Comparison of sleep problems in children with anxiety and attention deficit/hyperactivity disorders

Abstract

This cross-sectional case-control study compared sleep problems in consecutively referred children aged 7-13 years meeting DSM-IV criteria for anxiety disorder, attention deficit/hyperactivity disorder (ADHD), comorbid anxiety disorder and ADHD, and a group of control children of similar age and gender. Diagnoses were assessed with the Kiddie-SADS PL interview, parent form, and the sleep problems with a standardized sleep questionnaire, the Children's Sleep Habits Questionnaire (CSHQ), as reported by the mother. A total of 141 children were included (anxiety disorder (n = 41), ADHD (n = 39), comorbid condition (n = 25), controls (n = 36)). Children in the clinical groups had more sleep problems than controls. Children with anxiety disorders and children with comorbid condition were reported to have more sleep problems than children with ADHD alone. Night waking was associated with comorbid anxiety disorder and ADHD. Bedtime resistance was associated with anxiety disorder, while daytime sleepiness affected all clinical groups. Clinical management of children with ADHD and anxiety disorders needs to include assessment of sleep problems.

Advancing a Biopsychosocial and Contextual Model of Sleep in Adolescence: A Review and Introduction to the Special Issue

“…Several recent studies (Accardo et al 2012;Hansen et al 2011Hansen et al , 2014 have found that youth with comorbid ADHD and internalizing problems (i.e., anxiety, depression) have more sleep problems than youth with ADHD alone, including greater daytime sleepiness in addition to shorter sleep duration and more frequent night awakenings. For example, Moreau et al (2014) found that youth with comorbid ADHD and anxiety had the longest sleep onset delay, shortest sleep duration, and greatest daytime sleepiness in comparison to typically developing youth or youth with ADHD alone.…”

“…Taken together, studies examining sleep and comorbidity in ADHD samples point to potential bidirectional associations. However, all of these studies were conducted in school-aged children/young adolescents Hansen et al 2011Hansen et al , 2014Lycett et al 2014a, b;Moreau et al 2014) or in samples with a wide age range (ages 5/6-18) (Accardo et al 2012;Sung et al 2008), leaving it unclear how sleep and mental health are interconnected in youth with ADHD during middle and older adolescence when rates of certain mental health problems such as conduct disorder (Merikangas et al 2010), substance use , and depression/ suicidal ideation (Hinshaw et al 2012) are higher. Further, aside from the recent 1-year longitudinal studies by Becker et al (2014) and Lycett et al (2014a), all of the studies completed to date have been cross-sectional, leaving it unclear if comorbidities predict increases in sleep problems (and vice versa) over longer developmental periods or whether comorbid mental health symptoms differentially impact the sleep of adolescents with and without ADHD.…”

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

“…However, this relationship is yet to be fully elucidated. Previous studies are often limited to single clinical samples8 24 25 31 32 and exclude children with common comorbidities or those taking ADHD medication 28 29 33. Furthermore, researchers are yet to consider children with co-occurring internalising and externalising comorbidities.…”

Difficult to Bed and Difficult to Rise: Complex Interplay Among ADHD, Sleep, and Adolescence

“…Several recent studies (Accardo et al, 2012;Hansen, Skirbekk, Oerbeck, Richter, & Kristensen, 2011;Hansen, Skirbekk, Oerbeck, WentzelLarsen, & Kristensen, 2013) have found that youth with comorbid ADHD and internalizing problems (i.e., anxiety, depression) have more sleep problems than youth with ADHD alone, including greater daytime sleepiness in addition to shorter sleep duration and more frequent night wakings. For example, Moreau and colleagues (2014) found that youth with comorbid ADHD and anxiety had the longest sleep onset delay, shortest sleep duration, and greatest daytime sleepiness in comparison to typically developing youth or youth with ADHD alone.…”