A new review has shed light on why people living with obsessive-compulsive spectrum disorders (OCSDs), chronic tic disorders (CTDs), and attention-deficit/hyperactivity disorder (ADHD) often experience pronounced sleep disturbances—as well as how these intertwined problems could one day be better managed. The research, recently published in the Harvard Review of Psychiatry and summarised by several neuroscience outlets, finds that disruptions in a crucial brain circuit, the cortico-striatal-thalamo-cortical (CSTC) pathway, underpin both the psychiatric symptoms and the insomnia, delayed sleep onset, and other sleep issues reported in these populationsNeuroscience News.
For many Thai families, the burden of neurodevelopmental disorders like OCD, Tourette’s syndrome, and ADHD is compounded by frequent nights of poor sleep, which not only affects the person with the diagnosis but also their parents, siblings, and caregivers. While Thailand has made great strides in public awareness and support for children with these conditions, sleep problems remain a neglected aspect of care—despite their critical impact on functioning, mood, and family wellbeing. This new research offers crucial insights with real-world implications for Thai clinicians, students, educators, and families who are navigating the overlapping challenges of neurodevelopmental and sleep disordersFrontiers in Neurology.
Central to this latest analysis is the role of the CSTC neural circuit, a network that regulates everything from impulse control to movement to the formation of habits. In OCSDs, CTDs, and ADHD—collectively referred to as CSTC-conditions—the circuit is disrupted, due in part to dysregulation of the neurotransmitters dopamine and GABA. The reviewers, led by a researcher from Miami University and colleagues at Massachusetts General Hospital, poured through dozens of studies and found that such dysregulation is “bidirectionally” linked with sleep: poor sleep can aggravate psychiatric symptoms, and vice versaNewswise.
Both children and adults with these diagnoses consistently report symptoms such as insomnia, restless legs, and movement during sleep. Objective studies—though still limited—show delayed sleep onset and disruption in sleep spindles (a specific pattern of brain activity during sleep), essential for memory and brain repairs. Further, movement disorders during sleep, like periodic limb movements or even night-time tics, are especially evident in adults with tics or OCD. In Thai school settings, these symptoms often manifest as sleepiness in class, trouble concentrating, and increased irritability—factors that can be mistaken for academic laziness or behavioral defianceHealthline.
A senior psychiatrist from a leading Thai medical faculty explains: “For many of our students with ADHD or Tourette’s, the struggle isn’t just about paying attention or controlling movements—sleep is a constant battle. These findings help us understand there’s a shared biological basis, not a simple lifestyle issue or parental discipline problem.”
The review also highlights a dilemma in treatment, especially with children. While medications such as selective serotonin reuptake inhibitors (SSRIs) remain a frontline option for OCD and related conditions, they are also known to alter sleep architecture by delaying or reducing REM sleep—the phase crucial for emotional processing and learning. For Thai clinicians, this means balancing the benefits of symptom control against the long-term risks of chronic poor sleep. “We must choose medications and therapies that relieve core symptoms without worsening sleep. Sometimes, this means individualised medication titration, cognitive-behavioral therapy for insomnia, or even school-based interventions that accommodate daytime sleepiness,” commented a clinical psychologist from a major university hospital.
The research urges clinicians to consider three parallel approaches: treating the core CSTC disorder, directly addressing sleep problems, or pursuing both together. Thai guidelines for ADHD, OCD, and tic disorder treatment increasingly emphasize a multidisciplinary, individualized care model—a trend supported by this new evidence. Moreover, partnering with educators to create flexible school schedules or offer nap periods for children with severe sleep disruption is gaining traction, especially in progressive Bangkok and Chiang Mai schools.
Thai health policies have, in the past, tended to focus on awareness and destigmatisation of neurodevelopmental conditions, as seen in national campaigns and revised diagnostic guidelines from the Ministry of Public Health. This new research calls for updated screening in child psychiatric clinics to include regular assessment of sleep quality, as untreated sleep disturbances can lead to further structural changes in the fronto-striatal circuitry—possibly worsening long-term outcomes if not addressed earlyJournal of Science and Medicine.
Historical and cultural factors also play a role in shaping the Thai response to CSTC-conditions and sleep problems. Traditional beliefs may sometimes conflate neurodevelopmental symptoms with spiritual or behavioral causes, leading to delays in seeking medical care. Yet, recent years have seen a cultural shift, with growing acceptance of psychiatric explanations and scientific interventions. Influential Buddhist mental health advocates have also helped reduce stigma and promote mind–body approaches—including mindfulness and sleep hygiene—complementing biomedical strategies.
Looking ahead, the review’s authors and Thai mental health professionals alike stress the importance of more polysomnographic and neuroimaging studies among Thai children and adults. Local researchers are encouraged to investigate how CSTC-dysfunction-driven sleep problems might interact with unique Thai social, dietary, and environmental factors—like screen time before bed, high academic pressure, and communal sleeping arrangements common in smaller homes or rural areas. Emerging treatments, including digital sleep interventions and culturally tailored cognitive-behavioral therapies, offer hope for the future.
For Thai readers and caregivers, the practical messages are clear: Sleep problems are not “just a side effect” of OCD, ADHD, or tics—they are deeply intertwined with brain circuits that shape both symptoms and quality of life. Thai parents and educators should monitor sleep closely in children with these diagnoses, seek professional advice if persistent issues arise, and work collaboratively with healthcare providers to find individualized solutions. Attention to sleep hygiene, smart medication management, and flexibility in school expectations can set Thai youth with CSTC-conditions on a more successful path—both during the day and at night.
For those seeking further information, the original summary of the review can be found at Neuroscience News, with supporting research at Newswise and discussions of comorbidity and treatment challenges at Healthline and Frontiers in Neurology.