Sleep disturbances are bidirectionally associated with Child Behavior Checklist (CBCL) attention-deficit/hyperactivity disorder (ADHD) symptoms, according to study findings presented at the 2022 Annual Meeting of the American Academy of Sleep Medicine and the Sleep Research Society, held from June 4 to 8, 2022, in Charlotte, North Carolina.

The correlation between sleep problems and ADHD may begin when children are toddlers. Sleep-focused interventions in those early years may lead to better outcomes for ADHD. Prior studies have been cross-sectional with small, clinically referred samples, and long-term associations between sleep and ADHD symptoms are unknown. In this study, researchers analyzed concurrent and longitudinal associations of sleep problems and ADHD symptoms in pediatric patients who had not been clinically referred.

The researchers recruited pediatric patients from an academic medical center’s primary care clinics. The patients were assessed at T1 (n=1806 aged mean 20 months) and T2 (n=646 aged mean 37 months). Caregivers reported children’s sleep problems and ADHD symptoms through completing the CBCL Sleep and DSM-Oriented ADHD scales. They completed the ADHD Rating Scale (ADHD-RS) with inattention and hyperactive/impulsive subscales at T2. The researchers analyzed stability and associations between sleep and ADHD.


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Sleep problems were associated with raised CBCL ADHD at both time points (T1 r=.40 P <.001 T2 r=.49 P <.001). Increased sleep problems at T2 were associated with raised ADHD-RS scores (r=.44 P <.001), inattention (n=.41), and hyperactivity/impulsivity (r=.43). The investigators found that sleep problems and CBCL ADHD were moderately stable throughout the study.

When the researchers controlled for T1 ADHD, they found that partial correlations showed that T1 sleep was associated with T2 ADHD (r=.11 P <.01). Controlling for T1 sleep problems showed T1 ADHD association with T2 sleep problems (r=.17 P <.001).

“[These results] are consistent with conceptualization of ADHD as a 24-hour disorder and suggest that incorporating behavioral sleep techniques into empirically-based ADHD treatments may improve clinical outcomes for young children displaying ADHD symptoms,” the researchers said.

Reference

Davis N, Lunsford-Avery J, Compton S. Dawson, G. Associations between sleep problems and ADHD symptoms in early childhood: a longitudinal primary-care based study. Presented at SLEEP 2022; June 4-8; Charlotte, North Carolina. Abstract 497.