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Factors Associated with Sleep Problems in Children with ADHD: Focusing on Emotional Regulation, Emotional Intensity

Doga Sevincok1, Hasan Can Ozbay2, Mutlu Muhammed Ozbek3

  • 1Department of Child and Adolescent Psychiatry, Istinye University, Istanbul 34396, Türkiye.

Behavioral Sciences (Basel, Switzerland)
|March 28, 2026
PubMed

Insights

Children with Attention Deficit Hyperactivity Disorder (ADHD) experience sleep problems linked to emotional distress. Addressing internalizing symptoms is crucial for evaluating sleep issues in ADHD.

Area of Science:

  • Child Psychology
  • Neurodevelopmental Disorders
  • Sleep Medicine

Background:

  • Sleep problems are common in children with Attention Deficit Hyperactivity Disorder (ADHD).
  • The interplay between ADHD, emotion regulation (ER), emotional intensity (EI), and sleep disturbances requires further investigation.
  • Understanding these relationships is vital for comprehensive ADHD management.

Purpose of the Study:

  • To investigate sleep problems in children with ADHD.
  • To examine the roles of emotion regulation, emotional intensity, oppositional defiant symptoms, and internalizing symptoms in ADHD-related sleep issues.
  • To explore mediation pathways linking ADHD symptoms to sleep problems through emotional factors.

Main Methods:

  • A case-control study involving 100 children with ADHD and 50 controls (aged 6-14).
  • Assessments included semi-structured interviews and parent-completed questionnaires (e.g., Children's Sleep Habits Questionnaire, Conners' Parent Rating Scale, Emotion Regulation Scale, Revised Children Anxiety and Depression Scale).
  • Statistical analyses comprised group comparisons, correlations, multiple regressions, and serial mediation models, controlling for covariates.

Main Results:

  • No significant differences in sleep parameters or internalizing symptoms between ADHD and control groups.
  • In the ADHD group, total sleep problems correlated with ADHD symptoms, oppositional symptoms, EI, ER, and internalizing symptoms.
  • Internalizing symptoms predicted total sleep problems; EI predicted night wakings. Internalizing symptoms mediated the relationship between ADHD/oppositional symptoms and sleep problems, with EI/ER indirectly influencing this via internalization.

Conclusions:

  • Sleep problems in ADHD are associated with emotional distress pathways.
  • Internalizing symptoms play a significant mediating role in the relationship between ADHD/oppositional symptoms and sleep problems.
  • Concurrent assessment of internalizing symptoms alongside behavioral and emotional processes is essential for evaluating sleep problems in children with ADHD.

Keywords:
ADHDemotion regulationemotional intensityinternalizationoppositional defiant disordersleep

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