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The optimal system of care for the management of delayed sleep onset in adult ADHD in the UK: a modified Delphi consensus

Philip Asherson, Giovanni Giaroli, Paul Gringras, Heidi Phillips, Hugh Selsick, Michael Smith, Dietmar Hank

Frontiers in Psychiatry, Volume: 16

Swansea University Author: Heidi Phillips

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DOI (Published version): 10.3389/fpsyt.2025.1566390

Abstract

Introduction: Sleep-related disorders affect a significant number of individuals with ADHD, the most common of which has been found to be delayed sleep phase syndrome/delayed sleep onset. The presence of a sleep disorder can exacerbate ADHD symptoms and impair cognitive functions. Despite the signif...

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Published in: Frontiers in Psychiatry
ISSN: 1664-0640
Published: Frontiers Media SA 2025
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Despite the significance of these issues, they are often overlooked, potentially leading to unsafe self-medication practices and illicit substance abuse. While the literature supports the efficacy of melatonin in treating delayed sleep onset among children and adolescents with ADHD, evidence in adults is less well-established. This consensus study aims to establish consensus among healthcare professionals regarding the overall management of adults with ADHD experiencing delayed sleep onset in the UK, with the aim of guiding good clinical practice.Methods: The process employed a modified Delphi methodology. A literature review was conducted to understand the current evidence base. A steering group of seven experts from the UK attended a virtual meeting in April 2024. During this meeting, facilitated by an independent moderator, the group identified six primary domains. Based on these domains, 40 statements were developed into an online survey for testing with a wider panel of peers.Stopping criteria for consensus rounds were established as a survey duration of four months, a target of 200 responses, and the requirement that at least 90% of the statements achieve the consensus threshold of &#x2265;75% agreement.Results: A total of 212 responses were received from healthcare professionals experienced in managing adult patients with ADHD and sleep disorders in the UK. All proposed statements achieved consensus, with 90% of statements achieved &#x2265;90% agreement (n=36/40).Conclusion: Based on the agreement levels achieved, the steering group developed a series of recommendations for the management of delayed sleep onset in adult ADHD in the UK. Given the prevalence of sleep disorders in this population, a comprehensive management approach is essential. This should include effective treatments, such as melatonin, which could be initiated in primary care and monitored by general practitioners for newly diagnosed patients. 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spelling 2026-01-12T22:08:37.1554346 v2 70894 2025-11-13 The optimal system of care for the management of delayed sleep onset in adult ADHD in the UK: a modified Delphi consensus e3d3838a3e547e14f3b46ff2bbf09fdb Heidi Phillips Heidi Phillips true false 2025-11-13 MEDS Introduction: Sleep-related disorders affect a significant number of individuals with ADHD, the most common of which has been found to be delayed sleep phase syndrome/delayed sleep onset. The presence of a sleep disorder can exacerbate ADHD symptoms and impair cognitive functions. Despite the significance of these issues, they are often overlooked, potentially leading to unsafe self-medication practices and illicit substance abuse. While the literature supports the efficacy of melatonin in treating delayed sleep onset among children and adolescents with ADHD, evidence in adults is less well-established. This consensus study aims to establish consensus among healthcare professionals regarding the overall management of adults with ADHD experiencing delayed sleep onset in the UK, with the aim of guiding good clinical practice.Methods: The process employed a modified Delphi methodology. A literature review was conducted to understand the current evidence base. A steering group of seven experts from the UK attended a virtual meeting in April 2024. During this meeting, facilitated by an independent moderator, the group identified six primary domains. Based on these domains, 40 statements were developed into an online survey for testing with a wider panel of peers.Stopping criteria for consensus rounds were established as a survey duration of four months, a target of 200 responses, and the requirement that at least 90% of the statements achieve the consensus threshold of ≥75% agreement.Results: A total of 212 responses were received from healthcare professionals experienced in managing adult patients with ADHD and sleep disorders in the UK. All proposed statements achieved consensus, with 90% of statements achieved ≥90% agreement (n=36/40).Conclusion: Based on the agreement levels achieved, the steering group developed a series of recommendations for the management of delayed sleep onset in adult ADHD in the UK. Given the prevalence of sleep disorders in this population, a comprehensive management approach is essential. This should include effective treatments, such as melatonin, which could be initiated in primary care and monitored by general practitioners for newly diagnosed patients. It is also important that treatment for delayed sleep onset is continued as individuals transition from childhood into adulthood. Journal Article Frontiers in Psychiatry 16 Frontiers Media SA 1664-0640 attention deficit hyperactivity disorder, attention deficit disorder with hyperactivity, delayed sleep onset, Delphi consensus, UK 14 8 2025 2025-08-14 10.3389/fpsyt.2025.1566390 COLLEGE NANME Medical School COLLEGE CODE MEDS Swansea University Another institution paid the OA fee This study was funded by AGB Pharma. 2026-01-12T22:08:37.1554346 2025-11-13T16:19:24.1324406 Faculty of Medicine, Health and Life Sciences Swansea University Medical School - Medicine Philip Asherson 1 Giovanni Giaroli 2 Paul Gringras 3 Heidi Phillips 4 Hugh Selsick 5 Michael Smith 6 Dietmar Hank 7 70894__35626__004178cb84a84bb5ba79526231c53a2e.pdf 70894.VoR.pdf 2025-11-13T16:22:47.4421120 Output 2228454 application/pdf Version of Record true © 2025 Asherson, Giaroli, Gringras, Phillips, Selsick, Smith and Hank. This is an open access article distributed under the terms of the Creative Commons Attribution License (CC BY). true eng http://creativecommons.org/licenses/by/4.0/
title The optimal system of care for the management of delayed sleep onset in adult ADHD in the UK: a modified Delphi consensus
spellingShingle The optimal system of care for the management of delayed sleep onset in adult ADHD in the UK: a modified Delphi consensus
Heidi Phillips
title_short The optimal system of care for the management of delayed sleep onset in adult ADHD in the UK: a modified Delphi consensus
title_full The optimal system of care for the management of delayed sleep onset in adult ADHD in the UK: a modified Delphi consensus
title_fullStr The optimal system of care for the management of delayed sleep onset in adult ADHD in the UK: a modified Delphi consensus
title_full_unstemmed The optimal system of care for the management of delayed sleep onset in adult ADHD in the UK: a modified Delphi consensus
title_sort The optimal system of care for the management of delayed sleep onset in adult ADHD in the UK: a modified Delphi consensus
author_id_str_mv e3d3838a3e547e14f3b46ff2bbf09fdb
author_id_fullname_str_mv e3d3838a3e547e14f3b46ff2bbf09fdb_***_Heidi Phillips
author Heidi Phillips
author2 Philip Asherson
Giovanni Giaroli
Paul Gringras
Heidi Phillips
Hugh Selsick
Michael Smith
Dietmar Hank
format Journal article
container_title Frontiers in Psychiatry
container_volume 16
publishDate 2025
institution Swansea University
issn 1664-0640
doi_str_mv 10.3389/fpsyt.2025.1566390
publisher Frontiers Media SA
college_str Faculty of Medicine, Health and Life Sciences
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hierarchy_top_id facultyofmedicinehealthandlifesciences
hierarchy_top_title Faculty of Medicine, Health and Life Sciences
hierarchy_parent_id facultyofmedicinehealthandlifesciences
hierarchy_parent_title Faculty of Medicine, Health and Life Sciences
department_str Swansea University Medical School - Medicine{{{_:::_}}}Faculty of Medicine, Health and Life Sciences{{{_:::_}}}Swansea University Medical School - Medicine
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description Introduction: Sleep-related disorders affect a significant number of individuals with ADHD, the most common of which has been found to be delayed sleep phase syndrome/delayed sleep onset. The presence of a sleep disorder can exacerbate ADHD symptoms and impair cognitive functions. Despite the significance of these issues, they are often overlooked, potentially leading to unsafe self-medication practices and illicit substance abuse. While the literature supports the efficacy of melatonin in treating delayed sleep onset among children and adolescents with ADHD, evidence in adults is less well-established. This consensus study aims to establish consensus among healthcare professionals regarding the overall management of adults with ADHD experiencing delayed sleep onset in the UK, with the aim of guiding good clinical practice.Methods: The process employed a modified Delphi methodology. A literature review was conducted to understand the current evidence base. A steering group of seven experts from the UK attended a virtual meeting in April 2024. During this meeting, facilitated by an independent moderator, the group identified six primary domains. Based on these domains, 40 statements were developed into an online survey for testing with a wider panel of peers.Stopping criteria for consensus rounds were established as a survey duration of four months, a target of 200 responses, and the requirement that at least 90% of the statements achieve the consensus threshold of ≥75% agreement.Results: A total of 212 responses were received from healthcare professionals experienced in managing adult patients with ADHD and sleep disorders in the UK. All proposed statements achieved consensus, with 90% of statements achieved ≥90% agreement (n=36/40).Conclusion: Based on the agreement levels achieved, the steering group developed a series of recommendations for the management of delayed sleep onset in adult ADHD in the UK. Given the prevalence of sleep disorders in this population, a comprehensive management approach is essential. This should include effective treatments, such as melatonin, which could be initiated in primary care and monitored by general practitioners for newly diagnosed patients. It is also important that treatment for delayed sleep onset is continued as individuals transition from childhood into adulthood.
published_date 2025-08-14T05:33:53Z
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