Variation in sleep profiles in children with ADHD and associated clinical characteristics

Emma Sciberras; Harriet Hiscock; Samuele Cortese; Stephen P Becker; Julian W Fernando; Melissa Mulraney

doi:10.1111/jcpp.13835

Variation in sleep profiles in children with ADHD and associated clinical characteristics

J Child Psychol Psychiatry. 2023 Oct;64(10):1462-1469. doi: 10.1111/jcpp.13835. Epub 2023 Jun 4.

Authors

Emma Sciberras^{1

2

3}, Harriet Hiscock^{2

3

4}, Samuele Cortese^{5

6

7

8

9}, Stephen P Becker^{10

11}, Julian W Fernando¹, Melissa Mulraney^{2

3}

Affiliations

¹ School of Psychology, Deakin University, Geelong, Vic., Australia.
² Murdoch Children's Research Institute, Parkville, Vic., Australia.
³ Department of Paediatrics, University of Melbourne, Parkville, Vic., Australia.
⁴ The Royal Children's Hospital, Parkville, Vic., Australia.
⁵ Centre for Innovation in Mental Health, School of Psychology, Faculty of Environmental and Life Sciences, University of Southampton, Southampton, UK.
⁶ Clinical and Experimental Sciences (CNS and Psychiatry), Faculty of Medicine, University of Southampton, Southampton, UK.
⁷ Solent NHS Trust, Southampton, UK.
⁸ Hassenfeld Children's Hospital at NYU Langone, New York University Child Study Center, New York, NY, USA.
⁹ Division of Psychiatry and Applied Psychology, School of Medicine, University of Nottingham, Nottingham, UK.
¹⁰ Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.
¹¹ Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA.

Abstract

Background: Sleep difficulties are common in children with attention-deficit/hyperactivity disorder (ADHD). However, sleep problems are multifaceted and little is known about the variation in sleep difficulties across children with ADHD. We examined the profiles of sleep difficulties in children with ADHD and associated clinical factors (e.g. co-occurring mental health conditions, stimulant use and parent mental health).

Methods: Data from two harmonised studies of children with ADHD (total: N = 392, ages 5-13 years) were used. Parents completed measures of children's sleep, co-occurring mental health conditions and their own mental health. Both parents and teachers completed measures of child ADHD symptoms and emotional and conduct symptoms. Latent profile analysis was used to identify sleep profiles, and multinomial logistic regression assessed clinical correlates of the groups.

Results: Five sleep profiles were identified: (a) insomnia/delayed sleep phase (36%), (b) generalised sleep difficulties at sleep onset and overnight (25%), (c) high anxious/bedtime resistance difficulties (11%), (d) overnight sleep difficulties including obstructive sleep apnoea and parasomnias (5%) and (e) no sleep difficulties (22%). Compared with the group without sleep difficulties, the generalised, anxious/bedtime resistance and insomnia/delayed sleep phase sleep had greater parent-reported emotional and conduct symptoms, co-occurring anxiety and increased parent mental health difficulties. The generalised and anxious/bedtime resistance groups also had greater parent-reported ADHD symptoms, with the anxious/bedtime resistance sleep group also having more frequent co-occurring depression and teacher-reported emotional symptoms.

Conclusions: The sleep difficulties experienced by children with ADHD are varied. Supports to help children with ADHD need to consider the particular profiles of sleep difficulties experienced and broader clinical characteristics. Tailored intervention approaches are likely needed (including a need to address parent mental health).

Keywords: Attention-deficit/hyperactivity disorder; bedtime; comorbidity; sleep.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Anxiety / psychology
Attention Deficit Disorder with Hyperactivity* / complications
Child
Humans
Parents / psychology
Sleep
Sleep Initiation and Maintenance Disorders*
Sleep Wake Disorders* / complications