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Sleep problems predict comorbid externalizing behaviors and depression in young adolescents with attention-deficit/hyperactivity disorder

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Abstract

Children and adolescents with attention-deficit/hyperactivity disorder (ADHD) experience high rates of sleep problems and are also at increased risk for experiencing comorbid mental health problems. This study provides an initial examination of the 1-year prospective association between sleep problems and comorbid symptoms in youth diagnosed with ADHD. Participants were 81 young adolescents (75 % male) carefully diagnosed with ADHD and their parents. Parents completed measures of their child’s sleep problems and ADHD symptoms, oppositional defiant disorder (ODD) symptoms, and general externalizing behavior problems at baseline (M age = 12.2) and externalizing behaviors were assessed again 1 year later. Adolescents completed measures of anxiety and depression at both time-points. Medication use was not associated with sleep problems or comorbid psychopathology symptoms. Regression analyses indicated that, above and beyond demographic characteristics, ADHD symptom severity, and initial levels of comorbidity, sleep problems significantly predicted greater ODD symptoms, general externalizing behavior problems, and depressive symptoms 1 year later. Sleep problems were not concurrently or prospectively associated with anxiety. Although this study precludes making causal inferences, it does nonetheless provide initial evidence of sleep problems predicting later comorbid externalizing behaviors and depression symptoms in youth with ADHD. Additional research is needed with larger samples and multiple time-points to further examine the interrelations of sleep problems and comorbidity.

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Acknowledgments

This research was supported by a grant to the second and third authors from the United States National Institute of Mental Health (NIMH; R01MH082865). The contents of this manuscript do not necessarily represent the views of the National Institutes of Health and do not imply endorsement by the Federal Government.

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The authors declare that they have no conflict of interest.

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Authors and Affiliations

  1. Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children’s Hospital Medical Center, 3333 Burnet Avenue, MLC 10006, Cincinnati, OH, 45229-3039, USA

    Stephen P. Becker

  2. Department of Psychology, Virginia Commonwealth University, Richmond, VA, USA

    Joshua M. Langberg

  3. Department of Psychology, Ohio University, Athens, OH, USA

    Steven W. Evans

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  1. Stephen P. Becker
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Correspondence to Stephen P. Becker.

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Becker, S.P., Langberg, J.M. & Evans, S.W. Sleep problems predict comorbid externalizing behaviors and depression in young adolescents with attention-deficit/hyperactivity disorder. Eur Child Adolesc Psychiatry 24, 897–907 (2015). https://doi.org/10.1007/s00787-014-0636-6

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