Relationship Between Sleep Problems and Quality of Life in Children With ADHD

Sex Differences in Children with Uncomplicated Attention Deficit/Hyperactivity Disorder and Sleep Problems

BACKGROUND

Approximately 7.6% of children are diagnosed with attention deficit/hyperactivity disorder (ADHD), and sleep impairments affect 25-85%. There is a noticeable lack of research on girls and sex differences. The aim of this study was to examine sex differences in children with uncomplicated ADHD and sleep problems.

METHODS

Cross-sectional baseline data were retrieved from a randomized controlled trial with weighted blankets (55 boys and 41 girls, 6-14 years) on a cohort recently diagnosed with uncomplicated ADHD and sleep problems. Differences between boys and girls in ADHD symptoms, objectively and subjectively measured sleep, anxiety, and functioning were examined via parent- or self-reported validated instruments.

RESULTS

Girls reported significantly lower (worse) satisfaction with well-being, life overall, and school, but not for family. Parents reported more sleep anxiety and night-time wakings among boys, but no sex differences in other measures and also not in self-reported measures or objective sleep measures. Children who reported worry, sadness, or unhappiness had more sleep problems.

CONCLUSIONS

Boys with ADHD and sleep problems may need support with sleep-related anxiety and night-time wakings, while girls may require support with overall functioning. Additionally, children who express feelings of worry, sadness, or unhappiness alongside their ADHD symptoms should have attention given to their sleep.

Analyzing the Quality of Life in Individuals with Fragile X Syndrome in Relation to Sleep and Mental Health

The purpose of this paper was to examine the physical, emotional, social and school functioning domains of quality of life of individuals with Fragile X Syndrome, in relation to mental health and sleep patterns to gain a better understanding of how these aspects are affected by the disorder. This study included 119 individuals with Fragile X Syndrome who were given different cognitive examinations by a neuropsychologist or by parent-proxy questionnaires. This study focused on the Pediatric Quality of Life Inventory (PedsQoL), the Anxiety, Depression and Mood Scale (ADAMS), the Children's Sleep Habits Questionnaire (CSHQ), but did include other cognitive tests (Vineland Adaptive Behaviour Scales, Nonverbal IQ, Autism Diagnostic Observation Schedule). We identified significant associations between decreases in emotional, social and school domains of PedsQoL and the ADAMS subtests of Generalized Anxiety, Manic/Hyperactivity and Obsessive/Compulsivity, with the subtest of Depressed Mood having associations with lower physical and emotional domains. We also identified a significant impact between CSHQ subtests of Sleep Anxiety, Night Wakings, Daytime Sleepiness, and Parasomnia with the emotional and school domains of PedsQoL. There were associations connecting school functioning with Bedtime Resistance, and additional associations connecting emotional functioning with Sleep Duration and Sleep Onset Delay. Physical functioning was also associated with Sleep Anxiety. Our study shows how mental health and sleep defects impact improper sleep patterns and mental health which leads to decreases in the quality of life for individuals with FXS, and how it is important to screen for these symptoms in order to alleviate issues.

ADHD Symptoms and Sleep Problems During Middle Childhood: The Indirect Effect of Peer Victimization

The present cross-sectional study evaluated whether traditional and/or cyber peer victimization served as mechanisms linking ADHD symptoms to sleep disturbance and sleep impairment in a sample of 284 third- through fifth-grade students (51.9% boys; 50.4% Hispanic/Latine) from two elementary schools in the United States. ADHD symptoms were assessed using teacher ratings. Children provided reports of their traditional and cyber victimization as well as their sleep disturbance and impairment. Results from path analysis models revealed significant indirect effects of traditional victimization on the links from ADHD symptoms to sleep disturbance and impairment. There was also a significant indirect effect of cyber victimization on the link from ADHD symptoms to sleep impairment. These findings suggest that experiences of traditional and cyber peer victimization may need to be addressed among children exhibiting ADHD symptoms in order to mitigate their risk for sleep problems and downstream effects on other domains of psychosocial functioning.

Sleep problems in children with autism spectrum disorder and attention-deficit/hyperactivity disorder: A comparative study and effects on communication skills

Sleep disturbances are highly prevalent among children with neurodevelopmental disorders, like Autism Spectrum Disorder (ASD) and Attention-Deficit/Hiperactivity Disorder (ADHD). The first objective of this study is to examine the differences in sleep problems between a group of children with ASD without intellectual disabilities, a group with ADHD and a typically developing (TD) group. A second objective is aimed at analyzing the effects of sleep problems and symptom severity on their communication skills. Participants were 122 children between 7 and 12 years old distributed in three groups: 32 TD children, 47 children with ASD and 43 children with ADHD, matched on age and intelligence. Parents completed different questionnaires that measured sleep disturbances and communication skills. Findings show significant differences between the clinical groups and the TD group in most types of sleep disorders. Moreover, the group with ADHD showed significantly more sleep breathing disorders and hyperhidrosis in comparison with ASD and TD, as well as more total sleep problems. In contrast to ASD, the predictive power of sleep problems on communication difficulties was greater in the group with ADHD. The results of the mediation analysis indicate that in both groups, sleep problems partially mediate the relationship between symptoms and communication. This investigation highlights the need of considering sleep disorders when assessing communication skills in ASD and ADHD, given its indirect influence in this domain. Understanding the sleep dysfunctions of both conditions and their repercussions is crucial to develop adjusted interventions.

Randomised controlled trial of the effects of kefir on behaviour, sleep and the microbiome in children with ADHD: a study protocol

INTRODUCTION

Current interventions for children with attention-deficit/hyperactivity disorder (ADHD) are primarily medication, behavioural therapy and parent training. However, research suggests dietary manipulations may provide therapeutic benefit for some. There is accumulating evidence that the gut microbiome may be atypical in ADHD, and therefore, manipulating gut bacteria in such individuals may help alleviate some of the symptoms of this condition. The aim of this study is to explore the effects of supplementation with kefir (a fermented dairy drink) on ADHD symptomatology, sleep, attention and the gut microbiome in children diagnosed with ADHD.

METHODS AND ANALYSIS

A 6-week randomised, double-blind, placebo-controlled trial in 70 children aged 8-13 years diagnosed with ADHD. Participants will be recruited throughout the UK, through support groups, community groups, schools, social media and word of mouth. Children will be randomised to consume daily either dairy kefir or a placebo dairy drink for 6 weeks. The primary outcome, ADHD symptomatology, will be measured by The Strengths and Weakness of ADHD-symptoms and Normal-behaviour scale. Secondary outcomes will include gut microbiota composition (using shotgun metagenomic microbiome sequencing), gut symptomatology (The Gastrointestinal Severity Index questionnaire), sleep (using 7-day actigraphy recordings, The Child's Sleep Habits Questionnaire and Sleep Self Report questionnaire), inattention and impulsivity (with a computerised Go/NoGo test). Assessments will be conducted prior to the intervention and at the end of the intervention. Interaction between time (preintervention/postintervention) and group (probiotic/placebo) is to be analysed using a Mixed Model Analysis of Variances.

ETHICS AND DISSEMINATION

Ethical approval for the study was granted by St Mary's University Ethics Committee. Results will be disseminated through peer-reviewed publications, presentations to the scientific community and support groups.

TRIAL REGISTRATION NUMBER

NCT05155696.

The effectiveness of weighted blankets on sleep and everyday activities - A retrospective follow-up study of children and adults with attention deficit hyperactivity disorder and/or autism spectrum disorder

BACKGROUND

Attention deficit hyperactivity disorder (ADHD) and Autism Spectrum Disorder (ASD) are often accompanied by sleep problems influencing social, emotional and cognitive functioning in everyday activities.

AIM

The aim of this study was to investigate whether the use of a weighted blanket has a positive impact on sleep and everyday activities in individuals with ADHD and/or ASD.

MATERIAL AND METHODS

The study included 85 individuals diagnosed with ADHD and/or ASD, 48 children aged ≤17 (57%) and 37 adults ≥18 years (44%), who were prescribed with a weighted blanket. The participants responded via a telephone interview.

RESULTS

Findings demonstrated that a weighted blanket improved abilities related to falling asleep, sleeping the whole night, and relaxing during the day. Using a weighted blanket improved morning/evening daily routine, including preparing/going to sleep and waking up in the morning.

CONCLUSIONS

Weighted blankets showed positive impact on falling asleep, sleeping the whole night, and relaxing during the day, and they were used frequently by children and adults with ADHD and/or ASD. Findings indicate that a weighted blanket improved morning/evening routine, however this research area needs further investigation using both subjective and objective parameters.

In-person versus online delivery of a behavioral sleep intervention (Sleeping Sound©) for children with ADHD: protocol for a parallel-group, non-inferiority, randomized controlled trial

BACKGROUND

Children with Attention-Deficit/Hyperactivity Disorder (ADHD) often experience sleep difficulties such as difficulty initiating and maintaining sleep. Problem sleep may impact children's daily functioning and behaviors and exacerbate ADHD symptoms. Most effective behavioral interventions to improve sleep are conducted in person, limiting accessibility to treatment for individuals in remote or rural communities or those who are unable to attend a clinic. This trial aims to assess the efficacy of delivering an established behavioral intervention online, Sleeping Sound with ADHD©, compared to a face-to-face delivery mode.

METHODS

This parallel group, non-inferiority, randomized controlled trial (RCT) will include at least 68 children, aged 5-12 years old with ADHD. Families of children will be recruited from private developmental and psychological clinics and social media, within the state of Western Australia (WA). Once written informed consent and baseline questionnaires are completed, families are randomized to receive the behavioral intervention either in-person or online via Telehealth services. The intervention targets the assessment and management of reported sleep problems, through two individual consultations and a follow-up phone call with a trained clinician. The sleep outcomes assessed consist of a parent-reported sleep questionnaire and actigraphy.

DISCUSSION

To the best of our knowledge, this is the first RCT to investigate sleep treatment modality for children with ADHD. If effective, clinicians can provide an evidence-based sleep intervention in an accessible manner.

TRIAL REGISTRATION

ANZCTR, ACTRN12621001681842 . Registered 9 December 2021-Retrospectively registered.

Sleep problems in children and adolescents in an attention deficit hyperactivity disorder service

OBJECTIVES

Sleep problems are common amongst children and adolescents with attention deficit hyperactivity disorder (ADHD). The purpose of this study was to investigate sleep problems in children and adolescents attending a specialist ADHD service.

METHODS

This was a cross-sectional online survey combined with a retrospective chart review, conducted in the ADHD Assessment, Diagnosis, Management, initiation, Research and Education (ADMiRE) service, the first public specialist ADHD service for young people in Ireland. Participants were caregivers of children and adolescents with ADHD attending ADMiRE. Sleep was assessed using The Children's Sleep Habits Questionnaire (CSHQ) and ADHD symptoms were assessed using an abbreviated version of the Swanson, Nolan and Pelham Teacher and Parent Rating Scale (SNAP-IV). Details regarding patient demographics, co-morbidities and medication were collected from patient records.

RESULTS

Eighty-four percent of young people scored above the clinical cut-off for a sleep disorder. The most frequently reported sleep problems were related to sleep onset and sleep duration, and 64% of respondents met the criteria for two or more sleep problems. ADHD severity was associated with greater sleep problems. Co-morbid physical, neurodevelopmental, and mental health disorders as well as stimulant use were not associated with greater sleep problems.

CONCLUSION

Sleep problems are very common amongst children and adolescents with ADHD. This study has demonstrated an association between more sleep problems and ADHD severity. These findings highlight the need for both effective ADHD treatment to ensure optional sleep in young people as well as effective interventions for sleep problems to prevent worsening of ADHD symptoms.

The role of inflammation in the prospective associations between early childhood sleep problems and ADHD at 10 years: findings from a UK birth cohort study

BACKGROUND

Several underlying mechanisms potentially account for the link between sleep and attention deficit and hyperactivity disorder (ADHD), including inflammation. However, studies so far have been cross sectional. We investigate (a) the association between early childhood sleep and probable ADHD diagnosis in childhood and (b) whether childhood circulating inflammatory markers mediate these prospective associations.

METHODS

Data from the Avon Longitudinal Study of Parents and Children were available for 7,658 10-year-old children. Parent-reported sleep duration, night awakening frequency and regular sleep routines were collected at 3.5 years. The Development and Wellbeing Assessment was administered to capture children with clinically relevant ADHD symptoms, or probable ADHD diagnosis. Blood samples were collected at 9 years, from which two inflammatory markers were obtained [interleukin-6 (IL-6) and C-reactive protein (CRP)]. Logistic regression analyses were applied to investigate the associations between sleep variables at 3.5 years and probable ADHD diagnosis at 10 years. Further, path analysis was applied to examine the potential mediating role of inflammation at 9 years (as measured by CRP and IL-6) in the associations between early sleep and ADHD at 10 years.

RESULTS

Less regular sleep routines (OR = 0.51, 95% CI = 0.28-0.93, p = .029), shorter nighttime sleep (OR = 0.70, 95% CI = 0.56-0.89, p = .004) and higher night awakening frequency (OR = 1.27, 95% CI = 1.06-1.52, p = .009) at 3.5 years were associated with higher odds of ADHD at 10 years. Further, IL-6 at 9 years, but not CRP, mediated the association between irregular sleep routines and ADHD (bias-corrected estimate, -0.002; p = .005) and between night awakening and ADHD (bias-corrected estimate, 0.002; p = .003).

CONCLUSIONS

Several sleep problems in early childhood constitute a risk factor for probable ADHD diagnosis at 10 years. Further, these associations are partially mediated by IL-6 at 9 years. These results open a new research vista to the pathophysiology of ADHD and highlight sleep and inflammation as potential preventative targets for ADHD.

Exploring the Longitudinal Relationship Between Short Sleep Duration, Temperament and Attention Deficit Hyperactivity Disorder Symptoms in a Biethnic Population of Children Aged Between 6 and 61 Months: A Born in Bradford Study

OBJECTIVE

Examine the association between sleep duration, temperament and symptoms of Attention Deficit Hyperactivity Disorder (ADHD) in a biethnic child-population from The Born in Bradford cohort.

METHOD

Parent-report sleep duration categorized children as: early short, late short, consistently short or consistently normal sleepers between 6 and 36 months. Temperament was measured using the Infant Characteristics Questionnaire at 6 months. The Strengths and Difficulties Questionnaire assessed symptoms of ADHD at 37, 54, and 61 months.

RESULTS

Normal sleepers before 18 months had significantly fewer ADHD symptoms at 37 months compared with consistently short sleepers. Fussiness at 6 months was significantly positively associated with ADHD symptoms at 37 and 54 months; but does not appear to mediate the relationship between sleep duration and ADHD symptoms.

CONCLUSION

Awareness of the relationship between short sleep duration and fussiness in infancy and later ADHD symptomatology may support earlier identification of arising difficulties in children.

The Impact of Childhood Attention-Deficit/Hyperactivity Disorder (ADHD) on Children's Health-Related Quality of Life: A Systematic Review and Meta-Analysis

OBJECTIVE

To investigate the association between children's health-related quality of life (HRQoL) and childhood attention-deficit/hyperactivity disorder (ADHD).

METHOD

Databases were systematically searched for peer-reviewed literature published between 2010 and 2022. Two reviewers independently screened and assessed the quality of included studies. Meta-analysis was conducted for studies that used the Pediatric Quality of Life Inventory (PedsQL).

RESULTS

Twenty-three studies were included, with most rated as "good" quality. Meta-analysis found "very large" effect in both parent- (Hedges' g -1.67, 95% CI [-2.57, -0.78]) and child-reported (Hedges' g -1.28, 95% CI [-2.01, -0.56]) HRQoL for children with ADHD compared to children without ADHD. No difference between parent- and child-reported HRQoL in children with and without ADHD was found. However, parent-reported HRQoL was lower than child-reported HRQoL among children with ADHD.

CONCLUSION

ADHD was associated with substantially poorer children's HRQoL. Among children with ADHD, parents rated their children's HRQoL lower than the children themselves.

Behavioral Sleep Interventions for Children With ADHD: A Systematic Review and Meta-Analysis

OBJECTIVE

To evaluate intervention characteristics and components within behavioral sleep interventions in school-aged children with ADHD and examine evidence related to effectiveness.

METHOD

A systematic review was conducted using PsycINFO, Embase, MEDLINE, PubMed, and OpenGray. The subsequent meta-analysis used sleep outcomes to produce comparable effect sizes (Hedges' g) and compare intervention effects between randomized controlled trials and pre-post studies.

RESULTS

Eleven articles satisfied the inclusion criteria (562 children, across all groups, aged 5-14 years, M = 8.71). Studies reported improvements in sleep although there was marked heterogeneity between studies and limited use of objective sleep measures within them. On average, intervention groups improved more than control groups in the five randomized controlled trials (-0.46, 95% CI = [-0.58, -0.35], k = 4).

CONCLUSION

The findings support the use of behavioral sleep interventions for school-aged children with ADHD. Findings suggest that brief, individualized intervention may be more effective than standardized.

A Cross-Sectional Comparative Study of Sleep Disturbances in Children with ADHD and Matched Controls

Background: Systematic reviews conducted on sleep disturbances in attention deficit hyperactivity disorder (ADHD) have found inconsistent results due to the presence of several moderating variables which were not controlled for in previous studies. The aim of this study was to examine sleep disturbances in children with ADHD compared to their typically developing peers after controlling for moderating variables (age, sex, medication status, body mass index, and psychiatric and medical comorbidities). Methods: ADHD was diagnosed using DSM-IV-TR criteria (Diagnostic and Statistical Manual of Mental Disorders) and Conners’ Parent Rating Scales. Children recruited (aged 6−12 years) for the ADHD group (n = 40) met the following criteria: IQ > 80, unmedicated, and no psychiatric or medical comorbidities. The control group consisted of age- and sex-matched typically developing peers (n = 40). Sleep was assessed subjectively (through parent reported questionnaires and sleep logs) and objectively (using video polysomnography). Results: 65% of children with ADHD had a sleep disorder, as compared to 17% of controls. The ADHD group reported more sleep disturbances and disorders, both on subjective measures and objective measures. Conclusions: Sleep disturbances and primary sleep disorders in children with ADHD exist independent of moderating variables and differences in sleep assessment methods, thereby bolstering support for previously documented literature on the ADHD and sleep connection.

Meeting the 24-Hour Movement Guidelines and Outcomes in Adolescents with ADHD: A Cross-Sectional Observational Study

According to the 24-Hour Movement Guidelines, meeting daily recommendations for physical activity, sleep, and screen time is important for obtaining optimal health benefits. This cross-sectional observational study aimed to examine (a) the prevalence of meeting the movement guidelines; and (b) the associations between meeting the guidelines and selected outcomes in adolescents with attention-deficit/hyperactivity disorder (ADHD). Data from the 2018–2019 National Survey for Children’s Health dataset was used. Participants were adolescents (10–17 years) with ADHD and without other chronic conditions. Outcomes were flourishing, school engagement, and body weight status. Exposures of interest were adherence to the movement guidelines. The frequency of the participants’ adherence to the guidelines was estimated, and regression analyses were conducted to examine the associations between adherence to the guidelines and outcomes, adjusting for potential confounders. Complete observations were available for 634 adolescents with ADHD. Overall, 46.8% of the participants met at least one movement guideline, but only 6.5% met all three. The number of guidelines met had a significant and positive association with flourishing and school engagement (β = 0.21/0.17, p_trend < 0.001). Compared with meeting all three guidelines, significant associations with lower flourishing levels were found in participants who met none, sleep only, and sedentary time only (β = −0.38–−0.13, p < 0.05). Similar findings were identified in the school engagement outcome. Adherence to the guidelines was, however, not significantly associated with the odds of being overweight or obese. Collectively, the findings suggest the movement guidelines may be appropriate for extending to adolescents with ADHD and there is a need to increase adherence to the guidelines in this group.

A Systematic Review of Sleep and Circadian Rhythms in Children with Attention Deficit Hyperactivity Disorder

OBJECTIVE

Children and adults with ADHD often report sleep disturbances that may form part of the etiology and/or symptomatology of ADHD. We review the evidence for sleep changes in children with ADHD.

METHODS

Systematic review with narrative synthesis assessing sleep and circadian function in children aged 5 to 13 years old with a diagnosis of ADHD.

RESULTS

148 studies were included for review, incorporating data from 42,353 children. We found that sleep disturbances in ADHD are common and that they may worsen behavioral outcomes; moreover, sleep interventions may improve ADHD symptoms, and pharmacotherapy for ADHD may impact sleep.

CONCLUSION

Sleep disturbance may represent a clinically important feature of ADHD in children, which might be therapeutically targeted in a useful way. There are a number of important gaps in the literature. We set out a manifesto for future research in the area of sleep, circadian rhythms, and ADHD.

Risk and protective factors related to children's symptoms of emotional difficulties and hyperactivity/inattention during the COVID-19-related lockdown in France: results from a community sample

OBJECTIVE

The COVID-19 epidemic has spread worldwide since December 2019. To contain it, preventive measures including social distancing, economic shutdown, and school closures were introduced, carrying the risk of mental health burden in adults and children. Although the knowledge base regarding children's response to trauma and adverse events in general has broadened, descriptions of their mental health during epidemics remain scarce. In particular, the role of family socioeconomic characteristics and parental mental health are poorly understood.

METHODS

We assessed the correlates of children's emotional difficulties and symptoms of hyperactivity/inattention during the COVID-19 lockdown in a French community-based sample. Data came from 432 community-based parents (27-46 years, TEMPO cohort) and their children (mean age 6.8 ± 4.1) interviewed online. Children's symptoms of emotional difficulties and hyperactivity/inattention were assessed using the parent-reported Strengths and Difficulties Questionnaire during the 5th week of home confinement. Family socioeconomic characteristics and parental mental health and substance use were assessed weekly during the first 5 weeks of home confinement. Data were analyzed using logistic regression models.

RESULTS

7.1% of children presented symptoms of emotional difficulties and 24.7% symptoms of hyperactivity/inattention. Family financial difficulties and parental symptoms of anxiety and depression, as well as children's sleeping difficulties and screen time, were associated with the presence of psychological difficulties.

CONCLUSION

Children's emotional and behavioural difficulties are associated with parental mental health and socioeconomic difficulties. In the unprecedented situation of the COVID-19 epidemic, parents and professionals involved in caring for children should pay special attention to their mental health needs.

An Exploration of Sleep and Family Factors in Young Children at Familial Risk for ADHD

Objective: The aim of the current study was to examine relations between sleep problems and family factors and early markers of ADHD in young children with and without a familial risk for ADHD.Methods: Differences in sleep behavior and family functioning in children under 6 years with (n = 72) and without (n = 139) a familial risk for ADHD were investigated. The influence of family and sleep factors on the development of early temperament markers of ADHD (effortful control and negative affect) was explored. Parents/caregivers completed questionnaires on family functioning, child sleep behavior, and general regulatory behaviors.Results: A significant difference was observed between high-risk and low-risk groups for family functioning in the infant/toddler (<3 years) and preschool (>3 years) cohorts. Parents of infants/toddlers in the high-risk group reported poorer infant sleep. However, there were no sleep differences reported for the preschool cohort. Family functioning was found to predict effortful control, while sleep quality predicted negative affect.Conclusion: The results of this study highlight potential family and sleep issues for young children with a familial history of ADHD and the potential influence of these factors on early temperament markers of ADHD. Future research should explore these relations further in order to better establish whether early sleep and family interventions could mitigate later ADHD symptomatology.

Shorter rapid eye movement sleep duration in children with attention-deficit /hyperactivity disorder: the impact on quality of life

OBJECTIVES

The relationship of sleep with attention deficit hyperactivity disorder (ADHD) remains complex and unclear. The current study aimed to compare the subjective and objective sleep parameters among children with and without ADHD. Moreover, to address the effect of sleep parameters on the quality of life (QoL).

METHODS

We assessed 42 participants who were children with ADHD (aged 6-12 years), with predominant combined presentation (23), compared to 42 healthy children, who underwent a sleep study assessment subjectively (the Children's Sleep Habits Questionnaire), and objectively (one-night Polysomnographic recording). Also, parents completed the pediatric quality of life inventory (PedsQL-P).

RESULTS

Children with ADHD had more subjective sleep problems. ADHD patients also had a significant decrease in total sleep time and sleep efficiency, spending more time in wake and N1 sleep stages. Moreover, they had significantly lower rapid eye movement (REM)sleep duration and less duration of deep sleep stages. Multivariate regression analysis showed that REM sleep duration was the most contributing and predictive factor to QoL and school function impairment.

CONCLUSION

Children with ADHD have a significantly lower sleep quantity and poor sleep quality. In addition, short REM sleep duration independently contributes to further deterioration in different areas of QoL.

Evaluating the Feasibility and Acceptability of the Lifestyle Enhancement for ADHD Program

OBJECTIVE

To evaluate the feasibility and acceptability of the Lifestyle Enhancement for Attention Deficit Hyperactivity Disorder (ADHD) Program (LEAP), a novel parent behavior management training program that promotes physical activity (PA) and positive health behaviors and is enhanced with mobile health technology (Garmin) and a social media (Facebook) curriculum for parents of children with ADHD.

METHODS

The study included parents of children ages 5-10 years diagnosed with ADHD who did not engage in the recommended >60 min/day of moderate to vigorous PA based on parent report at baseline. Parents participated in the 8-week LEAP group and joined a private Facebook group. Children and one parent wore wrist-worn Garmin activity trackers daily. Parents completed the Treatment Adherence Inventory, Client Satisfaction Questionnaire, and participated in a structured focus group about their experiences with various aspects of the program.

RESULTS

Of 31 children enrolled, 51.5% had ADHD combined presentation, 36.3% with ADHD, predominately inattentive presentation, and 12.1% had unspecified ADHD (age 5-10; M = 7.6; 48.4% female). Parents attended an average of 86% of group sessions. On average, parents wore their Garmins for 5.1 days/week (average step count 7,092 steps/day) and children for 6.0 days/week (average step count 9,823 steps/day). Overall, parents and children were adherent to intervention components and acceptability of the program was high.

CONCLUSIONS

Findings indicate that the LEAP program is an acceptable and feasible intervention model for promoting PA among parents and their children with ADHD. Implications for improving ADHD symptoms and enhancing evidence-based parent training programs are discussed.

Association between sensory modulation and sleep difficulties in children with Attention Deficit Hyperactivity Disorder (ADHD)

BACKGROUND

Sleep difficulties have been reported in up to 85% of children with Attention Deficit hyperactivity disorder (ADHD). Children with ADHD exhibit commonly sensory modulation difficulties (SMD) and experience more significant functional difficulties. Sleep difficulties have also been associated with SMD. The aim of this study was to evaluate whether SMD are associated with sleep difficulties in children with ADHD.

METHODS

We assessed sleep difficulties using the Children's Sleep Habits Questionnaire, and SMD using the Short Sensory Profile (SSP) questionnaire. A total of 25 children with ADHD and atypical sensory profiles, 13 children with ADHD and typical sensory profiles and 38 children used as controls (all children aged 8-11 years) were included.

RESULTS

Sleep difficulties were detected in 86.4% of children with ADHD and atypical SSPs, as compared to 30.8% of children with ADHD and typical SSPs, and 16.7% of controls. A multivariate logistic regression revealed that children with ADHD and atypical SSPs had significantly increased odds for sleep difficulties as compared to controls (OR = 32.4; 95% CI 4.0-260.1, p = 0.001), while children with ADHD and typical SSPs were indistinguishable from controls. Suspected confounders (gender, age, mother's education, and stimulant therapy) did not contribute to sleep difficulties.

CONCLUSION

In this pilot study, SMD were associated with sleep difficulties in children with ADHD.

Sleep habits of children diagnosed with attention/ deficit/ hyperactivity disorder and effects of treatment on sleep related parameters

This study aimed to evaluate the baseline sleep habits of children with ADHD and the effects of treatment with methylphenidate (MPH) and atomoxetine (ATX) on sleep parameters. Treatment naive children with clinically normal intelligence diagnosed with ADHD were enrolled in the study. Children were treated naturalistically with MPH and ATX. Treatments were started at 0.5 mg/ kg/ day and titrated weekly to a maximum of 1.2 mg/ kg/ day. The daily equivalent dose was calculated according to clinician toolkits of Utah Academy of Child and Adolescent Psychiatry. DSM-IV Based Screening and Assessment Scale for Disruptive Behavior Disorders- Parent form (DBSASDBD) and Clinical Global Impression Scale were used to assess ADHD symptoms and Children's Sleep Habits Questionnaire (CSHQ)- Short Form was used to assess the sleep habits and problems before and after the treatment. Both MPH and ATX reduced symptom severity of ADHD in all domains and also reduced total CSHQ scores with similar effect sizes. (0.7 for MPH vs. 0.8 for ATX). The rate of clinically significant sleep problems at baseline was 93.5 %. At the end-point, 83.9 % of the sample still displayed clinically significant sleep problems while none of the children were judged to have moderate-severe sleep problems. Our results suggest that both ATX and MPH may selectively improve different sleep domains in children with ADHD. Studies using standardized dosing schemes for longer durations and evaluating sleep with objective measurements may clarify the differential effects of treatments on sleep among children with ADHD.

Moderate-to-vigorous physical activity and behavioral outcomes in adolescents with attention deficit and hyperactivity disorder: The role of sleep

BACKGROUND

Attention deficit and hyperactivity disorder (ADHD) is a neurodevelopmental disorder that has a worldwide prevalence of 7.2%. Individuals with ADHD often have sleep and behavioral problems.

OBJECTIVE

This cross-sectional survey aims to investigate the relationships between moderate-to-vigorous physical activity (MVPA), sleep, bullying, and school engagement in adolescents with ADHD.

METHODS

Data were obtained from the 2011-2012 National Survey of Children's Health. A subsample (n = 272) that fit the inclusion criteria was included. Path analysis was used to test the hypothesized model (i.e., MVPA → sleep → bullying/school engagement).

RESULTS

The proposed model fit the data well. MVPA was found to be associated with sleep, bullying, and school engagement. In addition, sleep mediated the relationship between MVPA and bullying/school engagement.

CONCLUSIONS

MVPA and sleep play an important role in understanding behavioral outcomes in adolescents with ADHD. Longitudinal or intervention studies are needed to support the present findings.

Do motor coordination and sleep difficulties predict peer functioning in children and adolescents with attention-deficit and hyperactivity disorder after accounting for existing ADHD symptomology?

Children with attention-deficit and hyperactivity disorder (ADHD) are more likely to experience peer problems compared to their non-ADHD peers, though ADHD-specific symptoms only partially explain this association. This study examined whether sleep difficulties and motor coordination problems are additional predictors of peer problems in an ADHD population. An ADHD sample of 72 participants aged 6-14 years (M = 9.86 years, SD = 1.79 years) was evaluated for an association of peer problems with measures of motor coordination, sleep difficulties as well as ADHD and comorbidity symptoms. Hierarchical multiple regression analysis (HMRA) was used to test the current study aims. Motor coordination, but not sleep difficulties, predicted additional variance in peer problems after controlling for inattention, hyperactivity/impulsivity, internalizing problems, oppositionality, and conduct problems. Poor motor coordination predicts peer problems beyond ADHD symptoms. Clinicians seeking to improve peer functioning in children with ADHD should also consider motor coordination difficulties in addition to existing treatment strategies. Statement of contribution What is already known Children with attention-deficit and hyperactivity disorder (ADHD) experience greater peer problems (i.e., making friends, being victimized, participating in play) than their typically developing peers. Previous studies have attributed this association between ADHD and peer problems to the symptoms of ADHD (i.e., inattention and/or hyperactivity) disrupting the typical trajectory of social development. However, quantitative studies have identified that symptoms of ADHD predict only portion of the variance in a child's peer problems - highlighting that there may be other unique factors that contribute to the higher incidence of peer problems typically observed in this population. What this study adds This study tested whether additional theoretically relevant factors could predict levels of peer problems in children with ADHD beyond the primary symptoms of the disorder. Internalizing symptomatology, conduct problems, oppositionality, motor coordination, and sleep difficulties were added to a regression model already including inattention and hyperactivity symptoms. These factors explained 51% of the variability in peer problems. In this sample of 72 ADHD children, the results of the final model highlighted that only motor coordination and conduct problems remained significant predictors of peer problems - highlighting two potentially important target areas for screening and intervention.

The Functional Impact of Sleep Disorders in Children With ADHD

Objective: Children with ADHD display higher rates of sleep problems, and both sleep disorders and ADHD have been shown to affect functioning in childhood. The current study examines the frequency and relationship between sleep problems and ADHD, and their impact on quality of life (QoL) and functional impairment. Method: Parents of 192 children with ADHD (M = 10.23 years) completed measures regarding their child's ADHD symptoms (Swanson, Nolan and Pelham [SNAP]), sleep disorders (Pediatric Sleep Questionnaire [PSQ]), QoL (Child Health Illness Profile [CHIP-PE]), and functioning (Weiss Functional Impairment Rating Scale-Parent Report [WFIRS-P]). Results: Common sleep complaints in participants were insomnia, excessive daytime sleepiness (EDS), and variability in sleep schedule. Regression analysis indicated that sleep problems and ADHD symptoms independently predicted lower levels of QoL (ΔR² = .12, p < .001) and social functioning (ΔR² = .12, p < .001). Conclusion: The results suggest that ADHD may coexist with somnolence and that both conditions have a significant impact on a child's functioning and QoL.

Associations Between Disruptive Behavior Problems, Parenting Factors, and Sleep Problems Among Young Children

OBJECTIVE

To examine within an at-risk/clinical sample of preschool-aged children with externalizing problems: (1) which disruptive behavior and attention disorder symptoms (i.e., inattention, hyperactivity/impulsivity, and oppositionality/aggression) and (2) what aspects of parenting (e.g., discipline practices or stress) are related to children's sleep problems (e.g., sleep habit and night waking problems).

METHOD

The sample consisted of 148 children (meanage = 5.06 years, 82% male) with at-risk/clinically elevated levels of externalizing behavior problems and their primary caregiver. As part of a larger study, parents reported on their stress and parenting practices and their children's behavioral and sleep functioning. Positive and negative parenting behaviors ("do" and "don't" skills, respectively) were also observed during a 15-minute parent-child interaction during play.

RESULTS

Oppositionality/aggression was the only disruptive behavior and attention disorder symptom associated with more sleep habit problems. Higher levels of inconsistent discipline and "don't" skills were also associated with more sleep habit problems. Within a combined model, an interaction emerged such that the association between "don't" skills and elevated sleep habit problems was only evident at low levels of inconsistent discipline. In terms of night waking problems, there was only an association with parenting stress, whereas the other parenting factors and disruptive behavior and attention disorder symptoms were unrelated.

CONCLUSION

Although the directionality of our associations cannot be ascertained because of the cross-sectional nature of our study, these findings, nevertheless, highlight the importance of parenting factors (e.g., inconsistent discipline and parenting stress) when considering sleep difficulties in young children with disruptive behavior and attention disorders.

Sleep problems and daytime sleepiness in children with ADHD: Associations with social, emotional, and behavioral functioning at school, a cross-sectional study

Background: Sleep problems and daytime sleepiness are common in children with attention-deficit hyperactivity disorder (ADHD) and are associated with poor parent-reported functional outcomes. However, the potential impact of sleep problems or daytime sleepiness on the school functioning of children with ADHD remains unknown. We aimed to determine if sleep problems and daytime sleepiness were associated with the social, emotional, and behavioral school-based functioning of children with ADHD and comorbid sleep problems. Methods: Children aged 5-13 years with ADHD and a moderate-severe sleep problem (confirmed using American Academy of Sleep Medicine diagnostic criteria) were recruited from 43 pediatric practices across Victoria and Queensland, Australia (N = 257). Parent-rated sleep problems were assessed using the Children's Sleep Habits Questionnaire (CSHQ) and teacher-rated daytime sleepiness using the Teacher's Daytime Sleepiness Questionnaire. Teacher-rated social, emotional, and behavioral school functioning was assessed using three scales (peer problems, emotional problems, and conduct problems) from the Strength and Difficulties Questionnaire. Data was analyzed using Pearson correlations and linear regression models. Results: Teacher-rated daytime sleepiness was associated with higher levels of emotional (β = 0.39; 95% CI = 0.25-0.52) and behavioral problems (β = 0.47; CI = 0.36-0.58) in adjusted models. While total sleep duration and parent-rated sleep problems were not associated with daytime sleepiness or school functioning, the CSHQ subscale night wakings was correlated with teacher-rated daytime sleepiness (r = 0.21; p < 0.01). Conclusions: Daytime sleepiness (possibly as an indicator of sleep quality) may be a better predictor of school functioning in children with ADHD who have concomitant sleep problems than total sleep duration or parent-rated sleep problems.

Sleep Difficulties in Infancy Are Associated with Symptoms of Inattention and Hyperactivity at the Age of 5 Years: A Longitudinal Study

OBJECTIVE

Sleep difficulties are associated with cognitive and behavioral problems in childhood. However, it is still unclear whether early sleep difficulties are related to later development. We studied whether parent-reported sleep duration, night awakenings, and parent-reported sleep problems in early childhood are associated with symptoms of inattention and hyperactivity at the age of 5 years.

METHOD

Our study is based on the Child-Sleep birth cohort initially comprising 1673 families, of which 713 were retained at the age of 5 years. We used the Brief Infant Sleep Questionnaire and the Infant Sleep Questionnaire, which were filled out by the parents when their child was 3, 8, and 24 months and 5 years old. Symptoms of inattention and hyperactivity at the age of 5 years were assessed using the Strengths and Difficulties Questionnaire and the Five-to-Fifteen questionnaire.

RESULTS

Sleep duration at the age of 3, 8, and 24 months was associated with inattentiveness at 5 years of age. Moreover, parent-reported sleep problems at the age of 24 months were related to both inattentive and hyperactive symptoms at the age of 5 years. Finally, at the age of 5 years, parent-reported sleep problems and night awakenings were associated with concurrent symptoms of inattention and hyperactivity.

CONCLUSION

Our findings suggest that certain sleep characteristics related to sleep quality and quantity in early childhood are associated with inattentiveness and hyperactivity at the age of 5 years. Interestingly, sleep duration in early childhood is consistently related to inattention at the age of 5 years.

The impact of comorbid mental health symptoms and sex on sleep functioning in children with ADHD

Children with attention-deficit/hyperactivity disorder (ADHD) display more sleep problems than their peers, but it remains unclear whether comorbid mental health symptoms [i.e., anxiety, depression, oppositional-defiant disorder (ODD)] are uniquely related to sleep functioning. It is also largely unknown whether boys and girls with ADHD differ in their sleep functioning. This study (1) examined whether boys or girls with ADHD differ in their sleep functioning, (2) evaluated comorbid symptoms as uniquely related to sleep functioning domains, and (3) explored whether sex moderated associations between comorbid symptoms and sleep. Participants were 181 children (ages 7-13; 69% male; 82% White) diagnosed with ADHD. Parents completed measures assessing their child's ADHD symptoms, comorbid symptoms, and sleep functioning. Girls had poorer sleep functioning than boys across most sleep functioning domains. Sixty percent of children met cutoff criteria for having sleep problems, though rates differed significantly between girls (75%) and boys (53%). No differences in rates of sleep problems were found between ADHD subtypes/presentations or between younger and older children. In path models including ADHD and comorbid symptom dimensions, anxiety symptoms were uniquely associated with increased bedtime resistance and sleep anxiety, ADHD hyperactive-impulsive symptoms were associated with more night wakings and more parasomnia behaviors, and ODD and depressive symptoms were associated with shorter sleep duration. Depression was also uniquely associated with increased daytime sleepiness and overall sleep problems. Sex did not moderate associations between comorbid symptoms and sleep problems. This study provides important preliminary evidence that girls with ADHD experience more sleep problems than boys with ADHD. Findings also demonstrate that the associations between comorbid symptoms and sleep functioning in children with ADHD vary based on both the specific symptoms and sleep domains examined.

Comorbidity of ADHD and Anxiety Disorders in School-Age Children: Impact on Sleep and Response to a Cognitive-Behavioral Treatment

OBJECTIVE

This exploratory study measured the impact of comorbid anxiety disorders on sleep in children with ADHD and tested the effect of cognitive-behavioral therapy (CBT) on these measures.

METHOD

Fifty-seven children (8-12 years old) were assessed with the Child Sleep Habits Questionnaire. Four groups were formed: ADHD ( n = 20), ADHD + Anxiety ( n = 20), Anxiety ( n = 8), and Healthy Controls ( n = 9). A subgroup of 10 children with ADHD + Anxiety underwent CBT for anxiety.

RESULTS

The results showed that sleep difficulties were better associated with anxiety than with ADHD. CBT reduced sleep onset latency and marginally decreased the total amount of sleep problems.

CONCLUSION

The present study demonstrates that comorbid anxiety in ADHD children is linked with specific sleep disturbances and is sensitive to CBT aimed at reducing anxiety.

Evaluation of the Relationship Between Attention Deficit Hyperactivity Disorder Symptoms and Chronotype

INTRODUCTION

The aim of the study is to investigate the relationship between circadian characteristics and behavioral problems in children with Attention Deficit Hyperactivity Disorder (ADHD) (n=53), and to compare this group with healthy controls (n=38).

METHOD

Fifty-three medication-free children with ADHD, aged 6-12 years, and 38 healthy children, age and sex matched, participated. Parents completed the Conners' Parent Rating Scale-Revised, the Children's Chronotype Questionnaire (CCTQ), and the Children's Sleep Habits Questionnaire (CSHQ) to assess sleep variables.

RESULTS

ADHD children had more sleep-onset problems and parasomnias (in CSHQ) compared to healthy controls. However, circadian preferences did not differ between the groups in CCTQ scores. Another important finding was a mild correlation between parasomnia, bedtime on schooldays, and ADHD symptoms.

CONCLUSION

Our study showed that children with ADHD showed more resistance to going to bed than did controls on school days. However, in contrast to our hypothesis, morningness/eveningness preference did not differ from controls in ADHD children.

Sleep Problems and Daily Functioning in Children With ADHD: An Investigation of the Role of Impairment, ADHD Presentations, and Psychiatric Comorbidity

OBJECTIVE

Little systematic information is available regarding how sleep problems influence daytime functioning in children with ADHD, as the role of ADHD presentations and comorbidity is unclear.

METHOD

In total, 397 children were assessed with the Children's Sleep Habits Questionnaire, the Weiss Functional Impairment Rating Scale, and the ADHD Rating Scale.

RESULTS

We found a moderate, positive correlation between sleep problems and impaired functioning in both children with ADHD and in typically developed children. ADHD presentations did not differ significantly with respect to sleep problem profile, but having a comorbid internalizing or autistic disorder lead to higher sleep problem score.

CONCLUSION

Sleep problems and impaired daily functioning were more common in children with ADHD, but the overall association between sleep problems and impaired daily functioning was similar in clinical and nonclinical children. Internalizing or autistic comorbid disorders added significantly to the sleep problems.

Sleep habits in children with attention-deficit/hyperactivity disorder predominantly inattentive type and associations with comorbid psychopathology symptoms

OBJECTIVES

Much of what is currently known about the sleep functioning of children with attention-deficit/hyperactivity disorder (ADHD) is based on samples of children with ADHD combined type, and no study to date has examined the association between sluggish cognitive tempo (SCT) and sleep functioning in children diagnosed with ADHD. Accordingly, the objectives of this study were to (1) describe the sleep habits of children diagnosed with ADHD predominantly inattentive type (ADHD-I) and (2) examine whether comorbid internalizing, oppositional, and/or SCT symptoms are associated with poorer sleep functioning in children with ADHD-I. This study extends the current literature by using a large, clinical sample of children with ADHD-I to examine the association between SCT and other psychopathology symptoms with children's sleep functioning.

METHODS

Participants included 147 children (age: 6-11, 59% male, 55% White) diagnosed with ADHD-I using a semi-structured diagnostic interview. Parents completed measures assessing their child's sleep habits as well as comorbid anxiety, depression, oppositionality, and SCT symptoms.

RESULTS

Fourteen percent of children with ADHD-I obtain less sleep than recommended and 31% have a sleep onset latency of greater than 20 minutes. The few children taking medication for ADHD had a longer sleep onset latency than those without medication. Twenty-seven percent of parents indicated that it is "difficult" to get their child out of bed on school days and 41% of parents indicated that their child needs to catch-up on sleep on the weekend "at least a little". Regression analyses found anxiety and SCT sleepy/tired symptoms to be the most consistent dimensions of psychopathology associated with sleep functioning, with little support for depression or oppositionality being associated with sleep.

CONCLUSIONS

A sizeable minority of children with ADHD-I experience impaired sleep. In addition to SCT sleepy/tired symptoms, comorbid anxiety was most consistently associated with poorer sleep functioning in children with ADHD-I. SCT daydreaming and working memory symptoms were unassociated with sleep functioning, and the size of the effects between SCT sleepy/tired and sleep functioning indicates that these are not overlapping constructs. Longitudinal studies are needed to evaluate the interrelations of sleep problems and comorbid psychopathology symptoms and their impact on the daytime functioning of children with ADHD-I.