Behavioral sleep problems and internalizing and externalizing comorbidities in children with...

Area of Science:

• Pediatric Psychology
• Child Psychiatry
• Sleep Medicine

Background:

• Behavioral sleep problems are prevalent in children with attention-deficit/hyperactivity disorder (ADHD).
• Internalizing and externalizing comorbidities frequently co-occur with ADHD, but their combined impact on sleep issues is not fully understood.
• Understanding these associations is crucial for informing clinical practice and improving patient outcomes.

Purpose of the Study:

• To investigate the association between sleep problems and the presence of internalizing and externalizing comorbidities in children diagnosed with ADHD.
• To determine if specific comorbidities or their co-occurrence are linked to increased sleep problem severity or specific sleep domains.

Main Methods:

• A cohort of 392 children aged 5-13 years with ADHD was recruited from pediatric practices in Victoria, Australia.
• Comorbidities (none, internalizing, externalizing, co-occurring) were assessed using the Anxiety Disorders Interview Schedule for Children IV/Parent version.
• Sleep problem severity and specific domains (e.g., bedtime resistance, sleep anxiety, onset delay) were evaluated using caregiver reports and the Children's Sleep Habits Questionnaire, with moderate/severe issues confirmed by the International Classification of Sleep Disorders.

Main Results:

• Children with ADHD and co-occurring internalizing and externalizing comorbidities were significantly more likely to experience moderate/severe sleep problems (adjusted OR 2.4) and issues across six of seven assessed sleep domains.
• Children with only internalizing comorbidities reported more sleep anxiety, while those with only externalizing comorbidities showed less night waking.
• Children with a single comorbidity (internalizing or externalizing alone) were not at increased risk for overall moderate/severe sleep problems compared to those without comorbidities.

Conclusions:

• Co-occurring internalizing and externalizing comorbidities in children with ADHD significantly elevate the risk for sleep problems.
• Targeted interventions addressing sleep may be particularly beneficial for ADHD patients with combined internalizing and externalizing conditions.
• Further research should explore the specific mechanisms linking these comorbidities to diverse sleep disturbances in pediatric ADHD.