Parent-Reported Attention-Deficit/Hyperactivity Disorder Symptomatology and Sleep Problems in a Preschool-Age Pediatric Clinic Sample

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Abstract

Objective

To examine the association between attention-deficit/hyperactivity disorder symptomatology and parent-reported sleep problems among preschoolers ages 2 to 5 years.

Method

A total of 1,073 parents of preschoolers ages 2 to 5 years attending a large pediatric clinic completed the Child Behavior Checklist 1½–5 years. A stratified probability sample of 193 parents of high scorers and 114 parents of low scorers were interviewed with the Preschool Age Psychiatric Assessment. Poisson regression was used to test the association between parent-reported sleep problems and attention-deficit/hyperactivity disorder symptomatology, as well as psychiatric and demographic covariates.

Results

When considered without reference to other psychiatric disorders, elevated hyperactive-impulsive symptomatology was positively associated with parent reported problems including sleep assistance, parasomnias, and dyssomnias; however, all of these effects were attenuated to nonsignificance once psychiatric comorbidity was controlled. In contrast, elevated inattentive symptomatology (especially at lower levels of hyperactive-impulsive symptoms) was positively associated with daytime sleepiness even after psychiatric comorbidity was controlled.

Conclusions

Neither hyperactive-impulsive nor inattentive attention-deficit/hyperactivity disorder symptomatology was uniquely related to parent-reported problems involving sleep assistance, parasomnias, or dyssomnias. However, inattentive symptomatology was uniquely related to daytime sleepiness above and beyond commonly occurring patterns of psychiatric comorbidity, sleep duration, and demographic factors. J. Am. Acad. Child Adolesc. Psychiatry, 2008; 47(9):1086–1094.

Section snippets

Method

We examined the association between ADHD and sleep problems using a screen-stratified sample of preschool-age children who are representative of the larger population of children attending primary care pediatric services. This sample was initially derived to provide a 1-week test-retest reliability evaluation of the Preschool Age Psychiatric Assessment (PAPA), a structured parent-report psychiatric interview about preschool-age children. Results relevant to the reliability and validity of the

PAPA

The PAPA is a parent-report interviewer-based structured psychiatric assessment involving a range of mandatory questions and probes, supplemented by further detailed exploratory probing to ensure that the ratings appropriately represent the child's problems.16 When symptoms (e.g., restlessness) were reported, their frequency, duration, and onset dates were also collected for a 3-month primary period to determine whether they met the criteria for the symptoms of various DSM-IV diagnoses. Symptom

Results

Weighted descriptive statistics for all symptom count, as well as sleep outcome, variables for the entire sample are provided in Table 2. Although the mean number of symptoms and sleep problems was relatively low, the full range of behaviors was observed for each variable.

Discussion

Although there has been interest in the association between ADHD and sleep problems for nearly 4 decades, it has been only relatively recently that researchers have attended to the common methodological shortcomings of earlier studies, including improved measurement of both ADHD and sleep outcomes, as well as the incorporation of an appropriate range of covariates (especially psychiatric comorbidity and medication status). The results of this study demonstrated that although there were

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    This research was supported by National Institute of Mental Health grant MH63670 (to A.A.).

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