Correlation between sleep disorder screening and executive dysfunction in children with attention deficit-hyperactivity disorder

Abstract

Objective: To compare frequency of sleep disorders (SD) and executive dysfunction (ED) in children with attention deficit-hyperactivity disorder (ADHD) and a control group. Method: We studied 156 children with ADHD with a mean age of 8.5 years, and a control group with 111 children with a mean age of 8.3 years. We utilized the Pediatric Sleep Questionnaire (PSQ) to screen SD and the working memory measurement from the Wechsler intelligence scale for children (WISC-IV) to screen ED. Results: We did not observe an increased frequency of SD in children with ADHD compared with the controls. However, we did identify ED in children with ADHD; additionally a significant correlation was observed between the type of ADHD and SD and among ED, WISC-IV measurements, and type of SD in children with ADHD. Conclusion: An increase of SD frequency in children with ADHD was not observed, but we did identify ED in children with ADHD. Additionally, a correlation among ADHD types, SD, ED, and WISC-IV measurements was observed in children with ADHD.Keywords: attention deficit-hyperactivity disorder, sleep disorders, executive dysfunction, pediatric sleep questionnaire, Wechsler intelligence scale for children. REsumEnObjetivo: Comparar la frecuencia de trastornos del sueño (TS) y disfunción ejecutiva (DE) en niños con trastorno por déficit de atención-hiperactividad (TDA-H) y un grupo control. Método: Estudiamos 156 niños con TDA-H con una media de 8,5 años. El grupo control incluyó 111 niños con una media de 8,3 años. Utilizamos la versión traducida del Cuestionario pediátrico del sueño (CPS) para tamizar TS. Para estudiar la DE, usamos la medición de la memoria de trabajo de la escala de inteligencia de Wechsler para niños-IV (WISC-IV). Resultados: No encontramos una mayor frecuencia de TS en niños con TDA-H. Sin embargo, encontramos DE y correlaciones entre los diferentes tipos de TDA-H, y entre los TS, DE y de mediciones del WISC-IV. Conclusión: No hallamos un incremento en la frecuencia de TS en niños con TDA-H. Encontramos evidencia de DE y correlaciones entre el tipo de TDA-H, TS, DE y medidas del WISC-IV.Palabras clave: trastorno por déficit de atención-hiperactividad, trastornos del sueño, disfunción ejecutiva, cuestionario pediátrico del sueño, escala de inteligencia infantil de Wechsler.Attention deficit-hyperactivity disorder (ADHD) is an alteration that begins early in infancy and whose main symptoms include inattention, hyperactivity, and impulsivity 1,2 . Children with ADHD present adaptation difficulties in several areas of their life, such as at school, at home, or in different social environments, due mainly to impulsivity, hyperactivity, and inattention that may affect their quality of life (QoL) 3 . Moreover, children with ADHD frequently present different co-morbidities such as oppositional defiant disorder (ODD), learning disabilities (LD), conduct disorder (CD), or others.

A Systematic Review of Sleep and Circadian Rhythms in Children with Attention Deficit Hyperactivity Disorder

“…In another study ( n = 56, 6–12 years), actigraphy-measured bed time movements predicted poorer performance on the cognitive assessment subscales of vocabulary and similarities (WISC-III subtests for assessing retrieval of learned verbal information and abstract reasoning/concept formation respectively) and general memory index score (assessing immediate and short term verbal memory) on a standardized memory and learning test (Suratt et al, 2011). Zambrano-sánchez et al (2013) found correlation between the presence of specific sleep disorders and WISC-IV measurements among 7 to 12 year old children with individual subtypes of ADHD ( n = 156); children with ADHD-combined presentation showed significant correlations between periodic limb movements during sleep and coding subtest value (measuring processing speed), between obstructive sleep apnea-hypopnea syndrome and block design values (measuring Perceptual reasoning) and between inadequate sleep hygiene and digit span subtest values (measuring working memory), whereas children with ADHD-Hyperactivity showed significant correlations between sleep apnea and digit space score and inadequate sleep hygiene and block design scores; and finally, children with ADHD-Inattentive showed significant correlations between inadequate sleep hygiene and each of coding, block designs, and digits span scores (Zambrano Sanchez et al, 2013). A prospective study (birth to 8.5 years, n = 1120) found persistent regulatory problems in sleep behaviors during infancy predicted lower IQ, increased attention deficits as observed during the test situation, and considerably increased odds of a ADHD diagnosis during preschool years (Schmid & Wolke, 2014).…”

“…There were also associations between poorer executive-cognitive functions and sleep deficits consistently reported in children with ADHD (Cremone, Kurdziel, et al, 2017; Hansen et al, 2013; Moreau et al, 2013). Cognitive functions assessed through manual/machine aided neuropsychological tests and sleep measures revealed cross sectional as well as longitudinal associations between these in ADHD (Cremone et al, 2018; Gruber et al, 2011; Kidwell et al, 2017; Saito et al, 2019; Sciberras et al, 2015; Surratt et al, 2011; Zambrano-sánchez et al, 2013). For example, Kidwell et al (2017) found longitudinal associations between sleep problems at age 3 and higher levels of inattention/hyperactivity in 4th grade predicted by higher executive functions deficits.…”

Differential motor alterations in children with three types of attention deficit hyperactivity disorder

“…The co-existence of ADHD and PLMS is reported to occur with a certain frequency 24 . Symptoms in children with ADHD include hyperactivity, distractibility during task performance, disorganization, inability to follow through on a plan, inability to shift set and reprogram activities when needed, and deficient rulegoverning behavior.…”