Sleep problems in children with attention-deficit/hyperactivity disorder: prevalence and the effect on the child and family

Abstract

Objectives: To determine the prevalence of sleep problems in children with attention-deficit/hyperactivity disorder (ADHD) and their associations with child quality of life (QOL), daily functioning, and school attendance; caregiver mental health and work attendance; and family functioning.

Design: Cross-sectional survey.

Setting: Pediatric hospital outpatient clinic, private pediatricians' offices, and ADHD support groups in Victoria, Australia.

Participants: Schoolchildren with ADHD. Main Exposure Attention-deficit/hyperactivity disorder.

Outcome measures: Primary measure was caregivers' reports of their children's sleep problems (none, mild, or moderate or severe). Secondary outcomes were (1) child QOL (Pediatric Quality of Life Inventory), daily functioning (Daily Parent Rating of Evening and Morning Behavior scale), and school attendance, (2) caregiver mental health (Depression Anxiety Stress Scale) and work attendance, and (3) family functioning (Child Health Questionnaire subscales). Caregivers also reported on how their pediatrician treated their children's sleep problems.

Results: Two hundred thirty-nine of 330 (74%) eligible families completed the survey. Child sleep problems were common (mild, 28.5%; moderate or severe, 44.8%). Moderate or severe sleep problems were associated with poorer child psychosocial QOL, child daily functioning, caregiver mental health, and family functioning. After adjusting for confounders, all associations held except for family impacts. Compared with children without sleep problems, those with sleep problems were more likely to miss or be late for school, and their caregivers were more likely to be late to work. Forty-five percent of caregivers reported that their pediatricians had asked about their children's sleep and, of these, 60% reported receiving treatment advice.

Conclusions: Sleep problems in children with ADHD are common and associated with poorer child, caregiver, and family outcomes. Future research needs to determine whether management of sleep problems can reduce adverse outcomes.