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Sleep problems in children with attention-deficit/hyperactivity disorder: impact of subtype, comorbidity, and
P Corkum1, H Moldofsky, S Hogg-Johnson
1Ontario Institute for Studies in Education, University of Toronto, Canada.
Insights
Sleep problems in children with attention-deficit/hyperactivity disorder (ADHD) are complex. Findings indicate specific sleep issues are linked to comorbid conditions or stimulant medication, not ADHD itself.
Area of Science:
- Child and Adolescent Psychiatry
- Sleep Medicine
- Neurodevelopmental Disorders
Background:
- Sleep problems are frequently reported in children with attention-deficit/hyperactivity disorder (ADHD).
- The precise nature of the relationship between sleep disturbances and ADHD, including its subtypes and comorbidities, requires further clarification.
Purpose of the Study:
- To investigate the association between sleep problems and attention-deficit/hyperactivity disorder (ADHD).
- To examine how ADHD diagnostic subtypes, comorbid disorders, and stimulant treatment influence sleep difficulties.
Main Methods:
- Children aged 6-12 were categorized into unmedicated ADHD, medicated ADHD, clinical comparison, and healthy comparison groups.
- Parent-completed questionnaires assessed current sleep problems and related factors, including routines, practices, and family sleep history.
Main Results:
- Factor analysis identified three sleep problem categories: dyssomnias, parasomnias, and sleep-related involuntary movements.
- Dyssomnias were linked to confounding factors like oppositional defiant disorder and stimulant medication, not ADHD.
- Parasomnias did not differ between clinical and nonclinical groups.
- The combined subtype of ADHD was associated with sleep-related involuntary movements, which were more strongly linked to separation anxiety.
Conclusions:
- The relationship between sleep problems and ADHD is intricate and influenced by the specific sleep issue.
- Confounding factors, such as comorbid disorders and stimulant medication, play a significant role in sleep disturbances observed in children with ADHD.
Objective:
To determine the relationship of sleep problems to attention-deficit/hyperactivity disorder (ADHD), diagnostic subtype, comorbid disorders, and the effects of stimulant treatment.
Method:
On the basis of clinical diagnostic interviews, children aged 6 to 12 years were assigned to 4 groups: unmedicated ADHD (n = 79), medicated ADHD (n = 22), clinical comparison (n = 35), and healthy nonclinical comparison (n = 36). These groups were compared on 2 sleep questionnaires completed by the parents that assessed current sleep problems and factors associated with sleep difficulties (i.e., sleep routines, sleep practices, child and family sleep history).
Results:
Factor analysis revealed 3 sleep problem categories: dyssomnias, parasomnias, and sleep-related involuntary movements. Linear regression analyses showed that (1) dyssomnias were related to confounding factors (i.e., comorbid oppositional defiant disorder and stimulant medication) rather than ADHD; (2) parasomnias were similar in clinical and nonclinical children; and (3) the DSM-IV combined subtype of ADHD was associated with sleep-related involuntary movements. However, sleep-related involuntary movements were more highly associated with separation anxiety.
Conclusions:
The results suggest that the relationship between sleep problems and ADHD is complex and depends on the type of sleep problem assessed as well as confounding factors such as comorbid clinical disorders and treatment with stimulant medication.