Sleep problems in children with attention-deficit hyperactivity disorder: associations with parenting style and sleep hygiene

Abstract

We aimed to examine the association between sleep problems and parenting and sleep hygiene in children with attention-deficit/hyperactivity disorder (ADHD). Participants included 5–13-year-old children with DSM 5 defined ADHD and a parent-reported moderate-to-severe sleep problem (N = 361). Sleep was assessed using the parent-reported Children’s Sleep Habits Questionnaire. Parents also completed checklists assessing sleep hygiene, parenting consistency, and parenting warmth. Linear regression established prediction models controlling for confounding variables including child age and sex, ADHD symptom severity, comorbidities, medication use, and socio-demographic factors. More consistent parenting was associated with decreased bedtime resistance (β = −0.16) and decreased sleep anxiety (β = −0.14), while greater parental warmth was associated with increased parasomnias (β = +0.18) and sleep anxiety (β = +0.13). Poorer sleep hygiene was associated with increased bedtime resistance (β = +0.20), increased daytime sleepiness (β = +0.12), and increased sleep duration problems (β = +0.13). In conclusion, sleep hygiene and parenting are important modifiable factors independently associated with sleep problems in children with ADHD. These factors should be considered in the management of sleep problems in children with ADHD.

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References

  1. 1.

    Cortese S, Brown TE, Corkum P et al (2013) Assessment and management of sleep problems in youths with attention-deficit/hyperactivity disorder. J Am Acad Child Adolesc Psychiatr. 52(8):784–796

    Article  Google Scholar 

  2. 2.

    LeBourgeois MK, Giannotti F, Cortesi F et al (2005) The relationship between reported sleep quality and sleep hygiene in Italian and American adolescents. Pediatrics 115(1):257–265

    Article  PubMed  PubMed Central  Google Scholar 

  3. 3.

    Bordeleau S, Bernier A, Carrier J (2012) Longitudinal associations between the quality of parent-child interactions and children’s sleep at preschool age. J Fam Psychol 26(2):254–262

    Article  PubMed  Google Scholar 

  4. 4.

    Sung V, Hiscock H, Sciberras E, Efron D (2008) Sleep problems in children with attention-deficit/hyperactivity disorder—prevalence and the effect on the child and family. Arch Pediatr Adolesc Med 162:336–342

    Article  PubMed  Google Scholar 

  5. 5.

    Hiscock H, Sciberras E, Mensah F et al (2015) Impact of a behavioral sleep intervention on ADHD symptoms, child sleep and parent health: a randomized controlled trial. BMJ 350:h68

    Article  PubMed  PubMed Central  Google Scholar 

  6. 6.

    Corkum P, Lingley-Pottie P, Davidson F et al (2016) Better nights/better days—distance intervention for insomnia in school-aged children with/without ADHD: A randomized controlled trial. J Pediatr Psychol. doi:10.1093/jpepsy/jsw031

    PubMed  Google Scholar 

  7. 7.

    Keshavarzi Z, Bajoghli H, Mohamadi MR, Salmanian M, Kirov R, Gerber M et al (2014) In a randomized case-control trial with 10-years olds suffering from attention deficit/hyperactivity disorder (ADHD) sleep and psychological functioning improved during a 12-week sleep-training program. World J Biol Psychiatr 15:609–619

    Article  Google Scholar 

  8. 8.

    Cortese S, Faraone SV, Konofal E, Lecendreux M (2009) Sleep in children with attention-deficit/hyperactivity disorder: meta-analysis of subjective and objective studies. J Am Acad Child Adolesc Psychiatry 48(9):894–908

    PubMed  Google Scholar 

  9. 9.

    Corkum P, Panton R, Ironside S et al (2008) Acute impact of immediate release methylphenidate administered three times a day on sleep in children with attention-deficit/hyperactivity disorder. J Pediatr Psychol 33(4):368–379

    Article  PubMed  Google Scholar 

  10. 10.

    Lycett K, Sciberras E, Mensah F, Hiscock H (2013) Behavioural sleep problems and internalising and externalising comorbidities in children with ADHD. Eur Child Adolesc Psychiatry 24:31–40

    Article  Google Scholar 

  11. 11.

    Van Veen MM, Kooij JS, Boonstra AM, Gordijn MC, Van Someren EJ (2010) Delayed circadian rhythm in adults with attention-deficit/hyperactivity disorder and chronic sleep-onset insomnia. Biol Psychiat 67(11):1091–1096

    Article  PubMed  Google Scholar 

  12. 12.

    Noble GS, O’Laughlin L, Brubaker B (2012) Attention deficit hyperactivity disorder and sleep disturbances: consideration of parental influence. Behav Sleep Med 10:41–53

    Article  Google Scholar 

  13. 13.

    Johnston C, Mash EJ (2001) Families of children with attention-deficit/hyperactivity disorder: review and recommendations for future research. Clin Child Fam Psychol Rev 4(3):183–207

    CAS  Article  PubMed  Google Scholar 

  14. 14.

    Adam EK, Snell EK, Pendry P (2007) Sleep timing and quantity in ecological and family context: a nationally representative time-diary study. J Fam Psychol 21(1):4–19

    Article  PubMed  Google Scholar 

  15. 15.

    Mindell JA, Meltzer LJ, Carskadon MA, Chervin RD (2009) Developmental aspects of sleep hygiene: findings from the 2004 National Sleep Foundation Sleep in America Poll. Sleep Med 10(7):771–779

    Article  PubMed  Google Scholar 

  16. 16.

    Van der Heijden KB, Smits MG, Gunning WB (2006) Sleep hygiene and actigraphically evaluated sleep characteristics in children with ADHD and chronic sleep onset insomnia. J Sleep Res 15(1):55–62

    Article  PubMed  Google Scholar 

  17. 17.

    Weiss MD, Wasdell MB, Bomben MM et al (2006) Sleep hygiene and melatonin treatment for children and adolescents with ADHD and initial insomnia. J Am Acad Child Adolesc Psychiatry 45(5):512–519

    Article  PubMed  Google Scholar 

  18. 18.

    Sciberras E, Mulraney M, Heussler H, Rinehart N, Schuster T, Gold L et al (2017) Does a brief, behavioural intervention, delivered by paediatricians or psychologists improve sleep problems for children with ADHD? Protocol for a cluster-randomised, translational trial. BMJ Open 7:e014158

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  19. 19.

    DuPaul GJ, Power TJ, Anastopoulos AD, Reid R (1998) ADHD rating scale IV: checklists, norms, and clinical interpretation. The Guilford Publications Inc, New York

    Google Scholar 

  20. 20.

    Quach J, Hiscock H, Canterford L, Wake MA (2009) Outcomes of child sleep problems over the school-transition period: Australian population longitudinal study. Pediatrics 123:1287–1292

    Article  PubMed  Google Scholar 

  21. 21.

    American Academy of Sleep Medicine (2014) International classification of sleep disorders, 3rd edn. American Academy of Sleep Medicine, Darien

    Google Scholar 

  22. 22.

    Harris PA, Taylor R, Thielke R, Payne J, Gonzalez N, Conde JG (2009) A metadata-driven methodology and workflow process for providing translational research informatics support. J Biomed Inform 42(2):377–381

    Article  PubMed  Google Scholar 

  23. 23.

    Lyneham HJ, Rapee RMJ (2005) Agreement between telephone and in-person delivery of a structured interview for anxiety disorders in children. J Am Acad Child Adolesc Psychiatry 44:274–282

    Article  PubMed  Google Scholar 

  24. 24.

    Mennin D, Biederman J, Mick E, Faraone S (2000) Towards defining a meaningful anxiety phenotype for research in ADHD children. J Atten Disord 3:192–199

    Article  Google Scholar 

  25. 25.

    Owens J, Spirito A, McGuinn M (2000) The Children’s Sleep Habits Questionnaire (CSHQ): psychometric properties of a survey instrument for school aged children. Sleep 23:1043–1051

    CAS  Article  PubMed  Google Scholar 

  26. 26.

    Zubrick SR, Lucas N, Westrupp EM, Nicholson JM (2014) Parenting measures in the Longitudinal Study of Australian Children: Construct validity and measurement quality, waves 1 to 4. Department of Social Services, Canberra

    Google Scholar 

  27. 27.

    Furukawa TA, Kessler RC, Slade T, Andrews G (2003) The performance of the K6 and K10 screening scales for psychological distress in the Australian National Survey of Mental Health and Well-Being. Psychol Med 33:357–362

    CAS  Article  PubMed  Google Scholar 

  28. 28.

    Australian Bureau of Statistics (2006) Socio-economic indexes for areas (SEIFA)—technical paper. ABS, Canberra

    Google Scholar 

  29. 29.

    Noble GS, O’Laughlin L, Brubaker B (2012) Attention deficit hyperactivity disorder and sleep disturbances: consideration of parental influence. Behav Sleep Med 10(1):41–53

    Article  Google Scholar 

  30. 30.

    Markovich AN, Gendron MA, Corkum PV (2015) Validating the Children’s Sleep Habits Questionnaire against polysomnography and actigraphy in school-aged children. Front Psychiatr 5:188

    Article  Google Scholar 

  31. 31.

    Accardo JA, Marcus CL, Leonard MB et al (2012) Associations between psychiatric comorbidities and sleep disturbances in children with attention-deficit/hyperactivity disorder. J Dev Behav Pediatr 33(2):97–105

    PubMed  PubMed Central  Google Scholar 

  32. 32.

    Corkum P, Tannock R, Moldofsky H et al (2001) Actigraphy and parental ratings of sleep in children with attention-deficit-hyperactivity disorder (ADHD). Sleep 24(3):303–312

    CAS  Article  PubMed  Google Scholar 

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Acknowledgements

This study was funded by the Australian National Health and Medical Research Council (NHMRC Grant 1058827). ES is supported by an NHMRC Early Career Fellowship (1037159) and NHMRC Career Development Award (1110688). TS is supported by funding from the Royal Children’s Hospital Foundation to the Melbourne Children’s Trial Centre. HH is supported by an NHMRC Career Development Award (607351). MCRI is supported by the Victorian Government’s Operational Infrastructure Support Program. 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.

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Correspondence to Harriet Hiscock.

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Ethics approval was granted by the Human Research Ethics Committees of The Royal Children’s Hospital (#34072). The research has been conducted in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments. All persons gave their informed consent prior to their inclusion in the study.

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Sciberras, E., Song, J.C., Mulraney, M. et al. Sleep problems in children with attention-deficit hyperactivity disorder: associations with parenting style and sleep hygiene. Eur Child Adolesc Psychiatry 26, 1129–1139 (2017). https://doi.org/10.1007/s00787-017-1000-4

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Keywords

  • ADHD
  • Sleep
  • Children
  • Parenting
  • Sleep hygiene
  • Comorbidity