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Sleep Problem Trajectories and Well-Being in Children with Attention-Deficit Hyperactivity Disorder: A Prospective
Kate Lycett1, Emma Sciberras, Harriet Hiscock
1*Murdoch Childrens Research Institute, Parkville, Australia; †Centre for Community Child Health, The Royal Children's Hospital, Parkville, Australia; ‡The University of Melbourne, Parkville, Australia; §Clinical Epidemiology and Biostatistics Unit, Murdoch Childrens Research Institute, The Royal Children's Hospital, Parkville, Australia.
Insights
Sleep problems in children with attention-deficit/hyperactivity disorder (ADHD) are linked to worse well-being. Addressing these sleep issues may significantly improve the quality of life for children with ADHD and their families.
Area of Science:
- Pediatric Psychology
- Neurodevelopmental Disorders
- Sleep Medicine
Background:
- Sleep problems are prevalent in up to 70% of children with attention-deficit/hyperactivity disorder (ADHD).
- Existing research primarily uses cross-sectional data, leaving the longitudinal impact of sleep problems on well-being in ADHD populations unclear.
- Understanding these long-term associations is crucial for effective intervention strategies.
Purpose of the Study:
- To investigate the longitudinal relationship between sleep problem trajectories and child and family well-being in children diagnosed with ADHD.
- To differentiate the impact of transient versus persistent sleep problems on well-being outcomes.
- To provide evidence for the importance of managing sleep disturbances in pediatric ADHD.
Main Methods:
- A cohort of 186 children with ADHD (aged 5-13 years) was followed for 12 months.
- Sleep problem severity was assessed at baseline, 6 months, and 12 months to define sleep trajectories.
- Child and family well-being (emotional/behavioral problems, quality of life) were measured via caregiver and teacher reports.
Main Results:
- Children with transient and persistent sleep problems reported significantly more behavioral/emotional issues and poorer quality of life compared to peers without sleep problems.
- These associations remained significant even after controlling for ADHD medication, symptom severity, and comorbidities.
- However, after adjusting for baseline well-being, many associations weakened, with only transient sleep problems showing a significant link to behavioral issues in the fully adjusted model (caregiver-reported). Teacher reports did not find these associations.
Conclusions:
- Transient or persistent sleep problems in children with ADHD are associated with poorer caregiver-reported well-being.
- Interventions targeting sleep problems in children with ADHD may be a viable strategy to enhance overall child well-being.
- Further research may be needed to explore the nuances of teacher vs. caregiver reporting and the long-term impact of transient sleep issues.
Objective:
Sleep problems affect up to 70% of children with attention-deficit/hyperactivity disorder (ADHD) and are associated with poorer child and family well-being in cross-sectional studies. However, whether these associations hold longitudinally is unclear. The authors aimed to examine the longitudinal relationship between sleep problem trajectories and well-being in children with ADHD.
Method:
Children with ADHD (n = 186), aged 5 to 13 years, were recruited from 21 pediatric practices across the state of Victoria, Australia. Sleep problem severity data were collected at 3 time points (baseline, 6, and 12 mo) and were used to classify sleep problem trajectories. Child and family well-being (e.g., child emotional and behavioral problems, quality of life [QoL]) were measured at baseline and 12 months by teacher and/or caregiver-report. The well-being of children with "transient" and "persistent" sleep problems was compared with those "never" experiencing sleep problems using a series of hierarchical linear regression models.
Results:
After accounting for socio-demographic factors, children with transient and persistent sleep trajectories experienced more caregiver-reported behavioral and emotional problems (effect size [ES] both 0.7) and poorer child QoL (ES: -0.7 and -1.2, respectively). These associations remained after also accounting for ADHD medication and symptom severity and comorbidities, but after accounting for baseline measures many associations weakened to the point of nonsignificance. In the fully adjusted model-transient sleep problems were associated with behavioral and emotional problems (ES: 0.2). These associations were not evident by teacher-report.
Conclusion:
Children with ADHD experiencing transient or persistent sleep problems have poorer caregiver-reported well-being. Managing sleep problems in children with ADHD may improve child well-being.
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