Correlates of Poor Sleep and Subsequent Risk of Misdiagnosis in College Students Presenting with Cognitive Complaints

Abstract

Objectives: To examine the relationships of poor sleep to both subjective and objective cognitive functioning, attention deficit hyperactivity disorder (ADHD) and sluggish cognitive tempo (SCT) symptoms, and mental health variables in college students, controlling for noncredible symptom reporting and noncredible performance.

Methods: 99 undergraduate students (Mage = 19.9, SD = 1.1), 60% female and 72% first-year students, completed a neuropsychological battery and self-report questionnaires at a single lab visit. 56% of the sample identified as "poor sleepers" (>5 on the Pittsburgh Sleep Quality Index [PSQI]).

Results: Poor sleepers reported worse current (college grade point average [GPA]) but not past (high school GPA, American college test [ACT] score) academic performance. Additionally, they reported more mental health concerns, including depression and stress, but not anxiety. Poor sleepers reported more functional impairment and subjective cognitive concerns, including more Diagnostic and Statistical Manual of Mental Disorders (DSM) inattentive and hyperactive/impulsive symptoms, more SCT symptoms, and more executive dysfunction, even when controlling for depressive symptoms. However, poor sleepers did not differ from good sleepers on measures of objective cognition.

Conclusions: ADHD and SCT symptoms and concerns in college students may be related to poor sleep, which can lead to misdiagnosis for individuals presenting with ADHD-like complaints for the first time in college. Sleep difficulties may be modifiable with empirically supported sleep interventions; thus, in assessment for either of these presentations, a careful sleep history should be taken.

Keywords: Attention deficit hyperactivity disorder; Cognitive; College; Mental health; Sleep; Sluggish cognitive tempo.