur among children with significant ADHD symptoms , it is significantly highly prevalent among children with mild hyperactive behaviors . Sleep studies further revealed that rapid eye movement disturbances are more likely to occur in children with significant symptoms , and they seem to impose significant but mild effects on daytime neurobehavioral functioning . We conclude that in children with significant symptoms of ADHD , the prevalence of SDB is not different from that of the general pediatric population and that rapid eye movement sleep in these children is disturbed and may contribute to the severity of their behavioral manifestations . Furthermore , SDB can lead to mild ADHD-like behaviors that can be readily misperceived and potentially delay the diagnosis and appropriate treatment Children and adolescents with attention-deficit/hyperactivity disorder ( ADHD ) experience high rates of sleep problems and are also at increased risk for experiencing comorbid mental health problems . This study provides an initial examination of the 1-year prospect i ve association between sleep problems and comorbid symptoms in youth diagnosed with ADHD . Participants were 81 young adolescents ( 75 % male ) carefully diagnosed with ADHD and their parents . Parents completed measures of their child ’s sleep problems and ADHD symptoms , oppositional defiant disorder ( ODD ) symptoms ,  and general externalizing behavior problems  at baseline ( Mage = 12.2 ) and  externalizing behaviors were assessed again 1 year later . Adolescents completed measures of anxiety and depression at both time-points . Medication use was not associated with sleep problems or comorbid psychopathology symptoms . Regression analyses indicated that , above and beyond demographic characteristics , ADHD symptom severity , and initial levels of comorbidity , sleep problems significantly predicted greater ODD symptoms , general externalizing behavior problems , and depressive symptoms 1 year later . Sleep problems were not concurrently or prospect ively associated with anxiety . Although this study precludes making causal inferences , it does nonetheless provide initial evidence of sleep problems predicting later comorbid externalizing behaviors and depression symptoms in youth with ADHD . Additional research is needed with larger sample s and multiple time-points to further examine the interrelations of sleep problems and comorbidity This study evaluated the efficacy and safety of lisdexamfetamine dimesylate ( LDX ) compared with placebo in children and adolescents with attention-deficit/hyperactivity disorder ( ADHD ) in Europe .  Osmotic-release oral system methylpheni date ( OROS-MPH ) was included as a reference arm . Patients ( 6 - 17 years old ) with a baseline ADHD Rating Scale version IV ( ADHD-RS-IV ) total score ≥ 28 were r and omized ( 1:1:1 ) to dose-optimized LDX  ( 30 , 50 , or 70 mg/day ) , OROS-MPH ( 18 , 36 , or 54 mg/day ) or placebo for 7 weeks . Primary and key secondary efficacy measures were the investigator-rated ADHD-RS-IV and the Clinical Global Impressions-Improvement ( CGI-I ) rating , respectively . Safety assessment s included treatment-emergent adverse events ( TEAEs ) , electrocardiograms , and vital signs . Of 336 patients r and omized , 196 completed the study . The difference between LDX and placebo in least squares mean change in ADHD-RS-IV total score from baseline to endpoint was -18.6 ( 95 % confidence interval [ CI ] : -21.5 to -15.7 ) ( p<0.001 ; effect size , 1.80 ) . The difference between OROS-MPH and placebo in least squares mean change in ADHD-RS-IV total score from baseline to endpoint was -13.0 ( 95 % CI : -15.9 to -10.2 ) ( p<0.001 ; effect size , 1.26 ) . The proportions ( 95 % CI ) of patients showing improvement ( CGI-I of 1 or 2 ) at endpoint were 78 % ( 70 - 86 ) , 14 % ( 8 - 21 ) , and 61 % ( 51 - 70 ) for LDX , placebo , and OROS-MPH . The most common TEAEs for LDX were decreased appetite , headache , and insomnia . Mean changes in vital signs were modest and consistent with the known profile of LDX . LDX was effective and generally well tolerated in children and adolescents with ADHD This prospect i ve longitudinal study evaluated the impact of daytime sleepiness on the school performance of 62 college students diagnosed comprehensively with attention deficit hyperactivity disorder . The primary goal of the study was to determine if self-reported daytime sleepiness rated at the beginning of the academic year could predict academic and overall functioning at the end of the academic year while also considering potentially important covariates , including symptoms of inattention , hyperactivity and impulsivity , medication status and whether or not students lived at home or on-campus . Self-reported  daytime sleepiness predicted longitudinally school maladjustment , overall functional impairment and the number of D and F grade s ( i.e. poor and failing ) students received in courses above and beyond both self- and parent-report of symptoms , but 
    Output:
    
Findings are mixed but overall suggest associations between sleep disturbances and 1 ) ADHD symptoms in the population and 2 ) poorer clinical , neurocognitive , and functional outcomes among adolescents with ADHD .