A prospective study of sleep problems in children with ADHD

BACKGROUND: Behavioral sleep problems are common in children with attention-deficit/hyperactivity disorder (ADHD), yet their persistence or otherwise is unknown. We examined behavioral sleep problem trajectories, types of sleep problems experienced, and associated risk/protective factors. METHODS: DESIGN: Prospective cohort study. SETTING: Twenty-one pediatric practices across Victoria, Australia. PARTICIPANTS: A total of 195 children with ADHD (5-13 years). OUTCOMES: Sleep problem trajectories classified as never, transient, or persistent on the basis of sleep problem severity measured at baseline, 6, and 12 months. Explanatory variables: Types of sleep problems, internalizing and externalizing comorbidities, ADHD symptom severity and medication use, autism spectrum disorder, caregiver mental health, and sociodemographic factors. ANALYSES: Multinomial logistic regression models. RESULTS: Sleep problems fluctuated over 12 months, but for 10% of children they persisted. In adjusted analyses, co-occurring internalizing and externalizing comorbidities were a risk factor for persistent (odds ratio (OR) 9.2, 95% confidence interval (CI) 1.6, 53.9, p = 0.01) and transient (OR 3.7, 95% CI 1.5, 8.8, p = 0.003) sleep problems, while greater ADHD symptom severity and poorer caregiver mental health were risk factors for persistent and transient sleep problems, respectively. CONCLUSIONS: Sleep problems in children with ADHD are commonly transient, but in a subgroup they are characterized as persistent. Early preventive/intervention strategies should target children at risk of persistent sleep problems.