Here’s What the Wall Street Journal Got Wrong about the Medication Treatment of ADHD Patients: A Lesson in Science Media Literacy

A recent Wall Street Journal article raised alarms by concluding that many children who start medication for ADHD will later end up on several psychiatric drugs. It’s an emotional topic that will make many parents, teachers, and even doctors worry: “Are we putting kids on a conveyor belt of medications?”

The article seeks to shine a light on the use of more than one psychiatric medication for children with ADHD.   My biggest worry about the article is that it presents itself as a scientific study because they analyzed a database.  It is not a scientific study.  It is a journalistic investigation that does not meet the standards of a scientific report..

The WJS brings attention to several issues that parents and prescribers should think about. It documents that some kids with ADHD are on more than one psychiatric medication, and some are receiving drugs like antipsychotics, which have serious side effects.  Is that appropriate? Access to good therapy, careful evaluation, and follow-up care can be lacking, especially for low-income families.  Can that be improved?  On that level, the article is doing something valuable: it’s shining a spotlight on potential problems.

It is, of course, fine for a journalist to raise questions, but it is not OK for them to pretend that they’ve done a scientific investigation that proves anything. Journalism pretending to be science is both bad science and bad journalism.

Journalism vs. Science: Why Peer Review Matters

Journalists can get big datasets, hire data journalists, and present numbers that look scientific.  But consider the differences between Journalism and Science. These types of articles are usually checked by editors and fact-checkers. Their main goals are:

 Is this fact basically correct?

 Are we being fair?

 Are we avoiding legal problems?

But editors are not qualified to evaluate scientific data analysis methods.  Scientific reports are evaluated by experts who are not part of the project.  They ask tough questions like: 

Exactly how did you define ADHD? 

How did you handle missing data? 

Did you address confounding? 

Did you confuse correlation with causation?

If the authors of the study cannot address these and other technical issues, the paper is rejected.

The WSJ article has the veneer of science but lacks its methodology.  

Correlation vs. Causation: A Classic Trap

The article’s storyline goes something like this:  A kid starts ADHD medication.  She has additional problems or side effects caused by the ADHD medications.   Because of that, the prescriber adds more drugs.  That leads to the patient being put on several drugs.  Although it is true that some ADHD youth are on multiple drugs, the WSJ is wrong to conclude that the medications for ADHD cause this to occur.  That simply confuses correlation with causation, which only the most naïve scientist would do.

In science, this problem is called confounding. It means other factors (like how severe or complex a child’s condition is) explain the results, not just the thing we’re focused on (medication for ADHD). 

The WSJ analyzed a database of prescriptions.  They did not survey the prescribers who made the prescriptions of the patients who received them.  So they cannot conclude that ADHD medication caused the later prescriptions, or that the later medications were unnecessary or inappropriate. 

Other explanations are very likely.   It has been well documented that youth with ADHD are at high risk for developing other disorders such as anxiety, depression,  and substance use.  The kids in the WSJ database might have developed these disorders and needed several medications.  A peer-reviewed article in a scientific journal would be expected to adjust for other diagnoses. If that is not possible, as it is in the case of the WSJ’s database, a journal would not allow the author to make strong conclusions about cause-and-effect.

Powerful Stories Don’t Always Mean Typical Stories

The article includes emotional accounts of children who seemed harmed by being put on multiple psychiatric drugs.  Strong, emotional stories can make rare events feel common.  They also frighten parents and patients, which might lead some to decline appropriate care. 

These stories matter. They remind us that each data point is a real person.  But these stories are the weakest form of data.  They can raise important questions and lead scientists to design definitive studies, but we cannot use them to draw conclusions about the experiences of other patients.  These stories serve as a warning about the importance of finding a qualified provider,  not as against the use of multiple medications.  That decision should be made by the parent or adult patient based on an informed discussion with the prescriber.

Many children and adults with ADHD benefit from multiple medications. The WSJ does not tell those stories, which creates an unbalanced and misleading presentation.  

Newspapers frequently publish stories that send the message:  “Beware!  Doctors are practicing medicine in a way that will harm you and your family.”   They then use case studies to prove their point.  The title of the article is, itself, emotional clickbait designed to get more readers and advertising revenue.  Don’t be confused by such journalistic trickery.

What Should We Conclude?

Here’s a balanced way to read the article.  It is true that some patients are prescribed more than one medication for mental health problems.  But the article does not tell us whether this prescribing practice is or is not warranted for most patients.  I agree that the use of antipsychotic medications needs careful justification and close monitoring.  I also agree that patients on multiple medications should be monitored closely to see if some of the medications can be eliminated.  Many prescribers do exactly that, but the WSJ did not tell their stories.  

It is not appropriate to conclude that ADHD medications typically cause combined pharmacotherapy or to suggest that combined pharmacotherapy is usually bad. The data presented by the WSJ does not adequately address these concerns.  It does not prove that medications for ADHD cause dangerous medication cascades.

We have to remember that even when a journalist analyzes data, that is not the same as a peer-reviewed scientific study.Journalism pretending to be science is both bad science and bad journalism.

Related posts

What The New York Times Got Wrong

Why The New York Times’ Essay on ADHD Misses the Mark

This New York Times article, “5 Takeaways from New Research about ADHD”, earns a poor grade for accuracy. Let’s break down their (often misleading and frequently inaccurate) claims about ADHD. 

The Claim: A.D.H.D. is hard to define/ No ADHD Biomarkers exist

The Reality: The claim that ADHD is hard to define “because scientists haven’t found a single biological marker” is misleading at best. While it is true that no biomarker exists, decades of rigorous research using structured clinical interviews and standardized rating scales show that ADHD is reliably diagnosed. Decades of validation research consistently show that ADHD is indeed a biologically-based disorder. One does not need a biomarker to draw that conclusion and recent research about ADHD has not changed that conclusion. 

Additionally, research has in fact confirmed that genetics do play a role in the development of ADHD and several genes associated with ADHD have been identified.  

The Claim: The efficacy of medication wanes over time

The Reality: The article’s statement that medications like Adderall or Ritalin only provide short-term benefits that fade over time is wrong. It relies almost entirely on one study—the Multimodal Treatment Study of ADHD (MTA). In the MTA study, the relative advantage of medication over behavioral treatments diminished after 36 months. This was largely because many patients who had not initially been given medication stopped taking it and many who had only been treated with behavior therapy suddenly began taking medication. The MTA shows that patients frequently switched treatments. It does not overturn other data documenting that these medications are highly effective. Moreover, many longitudinal studies clearly demonstrate sustained benefits of ADHD medications in reducing core symptoms, psychiatric comorbidity, substance abuse, and serious negative outcomes, including accidents, and school dropout rates. A study of nearly 150,000 people with ADHD in Sweden concluded “Among individuals diagnosed with ADHD, medication initiation was associated with significantly lower all-cause mortality, particularly for death due to unnatural causes”. The NY Times’ claim that medications lose their beneficial effects over time ignores compelling evidence to the contrary.

The Claim: Medications don’t help children with ADHD learn 

The Reality: ADHD medications are proven to reliably improve attention, increase time spent on tasks, and reduce disruptive behavior, all critical factors directly linked to better academic performance.The article’s assertion that ADHD medications improve only classroom behavior and do not actually help students learn also oversimplifies and misunderstands the research evidence. While medication alone might not boost IQ or cognitive ability in a direct sense, extensive research confirms significant objective improvements in academic productivity and educational success—contrary to the claim made in the article that the medication’s effect is merely emotional or perceptual, rather than genuinely educational. 

For example, a study of students with ADHD who were using medication intermittingly concluded “Individuals with ADHD had higher scores on the higher education entrance tests during periods they were taking ADHD medication vs non-medicated periods. These findings suggest that ADHD medications may help ameliorate educationally relevant outcomes in individuals with ADHD.”

The Claim: Changing a child’s environment can change his or her symptoms.

The Reality: The Times article asserts that ADHD symptoms are influenced by environmental fluctuations and thus might not have their roots in neurobiology. We have known for many years that the symptoms of ADHD fluctuate with environmental demands. The interpretation of this given by the NY Times is misleading because it confuses symptom variability with underlying causes. Many disorders with well-established biological origins are sensitive to environmental factors, yet their biology remains undisputed. 

For example, hypertension is unquestionably a biologically based condition involving genetic and physiological factors. However, it is also well-known that environmental stressors, dietary

habits, and lifestyle factors can significantly worsen or improve hypertension. Similarly, asthma is biologically rooted in inflammation and airway hyper-reactivity, but environmental triggers such as allergens, pollution, or even emotional stress clearly impact symptom severity. Just as these environmental influences on hypertension or asthma do not negate their biological basis, the responsiveness of ADHD symptoms to environmental fluctuations (e.g., improvements in classroom structure, supportive home life) does not imply that ADHD lacks neurobiological roots. Rather, it underscores that ADHD, like many medical conditions, emerges from the interplay between underlying biological vulnerabilities and environmental influences.

Claim: There is no clear dividing line between those who have A.D.H.D. and those who don’t.

The Reality: This is absolutely and resoundingly false. The article’s suggestion that ADHD diagnosis is arbitrary because ADHD symptoms exist on a continuum rather than as a clear-cut, binary condition is misleading. Although it is true that ADHD symptoms—like inattention, hyperactivity, and impulsivity—do vary continuously across the population, the existence of this continuum does not make the diagnosis arbitrary or invalidate the disorder’s biological basis. Many well-established medical conditions show the same pattern. For instance, hypertension (high blood pressure) and hypercholesterolemia (high cholesterol) both involve measures that are continuously distributed. Blood pressure and cholesterol levels exist along a continuum, yet clear diagnostic thresholds have been carefully established through decades of clinical research. Their continuous distribution does not lead clinicians to question whether these conditions have biological origins or whether diagnosing an individual with hypertension or hypercholesterolemia is arbitrary. Rather, it underscores that clinical decisions and diagnostic thresholds are established using evidence about what levels lead to meaningful impairment or increased risk of negative health outcomes. Similarly, the diagnosis of ADHD has been meticulously defined and refined over many decades using extensive empirical research, structured clinical interviews, and validated rating scales. The diagnostic criteria developed by experts carefully delineate the point at which symptoms become severe enough to cause significant impairment in an individual’s daily functioning. Far from being arbitrary, these thresholds reflect robust scientific evidence that individuals meeting these criteria face increased risks for the serious impairments in life including accidents, suicide and premature death. 

The existence of milder forms of ADHD does not undermine the validity of the diagnosis; rather, it emphasizes the clinical reality that people experience varying degrees of symptom severity.

Moreover, acknowledging variability in severity has always been a core principle in medicine. Clinicians routinely adjust treatments to meet individual patient needs. Not everyone diagnosed with hypertension receives identical medication regimens, nor does everyone with elevated cholesterol get prescribed the same intervention. Similarly, people with ADHD receive personalized treatment plans tailored to the severity of their symptoms, their specific impairments, and their individual circumstances. This personalization is not evidence of arbitrariness; it is precisely how evidence-based medicine is practiced. In sum, the continuous nature of ADHD symptoms is fully compatible with a biologically-based diagnosis that has substantial evidence for validity, and acknowledging symptom variability does not render diagnosis arbitrary or diminish its clinical importance.

In sum, readers seeking a balanced, evidence-based understanding of ADHD deserve clearer, more careful reporting. By overstating diagnostic uncertainty, selectively interpreting research about medication efficacy, and inaccurately portraying the educational benefits of medication, this article presents an overly simplistic, misleading picture of ADHD.

April 17, 2025

ADHD medication and risk of suicide

ADHD Medication and Risk of Suicide

A Chinese research team performed two types of meta-analyses to compare the risk of suicide for ADHD patients taking ADHD medication as opposed to those not taking medication.

The first type of meta-analysis combined six large population studies with a total of over 4.7 million participants. These were located on three continents - Europe, Asia, and North America - and more specifically Sweden, England, Taiwan, and the United States.

The risk of suicide among those taking medication was found to be about a quarter less than for unmediated individuals, though the results were barely significant at the 95 percent confidence level (p = 0.49, just a sliver below the p = 0.5 cutoff point). There were no significant differences between males and females, except that looking only at males or females reduced sample size and made results non-significant.

Differentiating between patients receiving stimulant and non-stimulant medications produced divergent outcomes. A meta-analysis of four population studies covering almost 900,000 individuals found stimulant medications to be associated with a 28 percent reduced risk of suicide. On the other hand, a meta-analysis of three studies with over 62,000 individuals found no significant difference in suicide risk for non-stimulant medications. The benefit, therefore, seems limited to stimulant medication.

The second type of meta-analysis combined three within-individual studies with over 3.9 million persons in the United States, China, and Sweden. The risk of suicide among those taking medication was found to be almost a third less than for unmediated individuals, though the results were again barely significant at the 95 percent confidence level (p =0.49, just a sliver below the p = 0.5 cutoff point). Once again, there were no significant differences between males and females, except that looking only at males or females reduced the sample size and made results non-significant.

Differentiating between patients receiving stimulant and non-stimulant medications once again produced divergent outcomes. Meta-analysis of the same three studies found a 25 percent reduced risk of suicide among those taking stimulant medications. But as in the population studies, a meta-analysis of two studies with over 3.9 million persons found no reduction in risk among those taking non-stimulant medications.

A further meta-analysis of two studies with 3.9 million persons found no reduction in suicide risk among persons taking ADHD medications for 90 days or less, "revealing the importance of duration and adherence to medication in all individuals prescribed stimulants for ADHD."

The authors concluded, "exposure to non-stimulants is not associated with a higher risk of suicide attempts. However, a lower risk of suicide attempts was observed for stimulant drugs. However, the results must be interpreted with caution due to the evidence of heterogeneity ..."

December 13, 2021

ADHD Medication and Academic Achievement: What Do We Really Know?

Parents and teachers often ask: Does ADHD medication actually improve grades and school performance? The answer is: yes, but with important limitations. Medications are very effective at reducing inattention, hyperactivity, and impulsivity but their impact on long-term academic outcomes like grades and test scores is not as consistent.

In the Classroom

The medications for ADHD consistently: Improve attention, reduce classroom disruptions, increase time spent on-task and help children complete more schoolwork and homework. Medication can help children with ADHD access learning by improving the conditions for paying attention and persisting with work.

Does Medication Improve Test Scores and Grades?

This is where the picture gets more complicated.  Medications have  stronger effect on how much work is completed but a weaker effect on accuracy. Many studies show that children on medication attempt more problems in reading, math, and spelling, but the number of correct answers doesn’t always improve as much. Some studies find small but significant improvements in national exam scores and higher education entrance tests during periods when children with ADHD are medicated.

Grades improve, as well, but modestly. Large registry studies in Sweden show that students who consistently take medication earn higher grades than those who don’t. However, these gains usually do not close the achievement gap with peers who do not have ADHD.

Keep in mind that small improvements for a group as a whole mean that some children are benefiting greatly from medication and others not at all.  We have no way of predicting which children will improve and which do not. 

Medication Alone Isn’t Enough

Academic success depends on more than just reducing inattention, hyperactivity and impulsivity. Skills like organization, planning, studying, and managing long-term projects are also critical.  Medication cannot teach these skills.

So, in addition to medication, the patient's treatment program should include educational support (tutoring, structured study skills programs), behavioral interventions (parent training, classroom management strategies), and accommodations at school (extra time, reduced distractions, organizational aids) Parents should discuss with their prescriber which of these methods would be appropriate.

Conclusions 

ADHD medication is a powerful tool for reducing symptoms and supporting learning. It improves test scores and grades for some children, especially when taken consistently. But it is not a magic bullet for academic success. The best results come when medication is combined with educational and behavioral supports that help children build the skills they need to thrive in school and beyond.

September 17, 2025

Here’s What the Wall Street Journal Got Wrong about the Medication Treatment of ADHD Patients: A Lesson in Science Media Literacy

A recent Wall Street Journal article raised alarms by concluding that many children who start medication for ADHD will later end up on several psychiatric drugs. It’s an emotional topic that will make many parents, teachers, and even doctors worry: “Are we putting kids on a conveyor belt of medications?”

The article seeks to shine a light on the use of more than one psychiatric medication for children with ADHD.   My biggest worry about the article is that it presents itself as a scientific study because they analyzed a database.  It is not a scientific study.  It is a journalistic investigation that does not meet the standards of a scientific report..

The WJS brings attention to several issues that parents and prescribers should think about. It documents that some kids with ADHD are on more than one psychiatric medication, and some are receiving drugs like antipsychotics, which have serious side effects.  Is that appropriate? Access to good therapy, careful evaluation, and follow-up care can be lacking, especially for low-income families.  Can that be improved?  On that level, the article is doing something valuable: it’s shining a spotlight on potential problems.

It is, of course, fine for a journalist to raise questions, but it is not OK for them to pretend that they’ve done a scientific investigation that proves anything. Journalism pretending to be science is both bad science and bad journalism.

Journalism vs. Science: Why Peer Review Matters

Journalists can get big datasets, hire data journalists, and present numbers that look scientific.  But consider the differences between Journalism and Science. These types of articles are usually checked by editors and fact-checkers. Their main goals are:

 Is this fact basically correct?

 Are we being fair?

 Are we avoiding legal problems?

But editors are not qualified to evaluate scientific data analysis methods.  Scientific reports are evaluated by experts who are not part of the project.  They ask tough questions like: 

Exactly how did you define ADHD? 

How did you handle missing data? 

Did you address confounding? 

Did you confuse correlation with causation?

If the authors of the study cannot address these and other technical issues, the paper is rejected.

The WSJ article has the veneer of science but lacks its methodology.  

Correlation vs. Causation: A Classic Trap

The article’s storyline goes something like this:  A kid starts ADHD medication.  She has additional problems or side effects caused by the ADHD medications.   Because of that, the prescriber adds more drugs.  That leads to the patient being put on several drugs.  Although it is true that some ADHD youth are on multiple drugs, the WSJ is wrong to conclude that the medications for ADHD cause this to occur.  That simply confuses correlation with causation, which only the most naïve scientist would do.

In science, this problem is called confounding. It means other factors (like how severe or complex a child’s condition is) explain the results, not just the thing we’re focused on (medication for ADHD). 

The WSJ analyzed a database of prescriptions.  They did not survey the prescribers who made the prescriptions of the patients who received them.  So they cannot conclude that ADHD medication caused the later prescriptions, or that the later medications were unnecessary or inappropriate. 

Other explanations are very likely.   It has been well documented that youth with ADHD are at high risk for developing other disorders such as anxiety, depression,  and substance use.  The kids in the WSJ database might have developed these disorders and needed several medications.  A peer-reviewed article in a scientific journal would be expected to adjust for other diagnoses. If that is not possible, as it is in the case of the WSJ’s database, a journal would not allow the author to make strong conclusions about cause-and-effect.

Powerful Stories Don’t Always Mean Typical Stories

The article includes emotional accounts of children who seemed harmed by being put on multiple psychiatric drugs.  Strong, emotional stories can make rare events feel common.  They also frighten parents and patients, which might lead some to decline appropriate care. 

These stories matter. They remind us that each data point is a real person.  But these stories are the weakest form of data.  They can raise important questions and lead scientists to design definitive studies, but we cannot use them to draw conclusions about the experiences of other patients.  These stories serve as a warning about the importance of finding a qualified provider,  not as against the use of multiple medications.  That decision should be made by the parent or adult patient based on an informed discussion with the prescriber.

Many children and adults with ADHD benefit from multiple medications. The WSJ does not tell those stories, which creates an unbalanced and misleading presentation.  

Newspapers frequently publish stories that send the message:  “Beware!  Doctors are practicing medicine in a way that will harm you and your family.”   They then use case studies to prove their point.  The title of the article is, itself, emotional clickbait designed to get more readers and advertising revenue.  Don’t be confused by such journalistic trickery.

What Should We Conclude?

Here’s a balanced way to read the article.  It is true that some patients are prescribed more than one medication for mental health problems.  But the article does not tell us whether this prescribing practice is or is not warranted for most patients.  I agree that the use of antipsychotic medications needs careful justification and close monitoring.  I also agree that patients on multiple medications should be monitored closely to see if some of the medications can be eliminated.  Many prescribers do exactly that, but the WSJ did not tell their stories.  

It is not appropriate to conclude that ADHD medications typically cause combined pharmacotherapy or to suggest that combined pharmacotherapy is usually bad. The data presented by the WSJ does not adequately address these concerns.  It does not prove that medications for ADHD cause dangerous medication cascades.

We have to remember that even when a journalist analyzes data, that is not the same as a peer-reviewed scientific study.Journalism pretending to be science is both bad science and bad journalism.

Oppositional Defiant Disorder, Autism, and ADHD: New Research Examines the Connection

Oppositional Defiant Disorder (ODD)—a pattern of chronic irritability, anger, arguing, or defiance—is one of the most challenging behavioral conditions families and clinicians face. 

A new study involving 2,400 children ages 3–17 offers one of the clearest pictures yet. Using parent-reported data from the Pediatric Behavior Scale, researchers compared how often ODD appears in Autism spectrum disorder (ASD), ADHD-Combined presentation (ADHD-C), ADHD-Inattentive presentation (ADHD-I), and those with both ASD and ADHD.

Results

ADHD-Combined + ODD: The Highest-Risk Group

Children with ADHD-Combined presentation show both hyperactivity/impulsivity and inattention.  They had the highest ODD rates of any single diagnosis: 53% of kids with ADHD-Combined met criteria for ODD.

But when autism was added to ADHD-Combined, the prevalence jumped to 62%. This group also had the highest overall ODD scores, suggesting more severe or more impairing symptoms. 

This synergy matters: while autism alone increases ODD risk, the presence of ADHD-Combined is what pushes prevalence into the majority range. Other groups showed lower, but still significant, rates of ODD:

  • Autism + ADHD-Inattentive: 28%
  • Autism Only: 24%
  • ADHD-Inattentive Only: 14%

These findings echo what clinicians often see: children with inattentive ADHD, while struggling significantly with attention and learning, tend to show fewer behavioral conflict patterns than those with hyperactive/impulsive symptoms.

It is important to note that ODD is considered to have two main components. Across all diagnostic groups, ODD consistently broke down into these two components: either Irritable/Angry (emotion-based) or Oppositional/Defiant (behavior-based). But the balance between these components differed depending on diagnosis. Notably, Autism + ADHD-Combined showed higher levels of the irritable/angry component than ADHD-Combined alone. The oppositional/defiant component did not differ much between groups. This suggests that autism elevates the emotional side of ODD more than the behavioral side, which is important for clinicians to note before tailoring interventions.

Understanding ADHD , ASD, & Comorbidity:

The study notes that autism, ADHD, and ODD often cluster together, with 55–90% comorbidity in some combinations.

As the authors explain, The high co-occurrence of ADHD-Combined in autism (80% in our study) largely explains the high prevalence of ODD in autism.” 

Clinical Implications: Why This Study Matters

The researchers point to a straightforward recommendation: clinicians shouldn’t evaluate these conditions in isolation. A child referred for autism concerns might also be struggling with ADHD. A child referred for ADHD might have undiagnosed ODD. And ignoring one disorder can undermine treatment for the others.

Evidence-based interventions (behavioral therapy, parent training, school supports, and/or medication) can reduce symptoms across all three diagnoses while improving long-term outcomes, including overall quality of life.

November 21, 2025

What Sleep Patterns Reveal About Mental Health: A Look at New Research

Background:

Sleep is more than simple rest. When discussing sleep, we tend to focus on the quantity rather than the quality,  how many hours of sleep we get versus the quality or depth of sleep. Duration is an important part of the picture, but understanding the stages of sleep and how certain mental health disorders affect those stages is a crucial part of the discussion. 

Sleep is an active mental process where the brain goes through distinct phases of complex electrical rhythms. These phases can be broken down into non-rapid eye movement (NREM) and rapid eye movement (REM). The non-rapid eye movement phase consists of three stages of the four stages of sleep, referred to as N1, N2(light sleep), and N3(deep sleep). N4 is the REM phase, during which time vivid dreaming typically occurs. 

Two of the most important measurable brain rhythms occur during non-rapid eye movement (NREM) sleep. These electrical rhythms are referred to as slow waves and sleep spindles. Slow waves reflect deep, restorative sleep, while spindles are brief bursts of brain activity that support memory and learning.

The Study: 

A new research review has compiled data on how these sleep oscillations differ across psychiatric conditions. The findings suggest that subtle changes in nightly brain rhythms may hold important clues about a range of disorders, from ADHD to schizophrenia.

The Results:

ADHD: Higher Spindle Activity, Mixed Slow-Wave Findings

People with ADHD showed increased slow-spindle activity, meaning those brief bursts of NREM activity were more frequent or stronger than in people without ADHD. Why this happens isn’t fully understood, but it may reflect differences in how the ADHD brain organizes information during sleep. Evidence for slow-wave abnormalities was mixed, suggesting that deep sleep disruption is not a consistent hallmark of ADHD.

Autism: Inconsistent Patterns, but Some Signs of Lower Sleep Amplitude

Among individuals with autism spectrum disorder (ASD), results were less consistent. However, some studies pointed to lower “spindle chirp” (the subtle shift in spindle frequency over time) and reduced slow-wave amplitude. Lower amplitude suggests that the brain’s deep-sleep signals may be weaker or less synchronized. Researchers are still working to understand how these patterns relate to sensory processing, learning differences, or daytime behavior.

Depression: Lower Slow-Wave and Spindle Measures—Especially With Medication

People with depression tended to show reduced slow-wave activity and fewer or weaker sleep spindles, but this pattern appeared most strongly in patients taking antidepressant medications. Since antidepressants can influence sleep architecture, researchers are careful not to overinterpret the changes.  Nevertheless, these changes raise interesting questions about how both depression and its treatments shape the sleeping brain.

PTSD: Higher Spindle Frequency Tied to Symptoms

In post-traumatic stress disorder (PTSD), the trend moved in the opposite direction. Patients showed higher spindle frequency and activity, and these changes were linked to symptom severity which suggests that the brain may be “overactive” during sleep in ways that relate to hyperarousal or intrusive memories. This strengthens the idea that sleep physiology plays a role in how traumatic memories are processed.

Psychotic Disorders: The Most Consistent Sleep Signature

The clearest and most reliable findings emerged in psychotic disorders, including schizophrenia. Across multiple studies, individuals showed: Lower spindle density (fewer spindles overall), reduced spindle amplitude and duration, correlations with symptom severity, and cognitive deficits.

Lower slow-wave activity also appeared, especially in the early phases of illness. These results echo earlier research suggesting that sleep spindles, which are generated by thalamocortical circuits, might offer a window into the neural disruptions that underlie psychosis.

The Take-Away:

The review concludes with a key message: While sleep disturbances are clearly present across psychiatric conditions, the field needs larger, better-standardized, and more longitudinal studies. With more consistent methods and longer follow-ups, researchers may be able to determine whether these oscillations can serve as reliable biomarkers or future treatment targets.

For now, the take-home message is that the effects of these mental health disorders on sleep are real and measurable.