TL;DR
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A perspective published in Frontiers in Psychiatry on Dec. 10, 2025, reviews evidence that delayed circadian timing and sleep problems affect a substantial subgroup of people with ADHD. It proposes screening and behavioral approaches, including fixed wake times and morning light, as adjuncts to care; the authors say larger, stratified trials are needed to establish effects on core ADHD symptoms.
A perspective article published Dec. 10, 2025 in Frontiers in Psychiatry argues that delayed circadian timing is a clinically relevant feature for a substantial subgroup of people with ADHD and proposes adding sleep and circadian screening to care. The authors review existing evidence and suggest behavioral measures, such as regular wake times and morning light exposure, as adjuncts—not replacements for established ADHD treatment—while calling for better trials to test whether shifting circadian timing improves core symptoms.
The authors describe high rates of sleep difficulties among people with ADHD. The article reports that insomnia or other sleep disturbances affect up to 80% of adults and up to 82% of children with ADHD, while delayed sleep-wake timing has been reported in as many as 78%. These are upper estimates drawn from prior research, not rates established by a new study conducted for this perspective.
The review summarizes findings of later timing in biological measures, including dim-light melatonin onset (DLMO), a marker used to estimate circadian phase. The article reports average delays of about 45 minutes in children and 90 minutes in adults compared with control groups in cited studies. It also describes reported differences in cortisol rhythms, pineal gland volume and peripheral clock-gene rhythms. These associations do not show that circadian disruption causes ADHD.
Some intervention studies reviewed by the authors found that melatonin and bright-light therapy can advance circadian phase in ADHD populations. The article says emerging data associate phase advancement with symptom improvement, and that sleep programs have improved sleep and functioning in children. The authors propose screening, sleep and chronotype tracking, fixed wake times, morning light, reduced evening light and, selectively, low-dose melatonin when delayed DLMO is confirmed or considered likely.
Adding Circadian Care to ADHD Treatment
The article’s practical implication is that clinicians and patients may need to look beyond sleep duration alone. If a person’s internal clock is substantially delayed, difficulty falling asleep at a conventional bedtime and waking for school or work could compound day-to-day impairment. Screening could help identify people whose sleep timing merits attention alongside their existing ADHD care.
However, the perspective presents this as a promising adjunctive approach, not a proven ADHD treatment. The reviewed interventions offer evidence that circadian timing can shift, but evidence that this shift reliably reduces core symptoms remains preliminary. The distinction matters to families considering changes: improving sleep or functioning may be worthwhile, but it does not establish that chronotherapy can replace medication, behavioral therapy or other clinician-guided care.
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What the Evidence Covers
The paper is a Perspective in the sleep disorders section of Frontiers in Psychiatry, not a new clinical trial or a formal treatment guideline. Its authors bring together previously published studies on sleep, biological rhythms and interventions in ADHD, then propose a clinical pathway for future consideration.
The proposed pathway starts with routine questions about sleep and circadian difficulties, followed by characterization using chronotype assessment and sleep tracking; DLMO testing could be used when feasible. Suggested behavioral steps include consistent wake times, morning light exposure, limiting bright light and screens in the evening, and regular daily cues such as activity schedules. The authors say exercise and combined interventions merit investigation in ADHD, drawing in part on findings from non-ADHD populations.
The article describes circadian features as relevant to a substantial subgroup, not everyone with ADHD. It also notes that ADHD symptoms and circadian disruption may interact in complex, bidirectional ways. The proposal is therefore to identify individual patterns rather than assume one sleep schedule or intervention fits all.
““circadian rhythm dysfunction is a clinically significant and highly prevalent phenotype in a substantial subgroup” of people with ADHD”
— The authors of the Frontiers in Psychiatry perspective
How Much Symptoms Can Shift
The perspective does not establish that circadian disruption causes ADHD, or that treating a delayed rhythm will improve core ADHD symptoms for most patients. The article summarizes associations and intervention findings from earlier work; the supplied report does not provide a single pooled treatment effect or a new controlled trial. It also does not establish which patients are most likely to respond, what intervention schedule is best, or how long any gains last.
The reported prevalence and timing estimates vary across the underlying studies, and the article’s upper percentages should not be read as universal rates. The contribution of medication, co-occurring conditions and differences in measurement also remains relevant. Low-dose melatonin should be discussed with a qualified clinician, particularly for children or people taking other medication; the article’s proposal is not individualized medical advice.
Trials to Test the Approach
The next step identified by the authors is well-designed, stratified clinical trials that measure core ADHD symptoms as well as sleep and functioning. Such studies would need to identify which circadian profiles predict response and compare specific protocols, including timing of light exposure and any melatonin use. Until those results are available, clinicians and patients will need to interpret circadian interventions as possible additions to individualized care rather than established stand-alone treatment.
Key Questions
Does this article say ADHD is a circadian rhythm disorder?
No. The authors argue that circadian dysfunction is a relevant feature for a substantial subgroup of people with ADHD. They do not say it explains every case or that it causes ADHD.
What circadian differences does the article report?
It summarizes prior findings of later sleep-wake timing and delayed DLMO—about 45 minutes in children and 90 minutes in adults in the cited research—along with reported differences in cortisol and other biological rhythms.
Does shifting circadian timing improve ADHD symptoms?
Some studies reviewed in the perspective associate phase advancement with symptom improvement, but the authors describe the evidence as emerging. Larger trials are needed to establish the size and reliability of any effect.
What interventions do the authors propose?
They suggest screening and sleep tracking, consistent wake times, morning bright light, reduced evening light and regular daily routines. They propose selective low-dose melatonin for confirmed or probable delayed DLMO, with clinical guidance.
Source: hn
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