Sleep Habits and Behavioral Problems in Preschool-aged Children with ADHD

Authors

  • Prakasit Wannapaschaiyong Department of Pediatrics, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand.
  • Amornrat Penphattarakul Department of Pediatrics, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand
  • Pat Rojmahamongkol Department of Pediatrics, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand
  • Sureelak Sutchritpongsa Department of Pediatrics, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand

DOI:

https://doi.org/10.33192/smj.v76i3.267462

Keywords:

ADHD, preschool children, behavioral problems, sleep disturbances

Abstract

Objective: This study aimed to investigate the relationship between sleep habits and behavioral problems in preschool-aged children with ADHD.

Materials and Methods: A cross-sectional study was conducted in a child developmental clinic at Siriraj Hospital between October and December 2023. Parents of children aged 4-6 years with ADHD completed the Children’s Sleep Habits Questionnaire (CSHQ) and the Strengths and Difficulties Questionnaire (SDQ). Descriptive analysis, Pearson correlation, and multivariate linear regression analysis were used to examine the association between sleep habits and behavioral problems.

Results: This study recruited 80 preschoolers with ADHD and 75% were boys. The mean total CSHQ score was 43.76 ± 7.38 and 40% of the participants had sleep problems. 31.3 % had clinically significant behavioral problems. The most common behavioral problems were hyperactivity (33.8%), emotional problems (16.3%), and conduct behavior (10%). More sleep disturbances were highly correlated with all behavioral problems in SDQ, with a Pearson correlation between 0.78 and 0.90. After multivariate regression analysis, the total CSHQ score remained the strongest predictor of all domains of behavioral problems in preschool-aged children with ADHD (p < 0.05).

Conclusion: More than 1/3 of preschool children with ADHD were affected by sleep disturbances. Furthermore, sleep problems in these children can contribute to significant behavioral problems. Therefore, the treatment of ADHD in preschoolers should always include the management of sleep disturbances.

References

Wannapaschaiyong P, Penphattarakul A, Rojmahamongkol P, Sutchritpongsa S. The Relationship Between Primary Caregivers’ Psychosocial Factors and Self Esteem in Children and Adolescents with ADHD: An Exploratory Cross-sectional Study. Siriraj Med J. 2023;75(8):584-91.

American Psychiatric Association D-TF. Diagnostic and statistical manual of mental disorders: DSM-5. 5th ed. Washington, DC: American Psychiatric Publishing, 2013.

Wolraich ML, Hagan JF, Jr., Allan C, Chan E, Davison D, Earls M, et al. Clinical Practice Guideline for the Diagnosis, Evaluation, and Treatment of Attention-Deficit/Hyperactivity Disorder in Children and Adolescents. Pediatrics. 2019;144(4):e20192528.

Addanki SS, Chandrasekaran V, Kandasamy P. Attention Deficit Hyperactivity Disorder in Preschool Children: A Cross-Sectional Study of Clinical Profile and Co-morbidity. Indian J Psychol Med. 2023;45(3):257-62.

Owens J, Sangal RB, Sutton VK, Bakken R, Allen AJ, Kelsey D. Subjective and objective measures of sleep in children with attention-deficit/hyperactivity disorder. Sleep Med. 2009;10(4):446-56.

Yin H, Yang D, Yang L, Wu G. Relationship between sleep disorders and attention-deficit-hyperactivity disorder in children. Front Pediatr. 2022;10:919572.

Paavonen EJ, Raikkonen K, Lahti J, Komsi N, Heinonen K, Pesonen AK, et al. Short sleep duration and behavioral symptoms of attention-deficit/hyperactivity disorder in healthy 7- to 8-year-old children. Pediatrics. 2009;123(5):e857-64.

Stickley A, Shirama A, Kitamura S, Kamio Y, Takahashi H, Saito A, et al. Attention-deficit/hyperactivity disorder symptoms and sleep problems in preschool children: the role of autistic traits. Sleep Med. 2021;83:214-21.

Mousavi M, Alavinezhad R, Boojari S. Sleep Problems and Aggressive Behavior in Children with ADHD. Practice in Clinical Psychology. 2015;3(2):107-12.

Sirirassamee F, Chonchaiya W, Pruksananonda C. Sleep Behaviors and Sleep Problems in School-Aged Children in Thailand. J Med Assoc Thai. 2015;98 Suppl 9:S71-7.

Woerner W, Nuanmanee S, Becker A, Wongpiromsarn Y, Mongkol A. A Normative data and psychometric properties of the Thai version of the Strengths and Difficulties Questionnaire (SDQ). Journal of Mental Health of Thailand. 2011;19(1):42-57.

Hosiri T, Punyapas S, Sawangsri W. The Prevalence and Patterns of Sleep Problem in Children with ADHD. J Med Assoc Thai. 2018;101:S34-40.

Cortese S, Brown TE, Corkum P, Gruber R, O'Brien LM, Stein M, et al. Assessment and management of sleep problems in youths with attention-deficit/hyperactivity disorder. J Am Acad Child Adolesc Psychiatry. 2013;52(8):784-96.

Chiraphadhanakul K, Jaimchariyatam N, Pruksananonda C, Chonchaiya W. Increased Sleep Disturbances in Thai Children With Attention-Deficit Hyperactivity Disorder Compared With Typically Developing Children. Behav Sleep Med. 2016;14(6):677-86.

Gultekin T, Bayik-Temel A. Sleep Problems and Effective Factors in Preschool Children. Florence Nightingale J Nurs. 2020;28(2):164-73.

Jenni OG, Fuhrer HZ, Iglowstein I, Molinari L, Largo RH. A longitudinal study of bed sharing and sleep problems among Swiss children in the first 10 years of life. Pediatrics. 2005;115(1 Suppl):233-40.

Tan T, Marfo K, Dedrick F. Preschool-age adopted Chinese children’s sleep problems and family sleep arrangements. Infant and Child Development Journal. 2009;18:422-40.

Faraone SV, Po MD, Komolova M, Cortese S. Sleep-Associated Adverse Events During Methylphenidate Treatment of Attention-Deficit/Hyperactivity Disorder: A Meta-Analysis. J Clin Psychiatry. 2019;80(3):18r12210.

Stein MA, Weiss M, Hlavaty L. ADHD treatments, sleep, and sleep problems: complex associations. Neurotherapeutics. 2012;9(3):509-17.

Paruthi S, Brooks LJ, D'Ambrosio C, Hall WA, Kotagal S, Lloyd RM, et al. Recommended Amount of Sleep for Pediatric Populations: A Consensus Statement of the American Academy of Sleep Medicine. J Clin Sleep Med. 2016;12(6):785-6.

Mindell JA, Sadeh A, Kwon R, Goh DY. Cross-cultural differences in the sleep of preschool children. Sleep Med. 2013;14(12):1283-9.

Rescorla LA, Achenbach TM, Ivanova MY, Harder VS, Otten L, Bilenberg N, et al. International comparisons of behavioral and emotional problems in preschool children: parents' reports from 24 societies. J Clin Child Adolesc Psychol. 2011;40(3):456-67.

Miklos M, Futo J, Komaromy D, Balazs J. Executive Function and Attention Performance in Children with ADHD: Effects of Medication and Comparison with Typically Developing Children. Int J Environ Res Public Health. 2019;16(20):3822.

Lee YC, Chen VC, Liang SH, Kelsen BA. Mother-Child Interaction of Boys With ADHD: A Behavioral Observation Study. J Atten Disord. 2022;26(13):1738-46.

Lucas I, Mulraney M, Sciberras E. Sleep problems and daytime sleepiness in children with ADHD: Associations with social, emotional, and behavioral functioning at school, a cross-sectional study. Behav Sleep Med. 2019;17(4):411-22.

Alrousan G, Hassan A, Pillai AA, Atrooz F, Salim S. Early Life Sleep Deprivation and Brain Development: Insights From Human and Animal Studies. Front Neurosci. 2022;16:833786.

Verweij IM, Romeijn N, Smit DJ, Piantoni G, Van Someren EJ, van der Werf YD. Sleep deprivation leads to a loss of functional connectivity in frontal brain regions. BMC Neurosci. 2014;15:88.

Kolk SM, Rakic P. Development of prefrontal cortex. Neuropsychopharmacology. 2022;47(1):41-57.

Published

01-03-2024

How to Cite

Wannapaschaiyong, P. ., Penphattarakul, A. ., Rojmahamongkol, P. ., & Sutchritpongsa, S. . (2024). Sleep Habits and Behavioral Problems in Preschool-aged Children with ADHD. Siriraj Medical Journal, 76(3), 116–124. https://doi.org/10.33192/smj.v76i3.267462

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