Behavioural sleep problems in children with attention-deficit/hyperactivity disorder (ADHD): protocol for a prospective cohort study

Introduction Children with attention-deficit/hyperactivity disorder (ADHD) commonly experience behavioural sleep problems, yet these difficulties are not routinely assessed and managed in this group. Presenting with similar symptoms to ADHD itself, sleep problems are complex in children with ADHD and their aetiology is likely to be multifactorial. Common internalising and externalising comorbidities have been associated with sleep problems in children with ADHD; however, this relationship is yet to be fully elucidated. Furthermore, limited longitudinal data exist on sleep problems in children with ADHD, thus their persistence and impact remain unknown. In a diverse sample of children with ADHD, this study aims to: (1) quantify the relationship between sleep problems and internalising and externalising comorbidities; (2) examine sleep problem trajectories and risk factors; and (3) examine the longitudinal associations between sleep problems and child and family functioning over a 12-month period. Methods and analysis A prospective cohort study of 400 children with ADHD (150 with no/mild sleep problems, 250 with moderate/severe sleep problems) recruited from paediatric practices across Victoria, Australia. The children's parents and teacher provide data at baseline and 6-month and 12-month post enrolment. Key measures Parent report of child's sleep problem severity (no, mild, moderate, severe); specific sleep domain scores assessed using the Child Sleep Habits Questionnaire; internalising and externalising comorbidities assessed by the Anxiety Disorders Interview Schedule for Children IV/Parent version. Analyses Multiple variable logistic and linear regression models examining the associations between key measures, adjusted for confounders identified a priori. Ethics and dissemination Ethics approval has been granted. Findings will contribute to our understanding of behavioural sleep problems in children with ADHD. Clinically, they could improve the assessment and management of sleep problems in this group. We will seek to publish in leading paediatric journals, present at conferences and inform Australian paediatricians through the Australian Paediatric Research Network.

[1]  L. O’Brien,et al.  Assessment and management of sleep problems in youths with attention-deficit/hyperactivity disorder. , 2013, Journal of the American Academy of Child and Adolescent Psychiatry.

[2]  Janet B W Williams,et al.  Diagnostic and Statistical Manual of Mental Disorders , 2013 .

[3]  T. Wentzel‐Larsen,et al.  Persistence of Sleep Problems in Children with Anxiety and Attention Deficit Hyperactivity Disorders , 2013, Child psychiatry and human development.

[4]  S. Miano.  The Complex Relationship Between ADHD and Pediatric Sleep Disorders , 2012 .

[5]  A. Emond,et al.  Sleep patterns in children with ADHD: a population-based cohort study from birth to 11 years , 2012, Journal of sleep research.

[6]  J. Shults,et al.  Associations Between Psychiatric Comorbidities and Sleep Disturbances in Children With Attention-Deficit/Hyperactivity Disorder , 2012, Journal of developmental and behavioral pediatrics : JDBP.

[7]  Brad Brubaker,et al.  Attention Deficit Hyperactivity Disorder and Sleep Disturbances: Consideration of Parental Influence , 2012, Behavioral sleep medicine.

[8]  H. Hiscock,et al.  Managing sleep problems in school aged children with ADHD: a pilot randomised controlled trial. , 2011, Sleep medicine.

[9]  J. Richter,et al.  Comparison of sleep problems in children with anxiety and attention deficit/hyperactivity disorders , 2011, European Child & Adolescent Psychiatry.

[10]  H. Hiscock,et al.  Children Attending Paediatricians Study: a national prospective audit of outpatient practice from the Australian Paediatric Research Network , 2011, The Medical journal of Australia.

[11]  D. Gozal,et al.  Sleep disturbances in children with attention-deficit/hyperactivity disorder , 2011, Expert review of neurotherapeutics.

[12]  M. Weiss,et al.  Sleep Problems in the Child with Attention-Deficit Hyperactivity Disorder , 2010, CNS drugs.

[13]  S. Cortese,et al.  Sleep and ADHD. , 2010, Sleep medicine.

[14]  Tokie Anme,et al.  Utility of Subjective Sleep Assessment Tools for Healthy Preschool Children: A Comparative Study Between Sleep Logs, Questionnaires, and Actigraphy , 2010, Journal of epidemiology.

[15]  Stephen V Faraone,et al.  Sleep in children with attention-deficit/hyperactivity disorder: meta-analysis of subjective and objective studies. , 2009, Journal of the American Academy of Child and Adolescent Psychiatry.

[16]  Jodi A. Mindell,et al.  A Clinical Guide to Pediatric Sleep: Diagnosis and Management of Sleep Problems , 2009 .

[17]  Melissa Wake,et al.  Outcomes of Child Sleep Problems Over the School-Transition Period: Australian Population Longitudinal Study , 2009, Pediatrics.

[18]  J. Owens,et al.  Subjective and objective measures of sleep in children with attention-deficit/hyperactivity disorder. , 2009, Sleep medicine.

[19]  J. Owens.  Sleep disorders and attention-deficit/hyperactivity disorder , 2008, Current psychiatry reports.

[20]  E. Bixler,et al.  ADHD subtypes and comorbid anxiety, depression, and oppositional-defiant disorder: differences in sleep problems. , 2008, Journal of pediatric psychology.

[21]  Kim Marie Bauer and Sarah Blunden.  How Accurate is Subjective Reporting of Childhood Sleep Patterns? A Review of the Literature and Implications for Practice , 2008 .

[22]  H. Hiscock,et al.  Sleep problems in children with attention-deficit/hyperactivity disorder: prevalence and the effect on the child and family. , 2008, Archives of pediatrics & adolescent medicine.

[23]  N. Bilenberg,et al.  Actigraphic and parental reports of sleep difficulties in children with attention-deficit/hyperactivity disorder. , 2008, Archives of pediatrics & adolescent medicine.

[24]  B. Horta,et al.  The worldwide prevalence of ADHD: a systematic review and metaregression analysis. , 2007, The American journal of psychiatry.

[25]  Jodi A Mindell,et al.  Relationship between child sleep disturbances and maternal sleep, mood, and parenting stress: a pilot study. , 2007, Journal of family psychology : JFP : journal of the Division of Family Psychology of the American Psychological Association.

[26]  J. Varni,et al.  Parent proxy-report of their children's health-related quality of life: an analysis of 13,878 parents' reliability and validity across age subgroups using the PedsQL™ 4.0 Generic Core Scales , 2007, Health and quality of life outcomes.

[27]  Melissa Wake,et al.  Adverse Associations of Sleep Problems in Australian Preschoolers: National Population Study , 2007, Pediatrics.

[28]  A. Sadeh,et al.  Sleep in children with attention-deficit hyperactivity disorder: a meta-analysis of polysomnographic studies. , 2006, Sleep medicine reviews.

[29]  Danielle N. Pappas.  ADHD Rating Scale-IV: Checklists, Norms, and Clinical Interpretation , 2006 .

[30]  D. Gozal,et al.  Sleep complaints and psychiatric symptoms in children evaluated at a pediatric mental health clinic. , 2006, Journal of clinical sleep medicine : JCSM : official publication of the American Academy of Sleep Medicine.

[31]  J. Owens.  The ADHD and Sleep Conundrum: A Review , 2005, Journal of developmental and behavioral pediatrics : JDBP.

[32]  L. Matza,et al.  Psychometric validation of the child health questionnaire (CHQ) in a sample of children and adolescents with attention-deficit/hyperactivity disorder , 2005, Quality of Life Research.

[33]  R. Rapee,et al.  Agreement between telephone and in-person delivery of a structured interview for anxiety disorders in children. , 2005, Journal of the American Academy of Child and Adolescent Psychiatry.

[34]  K. Lushington,et al.  Are sleep problems under-recognised in general practice? , 2004, Archives of Disease in Childhood.

[35]  K. Schuh,et al.  Once-daily atomoxetine treatment for children with attention-deficit/hyperactivity disorder, including an assessment of evening and morning behavior: a double-blind, placebo-controlled trial. , 2004, Pediatrics.

[36]  D. Gozal,et al.  Periodic limb movement disorder of sleep in children , 2003, Journal of sleep research.

[37]  R. Chervin,et al.  Inattention, hyperactivity, and symptoms of sleep-disordered breathing. , 2002, Pediatrics.

[38]  I. Moilanen,et al.  Poor sleep and psychiatric symptoms at school: an epidemiological study , 2002, European Child & Adolescent Psychiatry.

[39]  M. Hernán,et al.  Causal knowledge as a prerequisite for confounding evaluation: an application to birth defects epidemiology. , 2002, American journal of epidemiology.

[40]  R. Goodman,et al.  Psychometric properties of the strengths and difficulties questionnaire. , 2001, Journal of the American Academy of Child and Adolescent Psychiatry.

[41]  W. Silverman,et al.  Test-retest reliability of anxiety symptoms and diagnoses with the Anxiety Disorders Interview Schedule for DSM-IV: child and parent versions. , 2001, Journal of the American Academy of Child and Adolescent Psychiatry.

[42]  J. Owens,et al.  The Children's Sleep Habits Questionnaire (CSHQ): psychometric properties of a survey instrument for school-aged children. , 2000, Sleep.

[43]  M. Msall,et al.  Parental and self-report of sleep in children with attention-deficit/hyperactivity disorder. , 2000, Archives of pediatrics & adolescent medicine.

[44]  D. Mennin,et al.  Towards defining a meaningful anxiety phenotype for research in ADHD children , 2000 .

[45]  R Tannock,et al.  Sleep problems in children with attention-deficit/hyperactivity disorder: impact of subtype, comorbidity, and stimulant medication. , 1999, Journal of the American Academy of Child and Adolescent Psychiatry.

[46]  P. Lovibond,et al.  The structure of negative emotional states: comparison of the Depression Anxiety Stress Scales (DASS) with the Beck Depression and Anxiety Inventories. , 1995, Behaviour research and therapy.

[47]  Larry B. Silver,et al.  Attention Deficit Hyperactivity Disorder. A Handbook for Diagnosis and Treatment , 1991 .

[48]  R. Daroff,et al.  The International Classification of Sleep Disorders , 1991, Neurology.

[49]  R. Goetz,et al.  Sleep architecture and REM sleep measures in prepubertal major depressives. Studies during recovery from the depressive episode in a drug-free state. , 1983, Archives of general psychiatry.

[50]  J. Quach.  Randomised trial, nested in a population-based survey, of a behavioural sleep intervention to reduce sleep problems in new school entrants , 2010 .

[51]  J. Mindell,et al.  Comprar A Clinical Guide to Pediatric Sleep: Diagnosis and Management of Sleep Problems 2/e | Jodi Mindell PhD | 9781605473895 | Lippincott Williams & Wilkins , 2009 .

[52]  S. Faraone,et al.  Sleep disturbances associated with attention deficit hyperactivity disorder: the impact of psychiatric comorbidity and pharmacotherapy. , 2000, Journal of child and adolescent psychopharmacology.

[53]  Chien-Ming Yang,et al.  Psychology Research and Behavior Management Dovepress Comorbidity and Confounding Factors in Attention-deficit/hyperactivity Disorder and Sleep Disorders in Children , 2022 .