Sleep problem trajectories and well-being in children with attention-deficit hyperactivity disorder: a prospective cohort study

Objective: Sleep problems affect up to 70% of children with attention-deficit/hyperactivity disorder (ADHD) and are associated with poorer child and family well-being in cross-sectional studies. However, whether these associations hold longitudinally is unclear. The authors aimed to examine the longitudinal relationship between sleep problem trajectories and well-being in children with ADHD. Method: Children with ADHD (n 5 186), aged 5 to 13 years, were recruited from 21 pediatric practices across the state of Victoria, Australia. Sleep problem severity data were collected at 3 time points (baseline, 6, and 12 mo) and were used to classify sleep problem trajectories. Child and family well-being (e.g., child emotional and behavioral problems, quality of life [QoL]) were measured at baseline and 12 months by teacher and/or caregiver-report. The well-being of children with “transient” and “persistent” sleep problems was compared with those “never” experiencing sleep problems using a series of hierarchical linear regression models. Results: After accounting for socio-demographic factors, children with transient and persistent sleep trajectories experienced more caregiver-reported behavioral and emotional problems (effect size [ES] both 0.7) and poorer child QoL (ES: 20.7 and 21.2, respectively). These associations remained after also accounting for ADHD medication and symptom severity and comorbidities, but after accounting for baseline measures many associations weakened to the point of nonsignificance. In the fully adjusted model—transient sleep problems were associated with behavioral and emotional problems (ES: 0.2). These associations were not evident by teacher-report. Conclusion: Children with ADHD experiencing transient or persistent sleep problems have poorer caregiver-reported well-being. Managing sleep problems in children with ADHD may improve child well-being.