Examining bidirectional associations between sleep and behavior among children with attention-deficit/hyperactivity
Craig A Sidol1,2, Stephen P Becker1,3, James L Peugh1,3
1Division of Behavioral Medicine and Clinical Psychology Cincinnati Children's Hospital Medical Center Cincinnati Ohio USA.
JCPP Advances
|September 27, 2023
Summary
Children with ADHD experience more sleep problems, impacting behavior. This study found that better sleep efficiency, not total sleep time, improved ADHD symptoms and academic performance, with a bidirectional relationship observed.
Area of Science:
- Pediatric Psychology
- Sleep Medicine
- Neurodevelopmental Disorders
Background:
- Children with attention-deficit/hyperactivity disorder (ADHD) exhibit higher rates of sleep disturbances compared to their peers.
- These sleep problems exacerbate behavioral and functional impairments in children with ADHD.
Purpose of the Study:
- To investigate the bidirectional relationship between nightly sleep metrics (total sleep time and sleep efficiency) and daily behavior in children diagnosed with ADHD.
- To determine if sleep quality influences next-day behavior and if daily behavior impacts subsequent sleep in this population.
Main Methods:
- A 2-week study involving 43 children (ages 6-13) with ADHD during a Summer Treatment Program.
- Sleep was objectively measured using actigraphy, while behavior was assessed through clinical data and parent/counselor ratings of ADHD symptoms, oppositional behaviors, and emotion regulation.
- Hypothesized that improved sleep efficiency and total sleep time would correlate with better next-day behavior, and vice versa.
Main Results:
- Higher sleep efficiency was significantly associated with improved next-day parent ratings of ADHD symptoms (R² = 0.04, p = 0.04).
- Improved parent ratings of ADHD during the day predicted higher sleep efficiency that night (R² = 0.002, p = 0.02), indicating a bidirectional link.
- Greater daily assignment completion was linked to higher nightly sleep efficiency (R² = 0.035, p = 0.03).
- Total sleep time (TST) did not show significant relationships with any measured behavioral outcomes.
Conclusions:
- Sleep efficiency appears more critical than total sleep time for next-day behavioral outcomes in children with ADHD.
- A significant bidirectional relationship exists between sleep efficiency and ADHD symptom ratings.
- Clinical assessment and treatment for ADHD should consider manifestations of poor sleep efficiency, including waking minutes and awakenings after sleep onset.
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