Category: ADHD - Child
Children with ADHD display more sleep problems than their peers. However, surprisingly little research has examined whether boys and girls with ADHD differ in their sleep functioning. There is some evidence that girls with ADHD may represent a particularly severe phenotype, and associated impairments (e.g., peer difficulties) have a more detrimental impact on girls with ADHD as compared to boys with ADHD. Thus, girls with ADHD may experience more sleep problems than boys with ADHD, though this possibility remains largely untested. Likewise, it is unclear whether co-occurring internalizing or externalizing symptoms are related to specific sleep functioning domains in children with ADHD. The objectives of the present study were to (1) examine whether boys or girls with ADHD differ in their sleep functioning, (2) evaluate ADHD symptoms severity and co-occurring symptoms as uniquely related to sleep functioning domains and total sleep problems in children with ADHD, and (3) explore whether associations between psychopathology and sleep domains differ for boys and girls with ADHD. This study extends the current literature by using a clinical sample of children with ADHD to examine both internalizing and externalizing psychopathologies in relation to sleep functioning domains and whether sex moderates relations between psychopathology and sleep. Participants were 176 children (ages 7-13; 71% male; 83% White) with ADHD using a diagnostic interview with the child’s parent. Parents also completed measures assessing their child’s ADHD symptoms, co-occurring symptoms (i.e., anxiety, depression, ODD, SCT), and sleep functioning. Independent samples t-tests indicated that girls with ADHD had poorer sleep functioning than boys with ADHD across all sleep functioning domains except sleep onset delay. In addition, 79% of girls met the established cutoff for having sleep problems, compared to 60% of boys with ADHD (χ2=5.94, p=.02). Additionally, in multiple regression analyses that controlled for ADHD symptom severity, anxiety symptoms were uniquely associated with increased bedtime resistance and sleep anxiety across sex. Both depression and ODD symptoms were uniquely associated with shorter sleep duration and increased daytime sleepiness across sex. Finally, a significant sex × depression interaction was found, whereby depression was associated with increased night wakings for girls, but not boys, with ADHD. Medication use was unassociated with sleep, and primary findings were unchanged when controlling for medication use. Findings from this study demonstrate that girls with ADHD experience more sleep problems than boys with ADHD, and co-occurring internalizing and externalizing symptoms are related to poorer sleep functioning for both boys and girls with ADHD.
Caroline Cusick– Cincinnati Children's Hospital Medical Center
Craig Sidol– Graduate Student, University of Cincinnati, Cincinnati, Ohio
Jeffery Epstein– Professor, Cincinnati Children's Hospital Medical Center
Leanne Tamm– Associate Professor, Cincinnati Children's Hospital Medical Center
Stephen Becker– Assistant Professor, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio