The Relationship Between Sleep Disorder in Child with Attention Deficit Hyperactivity Disorder (ADHD) and Autism Spectrum Disorder (ASD) to Stress Level and Sleep Problem in Caregivers

Abstract

Background: Sleep disturbances are a frequent comorbidity in pediatric patients diagnosed with attention-deficit/hyperactivity disorder (ADHD) and autism spectrum disorder (ASD). Despite their high prevalence, these issues are often under-evaluated in clinical settings as they are not considered primary symptoms. Furthermore, the full scope of the negative impact of these sleep problems on both the affected children and their caregivers has yet to be clearly and comprehensively established. A deeper understanding of the nature and consequences of related sleep problems within the children with ADHD and ASD will help inform and develop integrated care strategies that provide comprehensive support for both the patients and their families.

Objectives: This study aimed to investigate the relationship between sleep problems in children with ADHD/ASD and the sleep problems and stress levels of their caregivers.

Methods: This cross-sectional study collected data from caregivers of pediatric patients (aged 2–13 years) with ADHD or ASD who attended the Child and Adolescent Mental Health Clinic at Krathum Baen Hospital, Samut Sakhon Province, from January to June 2025. Data were collected using the Thai versions of the children's sleep habits questionnaire (CSHQ), Thai version of the sleep condition indicator (SCI), and the Srithanya stress scale (ST-5). Descriptive statistics including frequencies, percentages, means, and standard deviations were used to present the data. The relationships between variables were analyzed using Spearman's rank correlation coefficient with a 95% confidence interval.

Results: A total of 126 caregivers participated, included 80 caregivers of ADHD group and 46 caregivers of ASD group. CSHQ scores showed that children with ADHD had a mean score of 50.26 ± 10.20, with 83.8% having sleep problems; and children with ASD had a mean score of 51.65 ± 9.51, with 89.1% having sleep problems. The most common subgroup of sleep problems was bedtime resistance, followed by sleep duration and sleep anxiety. For caregivers, 61.2% of those caring for children with ADHD had sleep problems, and 26.4% had stress problem. Meanwhile, 50% of caregivers of children with ASD had sleep problems, and 31.8% had stress problem. Spearman's rank correlation analysis revealed a statistically significant relationship between the children’s sleep problems and the caregivers' sleep quality (p < .01) and stress levels (p < .001).

Conclusion: Sleep problems in children with ADHD and ASD are significantly associated with both sleep problems and stress levels in their caregivers. Therefore, a holistic approach to patient care should include a continuous assessment of sleep problems in both children and caregivers, as well as an ongoing monitoring of caregivers' stress levels.