Sleep problems and daytime sleepiness in children with ADHD: Associations with social, emotional, and behavioral functioning at school, a cross-sectional study

ABSTRACT

Background: Sleep problems and daytime sleepiness are common in children with attention-deficit hyperactivity disorder (ADHD) and are associated with poor parent-reported functional outcomes. However, the potential impact of sleep problems or daytime sleepiness on the school functioning of children with ADHD remains unknown. We aimed to determine if sleep problems and daytime sleepiness were associated with the social, emotional, and behavioral school-based functioning of children with ADHD and comorbid sleep problems. Methods: Children aged 5–13 years with ADHD and a moderate-severe sleep problem (confirmed using American Academy of Sleep Medicine diagnostic criteria) were recruited from 43 pediatric practices across Victoria and Queensland, Australia (N = 257). Parent-rated sleep problems were assessed using the Children’s Sleep Habits Questionnaire (CSHQ) and teacher-rated daytime sleepiness using the Teacher’s Daytime Sleepiness Questionnaire. Teacher-rated social, emotional, and behavioral school functioning was assessed using three scales (peer problems, emotional problems, and conduct problems) from the Strength and Difficulties Questionnaire. Data was analyzed using Pearson correlations and linear regression models. Results: Teacher-rated daytime sleepiness was associated with higher levels of emotional (β = 0.39; 95% CI = 0.25–0.52) and behavioral problems (β = 0.47; CI = 0.36–0.58) in adjusted models. While total sleep duration and parent-rated sleep problems were not associated with daytime sleepiness or school functioning, the CSHQ subscale night wakings was correlated with teacher-rated daytime sleepiness (r = 0.21; p < 0.01). Conclusions: Daytime sleepiness (possibly as an indicator of sleep quality) may be a better predictor of school functioning in children with ADHD who have concomitant sleep problems than total sleep duration or parent-rated sleep problems.

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Acknowledgments

ES and MM conceived the study. IL assisted with data collection and conducted the analysis under the supervision of ES and MM. IL had full access to the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. MM and Tibor Schuster also made substantial contributions to data cleaning and overseeing data analysis. All authors contributed to the writing of the manuscript. Data were collected and managed using the REDCap electronic data capture tools hosted at MCRI. REDCap (Research Electronic Data Capture) is a secure, Web-based application designed to support data capture for research studies. We thank all families, pediatricians, and teachers for taking part in this research. We also thank the research assistants who contributed to the data collection for this study.

Funding

This study was funded by the Australian National Health and Medical Research Council (grant number 1058827). Dr. Sciberras’ position is funded by an NHMRC Early Career Fellowship in Population Health 1037159 (2012–2015) and an NHMRC Career Development Fellowship 1110688 (2016-19). MCRI is supported by the Victorian Government’s Operational Infrastructure Support Program.

Supplemental Material

Supplemental data for this article can be accessed here.

Additional information

Funding

This study was funded by the Australian National Health and Medical Research Council (grant number 1058827). Dr. Sciberras’ position is funded by an NHMRC Early Career Fellowship in Population Health 1037159 (2012–2015) and an NHMRC Career Development Fellowship 1110688 (2016-19). MCRI is supported by the Victorian Government’s Operational Infrastructure Support Program.